Right Ventricular Function in Heart Failure With Preserved Ejection Fraction: A Community Based Study
What is the prevalence and clinical significance of right ventricular (RV) systolic dysfunction in patients with heart failure and preserved ejection fraction (HFpEF)?
The study investigators prospectively identified 562 consecutive patients with HFpEF (Framingham HF criteria, EF ≤50%) from Olmsted County, MN. The study cohort underwent echocardiography at HF diagnosis and follow-up for cause-specific mortality and HF hospitalization. They categorized RV function by tertiles of tricuspid annular plane systolic excursion (TAPSE) and by semi-quantitative 2-D assessment (normal, mild RV dysfunction, or moderate-severe RV dysfunction).
The study investigators found that HFpEF patients with RV dysfunction were more likely to have atrial fibrillation, pacemakers, and chronic diuretic therapy. They also found that these patients had slightly lower LVEF, worse diastolic dysfunction, lower blood pressure and cardiac output, higher pulmonary artery systolic pressure (PASP), and more severe RV enlargement and tricuspid valve regurgitation. After adjusting for age, sex, PASP, and comorbidities, they found that presence of any RV dysfunction by semi-quantitative assessment was associated with higher all-cause (hazard ratio [HR] 1.35 [1.03-1.77; p = 0.03]) and cardiovascular (HR 1.85 [1.20-2.80; p = 0.006]) mortality and higher first (HR 1.99 [1.35-2.90; p = 0.0006]) and multiple (HR 1.81 [1.18-2.78; p = 0.007]) HF hospitalization rates. RV dysfunction (as defined by TAPSE values) showed similar, but weaker associations with mortality and HF hospitalizations.
The authors concluded that RV dysfunction is common in HFpEF patients, and is associated with clinical and echocardiographic evidence of more advanced HF and predictive of poorer outcomes.
This is an important study because it identifies an important subset of patients with diastolic HF. Larger studies are now needed to identify the natural history of HFpEF patients with and without RV dysfunction. Having a better understanding of the natural history of HFpEF should allow the development of successful therapies for these patients.
Keywords: Atrial Fibrillation, Blood Pressure, Cardiac Output, Diuretics, Heart Failure, Hospitalization, Pulmonary Artery, Tricuspid Valve Insufficiency, Ventricular Dysfunction, Right, Ventricular Function, Right
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