Right Ventricular to Pulmonary Arterial Uncoupling Is Associated With 1-Year Mortality in ST-Segment Elevation...

Area of Science:

• Cardiology
• Critical Care Medicine
• Echocardiography

Background:

• Right ventricular (RV)-pulmonary arterial (PA) coupling assesses RV function relative to pulmonary afterload.
• It is a prognostic marker in critically ill patients, measurable via echocardiography.

Purpose of the Study:

• To determine the prognostic significance of RV-PA coupling in ST-segment elevation myocardial infarction (STEMI) patients.
• To evaluate RV-PA uncoupling as a predictor of mortality after primary percutaneous coronary intervention.

Main Methods:

• Retrospective analysis of 973 STEMI patients undergoing primary percutaneous coronary intervention.
• RV-PA uncoupling assessed by the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP) ratio.
• A TAPSE/sPAP ratio cutoff of 0.405 mm/mm Hg identified high- and low-risk groups.

Main Results:

• RV-PA uncoupling was associated with significantly higher 1-year all-cause mortality (33.30% vs 3.04%).
• The TAPSE/sPAP ratio demonstrated superior predictive performance for 1-year mortality compared to TAPSE alone.
• RV-PA uncoupling independently predicted 1-year mortality in multivariate analysis.

Conclusions:

• Hemodynamic equilibrium between the RV and pulmonary circulation is crucial in STEMI patients.
• RV-PA uncoupling, defined by a TAPSE/sPAP ratio < 0.405 mm/mm Hg, is an independent predictor of 1-year mortality.
• This metric facilitates early risk stratification in STEMI patients.