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Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Heart Failure III: Clinical Manifestations01:26

Heart Failure III: Clinical Manifestations

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Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
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Mitral Stenosis I: Introduction01:22

Mitral Stenosis I: Introduction

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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

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The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
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Related Experiment Video

Updated: Feb 28, 2026

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
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Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction.

Lena Bosch1, Carolyn S P Lam2,3, Lingli Gong4

  • 1Experimental Cardiology, University Medical Center Utrecht, The Netherlands.

European Journal of Heart Failure
|June 10, 2017
PubMed
Summary

Right ventricular dysfunction significantly impacts heart failure prognosis, regardless of ejection fraction. This study highlights the importance of right ventricular-arterial coupling for predicting outcomes in heart failure patients.

Keywords:
Deformation imagingEchocardiographyHeart failurePreserved ejection fractionPulmonary hypertensionRight ventricular dysfunction

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Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Right ventricular (RV) dysfunction is a key prognostic indicator in left-sided heart failure (HF).
  • The specific role of RV dysfunction in HF with preserved ejection fraction (HFpEF) versus HF with reduced ejection fraction (HFrEF) remains unclear.
  • Understanding RV function is crucial for comprehensive HF management.

Purpose of the Study:

  • To compare the severity and prognostic significance of RV dysfunction in HFpEF versus HFrEF.
  • To investigate the relationship between RV function, pulmonary artery systolic pressure (PASP), and left ventricular (LV) function.
  • To assess the prognostic value of RV-arterial coupling in HF patients.

Main Methods:

  • Echocardiography was used to assess RV longitudinal strain (RVLS) and tricuspid annular plane systolic excursion (TAPSE) in 657 participants (HFpEF, HFrEF, and controls).
  • Pulmonary artery systolic pressure (PASP) was also measured.
  • Statistical analyses, including multivariable adjustment, were performed to determine independent predictors and prognostic factors.

Main Results:

  • RV function, measured by RVLS and TAPSE, progressively deteriorated from controls to HFpEF and HFrEF.
  • PASP increased across these groups, but RV dysfunction was independently associated with LV systolic dysfunction and atrial fibrillation, not PASP.
  • Both TAPSE/PASP and RVLS/PASP ratios were significant predictors of all-cause death and HF hospitalization in HF patients, irrespective of LVEF.

Conclusions:

  • RV dysfunction is prevalent in HFpEF and more severe in HFrEF, even with similar PASP levels.
  • LV dysfunction, not PASP, independently predicts RV dysfunction.
  • RV-arterial coupling is a critical prognostic factor in heart failure, regardless of left ventricular ejection fraction.