Right ventricular functional involvement and recovery in patients with a first acute myocardial infarction treated by primary PCI . Does essential hypertension play any role ?

The aim of this study was to assess right ventricular (RV) involvement in patients with acute ST-segment elevation myocardial infarction before undergoing primary PCI and to evaluate the changes in RV function throughout hospitalization. Considering that patients with essential hypertension are majority, we also thought to assess if there are specific changes in RV function during acute ST elevation myocardial infarction in this category. 53 patients with a first acute myocardial infarction (MI) referred for primary PCI were included and prospectively analyzed. 32 of them (60.4%) had anterior and 21 (39.6%) had nonanterior MI, while 11 (20.8%) patients had signs of RV necrosis on the surface ECG. Serial echocardiograms were performed before PCI, 24 hours afterwards and at discharge. In order to accurately quantify RV function, we used a multi-parametric approach, with conventional as well as novel parameters derived from 2D strain echocardiography. Right ventricular myocardial performance index (RV MPI) was high from admission in both patients with and without RV infarction and this parameter remained high at 24 hours and at discharge. RV systolic dysfunction (assessed by TAPSE, RV longitudinal strain and RV fractional area change) was present on admission in patients with RV infarction, but not in patients without RV infarction. RV systolic function gradually improved throughout hospitalization and became normal at discharge. Patients with essential hypertension didn’t show any specific changes in RV functional parameters. RV global dysfunction is found in the setting of an acute MI irrespective of the culprit coronary artery and it persists at discharge. On the other hand, RV systolic function, which is altered on admission in the subgroup with RV MI, normalizes over the course of hospitalization. Hypertensive patients didn’t show any specific changes in RV function in the setting of AMI.