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

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Physiology

Background:

• Left ventricular diastolic dysfunction (DD) is prevalent and can lead to heart failure with preserved ejection fraction (HFpEF).
• While right ventricular (RV) dilation and dysfunction are recognized in severe HFpEF, the impact of lesser degrees of DD on RV parameters is less understood.

Purpose of the Study:

• To investigate the association between varying grades of left ventricular (LV) diastolic dysfunction and right ventricular (RV) size and function.
• To explore the effects of early-stage DD on RV volumes, ejection fraction, and atrial function.

Main Methods:

• Utilized 3-dimensional echocardiography in 370 patients to assess RV volumes, ejection fraction, and strain.
• Graded LV diastolic function using the 2025 ASE algorithm.
• Compared RV measurements across different diastolic function groups, controlling for clinical confounders.

Main Results:

• Right ventricular end-diastolic volume (RVEDV) and indexed RVEDV increased significantly with worsening DD grades (p<0.0001).
• RV ejection fraction (RVEF) showed a significant, graded decrease across diastolic function groups, even with grade 1 DD (p < 0.0003).
• Atrial reservoir strain decreased in grade 1 DD compared to normal, despite similar indexed atrial volumes.

Conclusions:

• LV diastolic function is significantly associated with RVEDV and RVEF.
• Even mild (grade 1) DD leads to a statistically significant reduction in RVEF.
• Reduced atrial strain, particularly reservoir strain, is observed in early DD, suggesting subtle functional impairment.