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Right ventricular performance in patients with heart failure with mildly reduced ejection fraction: the forgotten ventricle

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Abstract

Right ventricular (RV) function is a major determinant of prognosis and adverse outcomes in patients with heart failure (HF). It is largely unknown if HF with mildly reduced ejection fraction (HFmrEF) patients have some special characteristics in RV function (RVF) that may distinguish them from HF with reduced or preserved ejection fraction (HFrEF or HFpEF) patients. Standard echocardiography was performed to estimate RVF [tricuspid annular systolic velocity (TDSV), plane systolic excursion (TAPSE), TAPSE to pulmonary artery systolic pressure (TAPSE/PASP) and RV myocardial performance index (MPI-TEI index)] in a cross-sectional study. In 306 participants, the RV systolic function evaluated with TAPSE and TDSV was impaired in 39.1 and 24.2%, respectively. TAPSE, TAPSE/PASP and TDSV were lower in HFmrEF compared with HFpEF and higher compared with HFrEF (p < 0.001 for among-groups comparison). RV diastolic dysfunction varied between 12.6 and 43.8% depending on the echocardiographic parameter. Diastolic RVF determined by tricuspid inflow E/A wave ratio (Et/At) was impaired in less patients with HFmrEF compared with those with HFpEF or HFrEF (25.9% vs 48.4% vs 56.3%; p = 0.030, respectively). RV diastolic dysfunction by et′/at′ (tissue Doppler tricuspid valve annulus e′ and a′ waves) was impaired in less patients with HFmrEF compared with HFrEF (11.8% vs 33.3%; p = 0.019). A multivariate regression analysis revealed a significant association between RV and LV systolic dysfunction. The present study shows a high prevalence of RV dysfunction in HFmrEF patients. Study findings provides some new insights on RV and LV systolic dysfunction coupling whereas RV diastolic dysfunction was not dependent on LV systolic dysfunction.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. 2nd Propedeutic Department of Internal Medicine, Aristotle University, Konstantinoupoleos 49, 54642, Thessaloniki, Greece

    Konstantinos Koutsampasopoulos, Charalampos Loutradis, Konstantinos P. Imprialos, Konstantinos Stavropoulos, Vasilios G. Athyros, Asterios Karagiannis & Michael Doumas

  2. Cardiology Department, Veria General Hospital, Veria, Greece

    Ioannis Vogiatzis

  3. 1st Cardiology Department, Aristotle University, Thessaloniki, Greece

    Antonios Ziakas & Vasilios Vasilikos

  4. 3rd Cardiology Department, Aristotle University, Thessaloniki, Greece

    Christodoulos Ε. Papadopoulos

  5. VAMC, George Washington University, Washington, DC, USA

    Michael Doumas & Vasilios Papademetriou

Authors
  1. Konstantinos Koutsampasopoulos
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  2. Ioannis Vogiatzis
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  6. Konstantinos P. Imprialos
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  7. Konstantinos Stavropoulos
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  8. Vasilios Vasilikos
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  9. Vasilios G. Athyros
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  10. Asterios Karagiannis
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  12. Vasilios Papademetriou
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Contributions

Study design: KK, MD, AZ, AK. Data collection and analysis: KK, KS, CL, KI, IV. Manuscript preparation: KK, KS, CL, VV, CP, VA, VP, MD.

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Correspondence to Michael Doumas.

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This is an observational study. The study protocol has been approved by the bioethics committee of Aristotle University of Thessaloniki, the Hellenic Data Protection Authority and the scientific Council of General Hospital of Veria.

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Koutsampasopoulos, K., Vogiatzis, I., Ziakas, A. et al. Right ventricular performance in patients with heart failure with mildly reduced ejection fraction: the forgotten ventricle. Int J Cardiovasc Imaging 38, 2363–2372 (2022). https://doi.org/10.1007/s10554-022-02652-6

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  • DOI: https://doi.org/10.1007/s10554-022-02652-6

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