Temporal Changes in Right Ventricular Structure and Function in Patients with Heart Failure and Preserved Ejection Fraction

Abstract

Background Heart failure with preserved ejection fraction (HFpEF) is often conceptualized as a primary disorder of the left ventricle (LV). No study has evaluated long-term changes in right ventricular (RV) structure and function in HFpEF. Methods Patients with HFpEF (n=271) and controls (n=27) underwent two echocardiographic evaluations >6 months apart (exams 1 and 2). RV dysfunction (RVD) was defined by RV fractional area change (FAC) Results After a median of 4.0 years (IQR 2.0 to 5.9), there was a 10% decline in RV FAC and 21% increase in RV diastolic area in HFpEF (both p Figure 1 ). Of 238 HFpEF patients with normal RV function at exam 1, 55 (23%) developed incident RVD by exam 2. The presence of atrial fibrillation (AF), higher body weight, coronary disease, higher pulmonary artery and LV filling pressures, and RV dilation at exam 1, and the development of persistent AF between exams 1 and 2, were independent predictors of incident RVD. Over a median follow-up of 6.0 years, there were 71 deaths. Patients with HFpEF who developed incident RVD had 2-fold increased risk of death ( Figure 2 and adjusted hazard ratio, 2.08; 95% confidential interval, 1.15-3.64; p=0.02). Conclusions While previous attention has centered on the LV in HFpEF, these data show that right ventricular structure and function deteriorate to greater extent over time as compared to changes in the LV, and worsening RV function is associated with increased mortality. Further study is required to evaluate whether interventions targeting modifiable risk factors for incident RVD, including abnormal hemodynamics, AF, coronary disease and obesity, can prevent RVD and improve outcomes.