Right ventricular function in heart failure with preserved ejection fraction: a community-based study.
BACKGROUND
The prevalence and clinical significance of right ventricular (RV) systolic dysfunction (RVD) in patients with heart failure and preserved ejection fraction (HFpEF) are not well characterized.


RESULTS
Consecutive, prospectively identified HFpEF (Framingham HF criteria, ejection fraction ≥50%) patients (n=562) from Olmsted County, Minnesota, underwent echocardiography at HF diagnosis and follow-up for cause-specific mortality and HF hospitalization. RV function was categorized by tertiles of tricuspid annular plane systolic excursion and by semiquantitative (normal, mild RVD, or moderate to severe RVD) 2-dimensional assessment. Whether RVD was defined by semiquantitative assessment or tricuspid annular plane systolic excursion ≤15 mm, HFpEF patients with RVD were more likely to have atrial fibrillation, pacemakers, and chronic diuretic therapy. At echocardiography, patients with RVD had slightly lower left ventricular ejection fraction, worse diastolic dysfunction, lower blood pressure and cardiac output, higher pulmonary artery systolic pressure, and more severe RV enlargement and tricuspid valve regurgitation. After adjustment for age, sex, pulmonary artery systolic pressure, and comorbidities, the presence of any RVD by semiquantitative assessment was associated with higher all-cause (hazard ratio=1.35; 95% confidence interval, 1.03-1.77; P=0.03) and cardiovascular (hazard ratio=1.85; 95% confidence interval, 1.20-2.80; P=0.006) mortality and higher first (hazard ratio=1.99; 95% confidence interval, 1.35-2.90; P=0.0006) and multiple (hazard ratio=1.81; 95% confidence interval, 1.18-2.78; P=0.007) HF hospitalization rates. RVD defined by tricuspid annular plane systolic excursion values showed similar but weaker associations with mortality and HF hospitalizations.


CONCLUSIONS
In the community, RVD is common in HFpEF patients, is associated with clinical and echocardiographic evidence of more advanced HF, and is predictive of poorer outcomes.
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.). mohammed.selma@mayo.edu.
Selma F
SF
Mohammed
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
Imad
I
Hussain
Omar F
OF
AbouEzzeddine
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
Omar F
OF
Abou Ezzeddine
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
Hiroyuki
H
Takahama
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
Susan H
SH
Kwon
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
Paul
P
Forfia
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
Véronique L
VL
Roger
From the Division of Cardiovascular Diseases (S.F.M., I.H., O.F.A.E., H.T., S.H.K., V.L.R., M.M.R.), Mayo Graduate School (S.F.M.), and Department of Health Sciences Research (V.L.R.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Medicine, Temple University, Philadelphia, PA (P.F.).
Margaret M
MM
Redfield
D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology*
diastole; heart failure; hypertension, pulmonary; ventricular dysfunction, right