Association of stress hyperglycemia ratio on right ventricular dysfunction and biventricular coupling in patients with acute coronary syndrome assessed by CMR feature tracking: a cross-sectional study.

BACKGROUND: Among individuals diagnosed with acute coronary syndrome (ACS), the stress hyperglycemia ratio (SHR) has been demonstrated to correlate with an elevated risk of unfavorable cardiovascular events. However, the relationship between SHR, right ventricular (RV) function and biventricular interdependence has not yet been reported. The present study aimed to explore the association of high SHR with RV deformation and biventricular coupling in ACS patients via cardiac magnetic resonance (CMR). METHODS: This study consisted of 103 patients with ACS and 57 age- and sex-matched controls. Based on the median of SHR values, ACS patients were stratified into low (<1.07, n=51) and high (≥1.07, n=52) SHR groups. Biventricular myocardial deformation, encompassing global peak strain (PS) in the radial, circumferential, and longitudinal directions for both left ventricle and right ventricle, was quantified and compared across groups. Linear regression and exploratory mediation analyses were conducted to evaluate the association between SHR and RV PS and to examine whether LV PS may partly explain this association. RESULTS: ACS patients, irrespective of SHR level, had significantly decreased left ventricular (LV) and RV PS, compared to controls (all P<0.001). Among ACS patients, the high SHR group had lower LV radial PS [14.32 (10.70, 21.39) vs. 21.45 (11.02, 28.84)], LV longitudinal PS [-7.92 (-10.77, -6.75) vs. -10.26 (-13.00, -6.34)], RV radial PS [25.03 (18.55, 35.02) vs. 33.31 (20.57, 44.66)], and RV longitudinal PS (-11.92±5.40 vs. -16.60±6.57) than the low-SHR group (all P<0.05). Exploratory mediation analysis suggested that LV radial and longitudinal PS may statistically account for part of the observed association between RV radial and longitudinal PS between the low- and high-SHR groups [indirect effect of LV radial PS: -6.159 (-8.982, -3.641) for RV radial PS and 1.859 (0.970, 2.828) for RV longitudinal PS; indirect effect of LV longitudinal PS: 1.859 (0.970, 2.828) for RV radial PS, and 1.617 (0.888, 2.444) for RV longitudinal PS]. CONCLUSIONS: Higher SHR was associated with more impaired RV radial and longitudinal PS in patients with ACS. Exploratory mediation analysis suggested that LV radial and longitudinal PS may partly explain the association between higher SHR and impaired RV radial and longitudinal PS.