The underlying pathophysiology of right ventricular (RV) dysfunction in heart failure with preserved ejection fraction (HFpEF) is still debated. The aim of this study is to assess the prognostic significance of echocardiographic right ventricular abnormalities in HFpEF.

We enrolled 150 patients with HFpFE in sinus rhythm and no history of chronic lung disease in this observational study. Over a median follow-up of 18 months, 58 patients (38.6%) reached the end point study of hospitalization for heart failure or death (group 1) and 92 remained asymptomatic (group 2).

While mean ages, sex ratio, BMI, creatinine level, left ventricular (LV) ejection fraction, LV and RV dimensions were similar between the 2 groups, group 1 patients compared to group 2, had higher ratio of early mitral diastolic inflow velocity E to early diastolic mitral annular velocity e’ (E/e’ ratio: 17±6 vs 13±7; P<0.01), higher pulmonary artery (PA) pressures (45±11 vs. 36±12mmHg; P<0.01) with higher right heart filling pressures. Furthermore, group 1 patients had reduced RV function evidenced by reduced tricuspid annulus systolic velocities obtained at the basal RV free wall (8.9±2.1 vs. 10.9±1.9cm/s; P<0.01), reduced tricuspid annular plane systolic excursion (TAPSE: 14.9±2.4 vs. 17.8±2.7mm; P<0.01) and reduced RV fractional area change (FAC: 41±6 vs. 48±7%; P<0.01).

In HFpEF patients, right ventricular dysfunction progresses with increasing afterload PA pressures, and is associated with worse outcome.