Abstract 15805: Right Heart Dysfunction in Heart Failure With Preserved Ejection Fraction: The Determinants and Prognostic Impact
Objectives: Right heart function is not well characterized in patients with heart failure and preserved ejection fraction (HFpEF). The goal was to compare ventricular-arterial function in HFpEF and controls and examine the hemodynamic, clinical, and prognostic correlates of right ventricular dysfunction (RVD) in HFpEF.
Methods: HFpEF patients (n=96) and controls (n=36) underwent right heart catheterization, detailed echocardiographic assessment, and were followed prospectively.
Results: RVD (RV fractional area change-FAC<40%) was present in 47% of HFpEF patients and was associated with more severe symptoms and greater comorbidity burden. While LV size and systolic function were similar in HFpEF and controls, right atrial (RA) and ventricular sizes were increased in HFpEF. RV and RA systolic function were impaired in HFpEF compared to controls using load-dependent and load-independent indices.A stress-shortening analysis showed that RV FAC was reduced in HFpEF after accounting for PA pressure overload, indicating primary impairment in RV contractility rather than afterload mismatch. HFpEF patients with RVD displayed higher pulmonary artery (PA) pressures, higher resistance, and elastance with lower PA compliance than HFpEF without RVD. In multivariable analysis, RVD was remained related to only to PA pressure and atrial fibrillation (AF). Patients in AF displayed greater impairments in RA/RV function and remodeling, independently of RV afterload (Figure A). Over a median follow-up of 529 days (IQR 143-1066), 31% of HFpEF patients died (Figure B). In multivariable Cox modeling, RVD was the strongest predictor of adverse outcome (OR: 2.36, p<0.0001), even after accounting for PA pressure and the presence of AF.
Conclusions: Right heart dysfunction commonly develops in HFpEF in relation to increased PA pressure loading and with the development of AF. RVD in HFpEF is associated with increased morbidity and mortality and may serve as therapeutic target.
- © 2013 by American Heart Association, Inc.