Impaired RV function, pulmonary coupling tied to hospitalizations, death in HFpEF patients

Worsening right ventricular (RV) function normally occurs in patients with heart failure and preserved left ventricular ejection fraction (HFpEF) and, along with its ratio to pulmonary pressure, is predictive of a higher risk of HF hospitalizations and cardiovascular death, reports a study.

A group of researchers examined measures of RV function by evaluating the absolute RV free wall longitudinal strain (RVFWLS) and its ratio to estimated pulmonary artery systolic pressure (PASP) in 528 patients (mean age 74 years, 56 percent female) with adequate echocardiographic images quality enrolled in the PARAGON-HF trial.

After accounting for confounders, the research team explored the associations with baseline N-terminal pro‒B-type natriuretic peptide and with total HF hospitalizations and cardiovascular death.

Of the patients, 311 (58 percent) presented with RV dysfunction, defined as absolute RVFWLS <20 percent. More than half of the 388 patients (73 percent) with normal tricuspid annular planar systolic excursion and RV fractional area change had impaired RV function.

Moreover, lower values of RVFWLS and RVFWLS/PASP ratios showed a significant correlation with higher circulating N-terminal pro–B-type natriuretic peptide.

A total of 277 HF hospitalizations and cardiovascular deaths occurred over a median follow-up of 2.8 years. Both absolute RVFWLS (hazard ratio [HR], 1.39, 95 percent confidence interval [CI], 1.05‒1.83; p=0.018) and RVFWLS/PASP ratio (HR, 1.43, 95 percent CI, 1.13‒1.80; p=0.002) significantly correlated with the composite outcome.

Notably, measures of RV function did not modify the treatment effect of sacubitril/valsartan.