ST-Segment Elevation Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: Prognostic Implications of Right Ventricular Systolic Dysfunction as Assessed with Two-Dimensional Speckle-Tracking Echocardiography.
BACKGROUND
Right ventricular (RV) systolic function in patients admitted with ST-segment elevation myocardial infarction (STEMI) with chronic obstructive pulmonary disease (COPD) and its impact on prognosis have not been characterized. The present study aims to compare the prevalence of RV systolic dysfunction in COPD versus non-COPD patients with STEMI and evaluate the prognostic implications.


METHODS
One hundred seventeen STEMI patients with COPD with transthoracic echocardiography performed within 48 hours of admission were retrospectively selected. Matched on age, gender, and infarct size (determined by cardiac biomarkers and left ventricular ejection fraction [LVEF]), 207 non-COPD patients were selected. RV dysfunction was defined based on tricuspid annular plane systolic excursion <17 mm (TAPSE), tricuspid annular systolic velocity <6 cm/s (S'), RV fractional area change <35% (FAC), and RV longitudinal free wall strain (FWSL) measured with speckle-tracking echocardiography >-20%. Patients were followed for the occurrence of all-cause mortality.


RESULTS
RV assessment was feasible in 112 COPD and 199 non-COPD patients (mean age, 69 ± 10; 74% male; mean, LVEF 47% ± 8%). Patients with COPD had significantly lower RV FAC (38% ± 11% vs 40% ± 9%; P = .04), equal TAPSE and S' (17.9 ± 3.7 vs 18.1 ± 3.8 mm, P = .72; and 8.4 ± 2.2 vs 8.5 ± 2.2 cm/sec, P = .605, respectively) and more impaired RV FWSL (-21.1% ± 6.6% vs -23.4% ± 6.5%, P = .005), compared with patients without COPD. RV dysfunction was more prevalent in patients with COPD, particularly when assessed with RV FWSL (46% vs 32%; P = .021). During a median follow-up of 30 (interquartile range 1.5-44) months, 49 patients died (16%). Multivariate models stratified for COPD status showed that RV FWS >-20% was independently associated with 5-year all-cause mortality (hazard ratio, 2.05; 95% CI, 1.12-3.76; P = .020), after adjusting for age, diabetes, peak troponin level, and LVEF. Interestingly, RV FAC < 35%, S'< 6 cm/sec, and TAPSE < 17 mm were not independently associated with survival.


CONCLUSION
In a STEMI population with relatively preserved LVEF, COPD patients had significantly worse RV FWSL compared with patients without COPD. Moreover, RV FWSL > -20% was independently associated with worse survival. In contrast, conventional parameters were not associated with survival.
['Goedemans|Laurien|L|', 'Hoogslag|Georgette E|GE|', 'Abou|Rachid|R|', 'Schalij|Martin J|MJ|', 'Marsan|Nina Ajmone|NA|', 'Bax|Jeroen J|JJ|', 'Delgado|Victoria|V|']
D000368:Aged D015150:Echocardiography, Doppler D005260:Female D006801:Humans D007090:Image Interpretation, Computer-Assisted D008297:Male D009426:Netherlands D011379:Prognosis D029424:Pulmonary Disease, Chronic Obstructive D012189:Retrospective Studies D000072657:ST Elevation Myocardial Infarction D018497:Ventricular Dysfunction, Right
ST-segment elevation myocardial infarction Chronic obstructive pulmonary disease Prognosis Right ventricular dysfunction