Heart failure with preserved ejection fraction: echocardiographic characteristics in relation to right ventricular function
Abstract
Background: KaRen is a prospective study designed to characterize and follow a multicentric cohort of HFpEF patients. We sought to describe the echocardiographic characteristics of our population according presence or not of right ventricular dysfunction as indicated by a tricuspid annular excursion <16 mm. Method and results: Patients were recruited in 10 hospitals. Following an acute HF accompanied with NT-proBNP>300 pg/mL and LVEF > 45%, patients were reassessed by echo-Doppler after 4 to 8 weeks after dedicated treatment.Image acquisition was standardized and the analysis was centralized. 349 patients had complete data set. The mean EF was 62±13%, mean LV global longitudinal strain was -15±3%, E/e' 12.9±6.2 was and LA volume was 49±18 ml/m2. Tricuspid regurgitation was 2.9±0.9m/s. TAPSE <16mm was found in 139 (39%) patients. 155 (44%) had a RV s' < 11cm/s. Main results are displayed table I. By multivariate analysis, TAPSE <16 was independently associated with LV end diastolic volume (odds ratio (OR) 1.022, 95% confidence interval (CI) 1.009-1.035), LV fractional shortening (OR 1.054, 95% CI 1.004-1.105), mean LV s' (odds ratio 1.436, 95% confidence interval 1.111-1.856), e' lateral (OR 0.877, 95% CI 0.767-1.00), and with right atrial area (OR0.941, 95% CI 0.877-1.01) and RV global longitudinal strain (OR 0.893, 95% CI 0.824-0.967). Conclusion: In the HFpEF patients included in KaRen, LV EF was normal but 39% of patients had right ventricular longitudinal systolic dysfunction by TAPSE. Right heart dysfunction is associated with significantly different left heart characteristics.