The secondary analysis of a US community-based cohort study suggested that right ventricular (RV) dysfunction played an important and underrecognized role in the progression to heart failure (HF). This study included 1004 elderly participants (mean age 76 years, 385 men, and 121 black) who underwent both 3-dimensional and 2-dimensional RV echocardiography from 2011 to 2013, with a median follow-up of 4.1 years. Mean RV ejection fraction (EF) was 53%. RVEF, RVEF/pulmonary artery systolic pressure (PASP), and RV longitudinal strain were each progressively lower across advancing HF stages. Using reference limits from stage 0 (no risk factors) participants, RVEF was abnormal in 103 asymptomatic persons with stage A HF (15%; at elevated risk for HF but without structural heart disease or clinical HF) and 27 with stage B HF (24%; structural heart disease but without clinical HF). Among participants free of HF at baseline, lower RVEF and worse RV-PA coupling (ie, lower RVEF/PASP ratio) both were associated with incident HF or death independent of LVEF and N-terminal pro b-type natriuretic peptide (hazard ratio 1.20 per 5% decrease in RVEF; hazard ratio 1.65 per 0.5 unit decrease in RVEF/PASP ratio). The findings suggest the importance of RV dysfunction as well as 3-D imaging for the more asymmetric RV. Source: https://jamanetwork.com/
