AimsInformations regarding the prognostic value of right ventricular function changes in the setting of a first acute ST elevation myocardial infarction irrespective of the site of the necrosis and of the left ventricular systolic function are scarce. Purpose of the study was to assess the relation between parameters reflecting global and systolic right ventricular function assessed by conventional, speckle tracking and three-dimensional echocardiography and in hospital major cardiac events (MACE).Materials and MethodsWe have prospectively analyzed a cohort of 44 consecutive patients (mean age 62,71 years, 70.5 % males) presenting with a first STEMI (2,3 % Topol 1, 38 ,6 % Topol 2, 20,6 % Topol 3, 31,8 % Topol 4, 6,8 % Topol5) treated by primary angioplasty. Patients with previous history of cardiac or pulmonary diseases were excluded. All patients underwent during hospitalization conventional 2D echocardiography and special techniques ( 2D speckle tracking echocardiography and also 3D echocardiography) RV global function was quantified by RV myocardial performance index (RV MPI) determined by PW Doppler ,whereas RV systolic function was studied using regional parameters like TAPSE , pulsed Doppler S wave and RV free wall 2D strain and global parameters like RV fractional area change (RV FAC) or RV ejection fraction ( RVEF) determined by 3D echocardiography . LV systolic function was described by LV ejection fraction (LVEF). The combined endpoint of major adverse cardiovascular events (MACE) was defined by all cause mortality, reinfarction, need for revascularization and occurrence of heart failure during hospitalization. The association between MACE and RV functional parameters was assessed by bivariate correlation analysis followed by binary logistic regression.ResultsInitially, regardless of the site of necrosis, the only RV functional parameter correlated with MACE was RV MPI (OR 9.17; 95% CI: 1.03 -83.7). After adjustment for LVEF all RV functional parameters were correlated with MACE: TAPSE (OR: 1.83; 95% CI : 0.41- 8.23), RV MPI (OR: 8.07; 95% CI : 0.9- 72.07), RVFAC (OR: 1.22; 95% CI : 0.25- 5.98) , RV free wall strain (OR : 1.04; 95% CI : 0.21- 5.08) , S wave (OR: 2.46 ; 95% CI : 0.14- 42.82), RVEF (OR: 0.83 ; 95% CI : 0.20- 3.43).ConclusionsOur study reveals that RV functional parameters are predictive for in hospital MACE beyond LV systolic function and regardless of the culprit coronary artery. Among these parameters, RV MPI seems to have the greatest predictive value for short term MACE in STEMI patients.

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.

Background: Despite advancement in medical and interventional treatments, cardiac remodeling may occur in almost 60% of patients who suffered a myocardial infarction. Stem cell therapy is specifically addressed to myocardial hypoperfusion and loss of myocardial mass, with the major goal in prevention and improvement of cardiac remodeling. Objectives: We aimed to investigate the feasibility, safety and effectiveness of autologous bone marrow stem cell therapy in patients with acute myocardial infarction having moderate to severe systolic dysfunction 6 months after transplantation. Methods: Eighteen patients with a first acute myocardial infarction with ST-segment elevation (STEMI) were included in the study; they were assigned either to intracoronary infusion of bone marrow cell suspension or to the control group. Results: At 6 months follow-up, there were no significant differences between groups regarding major adverse cardiac events. Furthermore, cell therapy led to smaller left ventricular volumes and significantly improved function. Conclusions: The autologous bone marrow stem cell therapy has proven to be a reliable method that can be used in clinical practice in well selected cases. The precise indications, the optimal timing for cell administration and the processing method are still to be determined, as well as the long term effects of cellular therapy.