Impact of first myocardial infarction on the right ventricle: a magnetic resonance-based assessment

Abstract Background Right ventricular (RV) dysfunction and RV myocardial infarction frequently complicate acute myocardial infarction (AMI), but it is markedly underrecognised in the absence of haemodynamic compromise. Cardiac magnetic resonance (CMR) imaging is the gold standard for evaluation of the right ventricle. CMR defined RV infarction in the acute setting has been suggested to have prognostic importance. However, limited data exists on the long-term impact that RV involvement in a first AMI has on clinical outcomes. We therefore characterized the RV with CMR at 30-90 days in an unselected cohort of patients from two large-volume primary angioplasty centres, following first acute myocardial infarction. Aims and Methods Consecutive patients diagnosed with a first AMI were retrospectively assessed, after they had undergone primary percutaneous coronary intervention (PCI) between 2016 and 2022. Multiparametric CMR scans to assess ventricular function and contrast enhanced imaging were performed between 30-90 days (median 51 days) following admission (scanned at 1.5T). RV infarction was defined as RVEF of < 40%, or one or more dysfunctional RV segments associated with LGE. Patients with a non-ischaemic CMR phenotype were not included in this cohort. Clinical data was collected from medical records. Results 399 patients with a first AMI were included (mean age 57.9 years, 82% male). RV infarction was observed in 16.3% of patients. In patients with RV infarction 46.2% had undergone PCI to the LAD, 38.5% to the RCA and 20.7% to the LCx territories. Multi-vessel PCI in their index procedure were no more likely to experience an RV infarct. Clinical risk factors including hypertension, diabetes, chronic renal failure, troponin and Killip Class were not associated with higher rates of RV infarction. RV infarction resulted in lower RVEF (52 vs 60%; p