Right Ventricular Dysfunction in Acute Coronary Syndrome: Insights From Cardiac Magnetic Resonance Imaging

Garcia-Cardenas M.; Martinez-Dominguez P.; Miranda-Segura R.; Acosta-Gutiérrez G.H.; Meléndez-Ramírez G.; Meave A.; Espinola-Zavaleta N. · American Journal of Cardiology (2026) · DOI: 10.1016/j.amjcard.2025.10.028

Resumen

Acute coronary syndrome (ACS) significantly impacts global morbidity and mortality, traditionally emphasizing left ventricular (LV) dysfunction. However, the prognostic importance of right ventricular (RV) dysfunction remains underexplored. Cardiac magnetic resonance (CMR), the gold standard for RV assessment, enables precise evaluation of ventricular function and structure. We conducted a retrospective cohort study of 268 patients with ACS who underwent CMR between January 2020 and December 2022 at the National Institute of Cardiology Ignacio Chavez. RV dysfunction was defined as RV ejection fraction (RVEF) <50% by CMR. Multivariate logistic regression identified factors associated with RV dysfunction. RV dysfunction occurred in 170 patients (63.4%). Compared to those without RV dysfunction, patients with RV dysfunction were more likely to be male (84% vs 70%, p = 0.011) and smokers (66% vs 51%, p = 0.017). These patients exhibited reduced LV ejection fraction (39% vs 44%, p < 0.001), higher end-systolic and end-diastolic volumes, and reduced RV fractional area change (42% vs 45%, p = 0.004). BMI (OR 1.13, 95% CI 1.04-1.24, p = 0.008) and mitral regurgitation (OR 5.40, 95% CI 1.47–27, p = 0.020) were independently associated with RV dysfunction. Although mortality was higher among patients with RV dysfunction (3.5% vs 1%), it was not statistically significant (p = 0.4). In conclusion RV dysfunction is common in ACS and it is independently associated with increased BMI and mitral regurgitation. CMR evaluation of RV function in ACS patients may be considered to enhance clinical outcomes. Future research should explore targeted therapeutic interventions for RV dysfunction.