Medicine (Baltimore). 2026 Jun 5;105(23):e49028. doi: 10.1097/MD.0000000000049028.
ABSTRACT
Right ventricular (RV) dysfunction in patients with coronary artery disease (CAD) and concomitant pulmonary hypertension (PH) is associated with poor outcomes, yet its short-term reversibility after percutaneous coronary intervention (PCI) remains unclear. Identifying echocardiographic predictors of RV functional improvement may inform tailored therapeutic strategies. This single-center retrospective cohort study enrolled 160 CAD patients with systolic pulmonary artery pressure (sPAP > 65 mm Hg) undergoing PCI between January 2024 and February 2025. Echocardiography was performed within 7 days before and after PCI, assessing RV function via tricuspid annular plane systolic excursion (TAPSE), Tei index, and speckle-tracking-derived RV free wall strain (RVFWS) and global strain (RVGS). The primary outcome was ≥ 1-level improvement in NYHA class. At 7-day follow-up, 57.5% of patients improved, with increased TAPSE (13.8 mm to 15.1 mm, P = .004) and RVFWS (-17.0% to - 19.6%, P < .001), and decreased Tei index (0.45-0.41, P = .031) and sPAP (68 mm Hg to 62 mm Hg, P = .026). Multivariable analysis showed higher baseline TAPSE (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.03-1.86; P = .029) and lower Tei index (OR 0.70, 95% CI 0.51-0.96; P = .037) independently predicted RV recovery. The model demonstrated good discrimination (AUC = 0.78, 95% CI 0.71-0.85) and calibration (Hosmer-Lemeshow P = .735). Subgroup analysis confirmed consistent findings in preserved left ventricular ejection fraction and severe symptoms. In CAD patients with elevated pulmonary pressure, PCI facilitated early RV improvement, with baseline TAPSE and Tei index serving as useful predictors for risk stratification.
PMID:42260861 | DOI:10.1097/MD.0000000000049028