JACC. Cardiovascular interventions · 2026
Right Ventricular to Pulmonary Arterial Uncoupling Is Associated With 1-Year Mortality in ST-Segment Elevation Myocardial Infarction.
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Graesser Christian, Bresha Jola, Roski Ferdinand, Petersen Emilia, Krefting Johannes, von Scheidt Moritz, Friess Christian, Tervooren Jule, Dutsch Alexander, Knoll Katharina, Ibrahim Tareq, Steger Alexander, Bradaric Christian, Cassese Salvatore, Schunkert Heribert, Laugwitz Karl-Ludwig, Sager Hendrik B, Kessler Thorsten, Xhepa Erion, Kastrati Adnan, Lachmann Mark, Müller Arne M, Trenkwalder Teresa
Аннотация
BACKGROUND: Right ventricular (RV)-pulmonary arterial (PA) coupling, a measure of RV function in relation to pulmonary afterload, has emerged as a promising prognostic marker in critically ill patients and can be readily assessed using echocardiography.
OBJECTIVES: The aim of this study was to evaluate the prognostic significance of RV-PA coupling in patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.
METHODS: This post hoc analysis of a retrospective study analyzed 973 STEMI patients (derivation and validation cohorts) undergoing primary percutaneous coronary intervention between 2014 and 2023 (median follow-up duration 4.2 years; Q1-Q3: 2.1-6.7 years). RV-PA uncoupling was assessed using echocardiography via the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP). Using maximally selected log-rank statistics, a cutoff of 0.405 mm/mm Hg for TAPSE/sPAP ratio was identified, effectively stratifying patients into high- and low-risk groups.
RESULTS: As confirmed in an external validation cohort, patients with RV-PA uncoupling showed significantly higher 1-year all-cause mortality compared with those with preserved RV-PA coupling (33.30% [95% CI: 4.65%-53.40%] vs 3.04% [95% CI: 1.40%-4.65%]; HR for 1-year mortality: 12.60; 95% CI: 4.49-35.40; P < 0.001). TAPSE/sPAP ratio outperformed TAPSE alone in predicting 1-year mortality, as demonstrated by receiver-operating characteristic curve analysis (area under the curve: 0.732 [95% CI: 0.643-0.821] vs 0.643 [95% CI: 0.537-0.732]; P = 0.018). Multivariate analysis confirmed that RV-PA uncoupling independently predicted 1-year mortality.
CONCLUSIONS: This study highlights the importance of hemodynamic equilibrium between the RV and pulmonary circulation in STEMI patients. RV-PA uncoupling (TAPSE/sPAP ratio < 0.405 mm/mm Hg) is an independent predictor of 1-year all-cause mortality in these patients, aiding in early risk stratification.
OBJECTIVES: The aim of this study was to evaluate the prognostic significance of RV-PA coupling in patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.
METHODS: This post hoc analysis of a retrospective study analyzed 973 STEMI patients (derivation and validation cohorts) undergoing primary percutaneous coronary intervention between 2014 and 2023 (median follow-up duration 4.2 years; Q1-Q3: 2.1-6.7 years). RV-PA uncoupling was assessed using echocardiography via the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP). Using maximally selected log-rank statistics, a cutoff of 0.405 mm/mm Hg for TAPSE/sPAP ratio was identified, effectively stratifying patients into high- and low-risk groups.
RESULTS: As confirmed in an external validation cohort, patients with RV-PA uncoupling showed significantly higher 1-year all-cause mortality compared with those with preserved RV-PA coupling (33.30% [95% CI: 4.65%-53.40%] vs 3.04% [95% CI: 1.40%-4.65%]; HR for 1-year mortality: 12.60; 95% CI: 4.49-35.40; P < 0.001). TAPSE/sPAP ratio outperformed TAPSE alone in predicting 1-year mortality, as demonstrated by receiver-operating characteristic curve analysis (area under the curve: 0.732 [95% CI: 0.643-0.821] vs 0.643 [95% CI: 0.537-0.732]; P = 0.018). Multivariate analysis confirmed that RV-PA uncoupling independently predicted 1-year mortality.
CONCLUSIONS: This study highlights the importance of hemodynamic equilibrium between the RV and pulmonary circulation in STEMI patients. RV-PA uncoupling (TAPSE/sPAP ratio < 0.405 mm/mm Hg) is an independent predictor of 1-year all-cause mortality in these patients, aiding in early risk stratification.
Предметные рубрики MeSH
HumansST Elevation Myocardial InfarctionTime FactorsVentricular Function, RightMaleRisk FactorsRetrospective StudiesFemalePercutaneous Coronary InterventionRisk AssessmentMiddle AgedPulmonary ArteryAgedTreatment OutcomePredictive Value of TestsVentricular Dysfunction, RightArterial PressurePulmonary Circulation