Impact of Left Ventricular Diastolic Function on Right Ventricular Size and Function

Diastolic dysfunction (DD) of the left ventricle is common. When severe it can result in heart failure with preserved ejection fraction (HFpEF). While right ventricular (RV) dilation and dysfunction are known to occur in HFpEF, the effects of lesser degrees of DD on RV size and function have not been explored.

A broad sample of 370 patients (age 60 ± 15 years, 66% female) undergoing clinically indicated echocardiography had three-dimensional imaging of the right ventricle. A semiautomated program was used to measure RV volumes, ejection fraction, linear dimensions, and longitudinal strain. Left ventricular diastolic function was graded per the 2025 American Society of Echocardiography algorithm, and RV measurements were compared across diastolic function groups.

Right ventricular end-diastolic volume (RVEDV) and indexed RVEDV increased moving from normal diastolic function to grade 2/3 DD (P < .0001). Regression analysis, controlling for age, sex, race, body surface area, and systolic pulmonary artery pressure, found DD remained significantly associated with RVEDV. Right ventricular basal and midcavity dimensions also increased across diastolic function groups (P = .0001), while RV longitudinal dimension was not associated with DD. Right ventricular ejection fraction (RVEF) showed a significant, graded decrease across diastolic function groups, independent of age, sex, race, body surface area, and systolic pulmonary artery pressure. Even comparing grade 1 DD with normal, there was a significant decrease in RVEF (P < .0003). Indexed left and right atrial volumes were similar when comparing normal with grade 1 DD; however, reservoir strain of each atrium was decreased with grade 1 DD.

Right ventricular end-diastolic volume and RVEF were significantly associated with left ventricular diastolic function. Even moving from normal diastolic function to grade 1 DD was associated with a statistically significant drop in RVEF. Right and left atrial strains also decreased when comparing grade 1 DD with normal diastolic function, while indexed atrial volumes showed no significant change.