engleski

It is the real deal: right ventricular dysfunction is a common finding across different ejection fraction phenotypes in acutely decompensated heart failure patients

Background: Dysfunction of the right ventricle (RV) can often be underestimated during the work-up of a congested patient with acutely decompensated heart failure (ADHF). Purpose: To determine the prevalence of RV dysfunction in ADHF patients and to characterize parameters of RV dysfunction when stratified by sex and the left ventricular ejection fraction (LVEF). Methods: Twenty-six patients with LVEF <50% and 26 with LVEF ≥50%, that fulfilled ESC 2016 HF criteria for ADHF were consecutively enrolled in the study. Parameters of RV function including tricuspid annular plane systolic excursion (TAPSE), tricuspid lateral annular systolic velocity (S’), fractional area change (FAC), RV 2D free wall strain (FWS) and pulmonary artery systolic pressure (PASP) were measured by transthoracic echocardiography with abnormal cut-offs defined by ASE/EACVI criteria. Results: Mean age of patients was 69.6 ± 10.6 years with equal sex distribution. Reduced FWS was the most common (71.9%) RV abnormality among ADHF cohort while decreased S’ was least frequently (49%) encountered (Figure 1). Women had significantly higher RV FAC and RV 2D FW strain values than men (35.9 ± 9.1 vs. 29.1 ± 9.8 % and -19.2 ± 6.2 vs. -14.7 ± 4.9 %, respectively). Distribution of reduced TAPSE and RV S’ was significantly higher among patients with LVEF <50% compared to those with LVEF ≥50% (p=0.031 and p=0.023, respectively ; Mann-Whitney U test) (Table 1). Conclusions: RV dysfunction is a common finding among ADHF patients and seems to affect men more than women. Prevalence of RV dysfunction is substantial in both LVEF phenotypes, although those with LVEF <50% are generally more affected and dominantly present with reduced RV FW strain while elevated pulmonary pressures seem to predominate among patients with preserved LVEF.

right ventricular dysfunction ; right ventricle failure ; echocardiography ; acute decompensated heart failure ; TAPSE ; free-wall strain ; left ventricular ejection fraction

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