Table 1. Comparative prevalence and prognostic value of right ventricular dysfunction in selected studies conducted on patients with pulmonary arterial hypertension and in those with heart failure preserved ejection fraction.
| First author, journal, year | Number | RV dysfunction criteria | Prevalence of RV dysfunction | Link with outcomes |
|---|---|---|---|---|
| Pulmonary arterial hypertension | ||||
| Forfia et al. AJRCCM, 2006 | 63 precapillary PH | TAPSE; RVFAC | 44% with TAPSE <18 mm, 50% with RVFAC <30% | During a median FU of 19.3 months, TAPSE <18 mm and RVFAC <30% were predictors of all-cause death. |
| Mathai et al. The Journal of Rheumatology, 2011 | 50 SSc-PAH | TAPSE; RVFAC | 50% with TAPSE <17 mm, 50% with RVFAC <30.9% | During a median FU of 15.7 months, TAPSE ≤17 mm conferred a nearly 4-fold increased risk of death [HR =3.81, 95% CI (1.31–11.1), P<0.01] |
| Van de Veerdonk et al. JACC, 2011 | 110 PAH | RVEF by CMR | 50% with RVEF <36% | During a 47-month FU, RVEF was associated with mortality independently from pulmonary vascular resistance. Changes in RVEF at 1 year were also associated with survival |
| Fine et al. Circulation: CV imaging, 2013 | 575 suspected or confirmed pre-capillary PH | Peak RV longitudinal strain (RVLS) | 50% had an RVLS −21 | During a median FU of 16.5 months, RVLS predicted survival in addition to NYHA class and NT-proBNP levels |
| Ryo et al. Circulation: CV Imaging, 2015 | 92 patients with pre-capillary PH | RV end-systolic volume index by 3D echo | 50% with TAPSE <19 mm; 50% with 3D RVEF <33%; 50% with 3D RV global area strain >−21% | During the 6-month FU, RV end-systolic volume indexed on body surface area was associated with PH-related hospitalization, death, or lung surgery (lung transplantation or pulmonary endarterectomy) |
| Amsallem et al. Circulation: CV Imaging, 2017 | 228 PAH | RVESRI; RVLS; RVFAC; TAPSE | 72% had a RVLS >−20%; 88% had a RVFAC <35%; 53% had a TAPSE <18 mm | During the 5-year FU, RVESRI predicted clinical worsening (death, transplant or readmission for heart failure) in addition to NYHA class and NT-proBNP levels. RVESRI was more reproducible and prognostic than RVLS, and incremental to the REVEAL score. |
| Swift et al. AJRCCM, 2017 | 576 PAH | RVEF; RVESVi | 50% had RVEF <39% | During the 42-month FU, RVESV index was an independent predictor of mortality in addition to relative pulmonary arterial change (stiffness) |
| Heart failure with preserved ejection fraction | ||||
| Burke et al. Circulation: Heart Failure, 2013 | 419 HFpEF | TAPSE; RVFAC; RVESAI; RVEDAI | 28% had TAPSE <16 mm; 15% had RVFAC <35% | During an 18-month FU, TAPSE was a predictor of outcome independently of pulmonary pressures |
| Mohammed et al. Circulation, 2014 | 562 HFpEF | TAPSE; Semiquantitative RV function | 50% had TAPSE <17 mm | During the 8-year FU, semiquantitative RV dysfunction (or TAPSE) was associated with mortality, independently from pulmonary pressures |
| Melenovsky et al. Eur Heart J, 2014 | 96 HFpEF | RVFAC | 33% had RVFAC <35% | During a 529-day FU, RVFAC <35% was the strongest predictor of death |
| Aschauer et al. Eur J Heart Failure, 2015 | 171 HFpEF | RVEF; by CMR | 19% had RVEF <45% | During a 573-day FU, RVEF <45% was a predictor of cardiac death or admission for heart failure, independently from diabetes, 6-minute walk distance and systolic pulmonary arterial pressure |
| Morris et al. Eur H J: CV Imaging, 2017 | 218 HFpEF | RV strain (global and free-wall); TAPSE; RVFAC; S’ | 50% had TAPSE <19 mm | RV global and free wall systolic strain were significantly linked to the symptomatic status of the patient. No data on outcomes |
| Hussain et al. Circulation: Heart Failure, 2016 | 137 HFpEF (subgroup from RELAX trial) | TAPSE; TAPSE/RVSP | 50% had TAPSE <17 mm | No data on outcomes |
CMR, cardiac magnetic resonance; FU, follow-up; HFpEF, heart failure with preserved ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; PAH: pulmonary arterial hypertension; PH, pulmonary hypertension; REVEAL, registry to evaluate early and long-term PAH disease management; RVEDAI, right ventricular end-diastolic area index; RVEF, right ventricular ejection fraction; RVESAI: right ventricular end-systolic area index; RVESRI, right ventricular end-systolic remodeling index; RVESVi, right ventricular end-systolic volume index; RVFAC, right ventricular fractional area change; RVLS, right ventricular longitudinal strain; RVSP, right ventricular systolic pressure estimated by echocardiography; SSc-PAH, systemic sclerosis-related PAH; TAPSE, tricuspid annular plane systolic excursion.