A study of right ventricular structure and function in patients with heart failure with preserved ejection fraction

Sura Kishore Mishra, Vaibhav Yawalkar, Indira Palo, Abinash Panda

Abstract


Background: Heart failure with preserved ejection fraction (HFpEF) is now considered as distinct syndrome. Epidemiological studies have observed its prevalence to be about 50% among the heart failure patients. Heart failure with reduced ejection fraction (HFrEF) there is an eccentric ventricular remodeling
whereas, in HFpEF there is concentric remodeling. The steeper end-systolic pressure– volume relationship is steeper leading to a marked sensitivity to volume changes. There is also a substantial drop in blood pressure with vasodilator therapy. Right ventricular (RV) structure and function show chronic changes. The present study was carried out to find out the changes in RV structure and function over time in patients with HFpEF using established echocardiographic parameters. 
Materials and Methods: The longitudinal study was carried out on a convenience sample of 100 patients with heart failure and having preserved ejection fraction. Patients were managed as per the standard
guidelines of ESC heart failure mana gement. The outcome variables like systolic blood pressure, diastolic blood pressure, heart rate, NYHA functional capacity class, number of re-hospitalizations for heart failure during the study period and cardio-vascular mortality were measured at baseline and at 12 months. Apart
from routine investigations, transthoracic echocardiography was performed. Descriptive statistics was used to present the data. Data analyis was done using GraphPad Prism 7.0 (trial version).
Results: Majority of patients of HFpEF were between 71-80 years of age. Systemic hypertension was the commonest co-morbidity. 58% patients were in NYHA functional class I and 28% patients had NYHA class IV. 23% patients had RV dysfunction at baseline based on the fractional area change criteria with FAC
< 35%. The incidence of RV dysfunction for follow up period of one year was 7.8. RV dysfunction defined as FAC<35% was present in 23 patients at baseline and increased to 29 patients at the end of follow up. Also, there was an increase incidence of atrial fibrillation (from 32 to 43%).
Conclusion: Right ventricular dysfunction marked by a significant structural and functional deterioration is an important pathophysiological aspect in patients with HFpEF.

Keywords: Heart failure with preserved ejection fraction (HFpEF) right ventricular structure and function transthoracic echocardiograph.


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