Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction.

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.