What influences right ventricle function in pulmonary hypertension due to HFpEF?

Abstract

Right ventricular (RV) function and pulmonary hypertension (PH) are increasingly recognized in heart failure with preserved ejection fraction (HFpEF), with high prevalence and poor outcome. Factors leading to worse RV function in PH-HFpEF patients are unknown. We thought to determine the parameters of RV dilation in HFpEF patients with PH. We analysed clinical, echocardiographic and hemodynamic characteristics of 112 PH-HFpEF patients (71 women) enrolled prospectively in our center. PH-HFpEF was defined by a resting mean pulmonary artery pressure (mPAP) ≥ 25 mmHg and pulmonary artery wedge pressure (PAWP) > 15 mmHg. RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) < 16 mm at echocardiography. Mean age (± SD) was 69 ± 11 years, mPAP was 40 ± 10 mmHg, PAWP was 21 ± 5 mmHg. Forty-seven PH-HFpEF patients (40%) had RV dysfunction. In univariate analysis, RV dysfunction was related to history of hypertension ( P = 0.04, OR = 1.01), atrial fibrillation ( P < 0.01; OR = 0.21), mPAP ( P = 0.06; OR = 0.97), and right atrial pressure (RAP) ( P = 0.02, OR = 0.92). In PH-HFpEF patients, we documented a significant relationship between RV dysfunction and Hypertension, atrial fibrillation, mPAP and RAP.