Background: Myocardial infarction (MI) remains a leading
cause of death worldwide. Right ventricular (RV) dysfunction,
though often overlooked, is strongly associated with higher
mortality and cardiogenic shock. While left ventricular (LV)
function has been a traditional prognostic factor, its value is
reduced with modern revascularization. RV strain may provide
additional prognostic insight, even without evident RV
infarction. Aim: To assess the prognostic role of RV strain
imaging in patients with first acute anterior ST-elevation
myocardial infarction (STEMI) without RV infarction. Methods:
This prospective, single-center study included 200 consecutive
patients admitted with first acute anterior STEMI to Benha
University Hospital from September 2023 to August 2024.
Patients were classified as ―complicated‖ (major adverse
cardiovascular events [MACE]) or ―non-complicated.‖ All
underwent clinical evaluation, electrocardiography,
echocardiography, and speckle tracking echocardiography.
Results: Mean age was 62 ± 7 years; 59% were male.
Comorbidities included diabetes (51%), hypertension (59%),
dyslipidemia (33%), and smoking (43.3%). Compared to the noncomplicated group, MACE patients showed higher RVMPI (0.50
± 0.03 vs. 0.44 ± 0.05, P < 0.001), lower TAPSE (15.24 ± 1.13
vs. 17.18 ± 0.49 mm, P < 0.001), and reduced FAC (34.7 ± 1.6%
vs. 39.2 ± 1.4%, P < 0.001). RV free wall strain (19.1 ± 2.2% vs.
20.5 ± 0.6%) and RV global longitudinal strain (16.1 ± 2.1% vs.
17.4 ± 0.3%) were also significantly lower (P < 0.001).
Conclusion: In anterior STEMI without RV infarction, impaired
RV strain—particularly RVGLS and free wall strain—
independently predicts MACE, highlighting its value for
prognosis and management.