Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jan;37(1):255-266.
doi: 10.1007/s10554-020-01953-y. Epub 2020 Jul 31.

Prevalence of right ventricular dysfunction and prognostic significance in heart failure with preserved ejection fraction

Prathap Kanagala  1   2   3 , Jayanth R Arnold  4 , Anvesha Singh  4 , Jamal N Khan  4 , Gaurav S Gulsin  4 , Pankaj Gupta  4 , Iain B Squire  4 , Leong L Ng  4 , Gerry P McCann  4
Affiliations
Observational Study

Prevalence of right ventricular dysfunction and prognostic significance in heart failure with preserved ejection fraction

Prathap Kanagala et al. Int J Cardiovasc Imaging. 2021 Jan.

Abstract

There is a paucity of data characterizing right ventricular performance in heart failure with preserved ejection fraction (HFpEF) using the gold standard of cardiovascular magnetic resonance imaging (CMR). We aimed to assess the proportion of right ventricular systolic dysfunction (RVD) in HFpEF and the relation to clinical outcomes. As part of a single-centre, prospective, observational study, 183 subjects (135 HFpEF, and 48 age- and sex-matched controls) underwent extensive characterization with CMR. transthoracic echocardiography, blood sampling and six-minute walk testing. Patients were followed for the composite endpoint of death or HF hospitalization. RVD (defined as right ventricular ejection fraction < 47%) controls was present in 19% of HFpEF. Patients with RVD presented more frequently with lower systolic blood pressure, atrial fibrillation, radiographic evidence of pulmonary congestion and raised cardiothoracic ratio and larger right ventricular volumes. During median follow-up of 1429 days, 47% (n = 64) of HFpEF subjects experienced the composite endpoint of death (n = 22) or HF hospitalization (n = 42). RVD was associated with an increased risk of composite events (Log-Rank p = 0.001). In multivariable Cox regression analysis, RVD was an independent predictor of adverse outcomes (adjusted Hazard Ratio [HR] 3.946, 95% CI 1.878-8.290, p = 0.0001) along with indexed extracellular volume (HR 1.742, CI 1.176-2.579, p = 0.006) and E/E' (HR 1.745, CI 1.230-2.477, p = 0.002). RVD as assessed by CMR is prevalent in nearly one-fifth of HFpEF patients and is independently associated with death and/or hospitalization with HF.The trial was registered retrospectively on ClinicalTrials.gov (Identifier: NCT03050593). The date of registration was February 06, 2017.

Keywords: Cardiovascular magnetic resonance imaging; Heart failure with preserved ejection fraction; Prevalence; Prognosis; Right ventricular dysfunction.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no competing interests relevant to this study. All authors also state that they have full control of all primary data and that they agree to allow the journal to review their data if requested.

Figures

Fig. 1
Fig. 1
Assessment of ventricular volumes, function and mass. End-diastolic (a) and end-systolic (b) cine frames illustrating manually drawn contours of the left ventricular endocardium (pink), left ventricular epicardium (green) and right ventricular endocardium (yellow) for volumetric and mass analysis. (white arrows) papillary muscles and trabeculations were excluded from left ventricular mass calculations
Fig. 2
Fig. 2
Study recruitment overview. Flow chart illustrating recruitment and reasons for exclusion. CMR cardiovascular magnetic resonance imaging, HFpEF heart failure with preserved ejection fraction, RV right ventricle
Fig. 3
Fig. 3
Survival analysis stratified according to the presence or absence of right ventricular dysfunction. Kaplan–Meier analysis for the composite endpoint of death and/or hospitalization with heart failure; RVD right ventricular dysfunction
See this image and copyright information in PMC

References

    1. Di Salvo TG, Mathier M, Semigran MJ, et al. Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol. 1995;25(5):1143–1153. doi: 10.1016/0735-1097(94)00511-N. - DOI - PubMed
    1. Gulati A, Ismail TF, Jabbour A, et al. The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy. Circulation. 2013;128(15):1623–1633. doi: 10.1161/CIRCULATIONAHA.113.002518. - DOI - PubMed
    1. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251–259. doi: 10.1056/NEJMoa052256. - DOI - PubMed
    1. Gorter TM, van Veldhuisen DJ, Bauersachs J, et al. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Failure. 2017;10:20. doi: 10.1002/ejhf.1029. - DOI - PubMed
    1. Zakeri R, Mohammed SF. Epidemiology of right ventricular dysfunction in heart failure with preserved ejection fraction. Curr Heart Fail Rep. 2015;12(5):295–301. doi: 10.1007/s11897-015-0267-3. - DOI - PubMed

Publication types

MeSH terms

Associated data