Right ventricular-pulmonary arterial coupling in patients with first acute myocardial infarction: an emerging post-revascularization triage tool.

Autor:	Anastasiou V; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Daios S; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Moysidis DV; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Liatsos AC; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Papazoglou AS; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Didagelos M; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Savopoulos C; First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Bax JJ; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands., Ziakas A; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece., Kamperidis V; First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece. Electronic address: vkamperidis@outlook.com.
Jazyk:	angličtina
Zdroj:	Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese [Hellenic J Cardiol] 2024 Jul 06. Date of Electronic Publication: 2024 Jul 06.
DOI:	10.1016/j.hjc.2024.07.002
Abstrakt:	Background: The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular-pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI), which may cause acute RV pressure overload, remains unexplored. Objective: This study aimed to determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization. Methods: Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2 ± 11.8, 24% females). Echocardiography was performed 24 h after successful revascularization, and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded. Results: The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality after adjustment for Global Registry of Acute Coronary Events (GRACE) risk score and LVEF (odds ratio 0.14 [95% confidence interval 0.03-0.56], P = 0.007). The prognostic value of a baseline model including the GRACE risk score and NT-pro-BNP (χ 2 26.55) was significantly improved by adding LVEF ≤40% (χ 2 44.71, P < 0.001), TAPSE ≤ 17 mm (χ 2 75.42, P < 0.001) and TAPSE/PASP ≤ 0.49 mm/mmHg (χ 2 101.74, P < 0.001) for predicting cardiovascular in-hospital mortality. Conclusion: RV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤ 0.49 mm/mmHg 24 h after revascularization, may improve risk stratification for cardiovascular in-hospital mortality after first AMI. Competing Interests: Conflict of interest None relevant to this work. (Copyright © 2024 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu