It Is Time to Look at Heart Failure With Preserved Ejection Fraction From the Right Side

Chatterjee, Neal A.; Steiner, Julia; Lewis, Gregory D.

doi:10.1161/circulationaha.114.013536

Cited by 27 publications

(22 citation statements)

References 37 publications

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“…Chronic RV pressure overload due to Group 2 PH likely plays an important role and the RV may be more sensitive to load in HFpEF. 10 Here and in other observational studies assessing RV function in HFpEF, 2–4 a much higher prevalence of atrial fibrillation was observed in HFpEF patients with RVD in the setting of chronic and adequate heart rate control. Other studies have described impaired RV function in atrial fibrillation 16 .…”

Section: Discussionmentioning

confidence: 55%

“…In contrast, in the TOPCAT trial echocardiographic sub-study, only 4% of patients had a reduced RV FAC 15 . As recently reviewed, in most HFpEF studies, RVD was associated with worse clinical outcomes 10 but the physiologic phenotyping of patients with RVD was limited.…”

Section: Discussionmentioning

confidence: 99%

“…7, 10 Guazzi et al demonstrated that the non-invasively assessed TAPSE/PASP ratio was associated with poor outcomes in a large (n=293) cohort of patients with HF, including 46 with HFpEF 7 . In the current study, indexing TAPSE to PASP did significantly strengthen the association between several biological markers of HF severity and RV function, suggesting that this simple measure provides further insight into the severity of physiologic derangements in HFpEF.…”

Section: Discussionmentioning

confidence: 99%

“…8 It has been proposed that response to sildenafil in HFpEF may require the presence of markedly perturbed RV-PA coupling due to the both PH and RVD. 9, 10 Thus, in an exploratory analysis, we tested the hypothesis that sildenafil would improve RV function, exercise capacity and ventilatory efficiency in patients with the most perturbed RV-PA coupling.…”

mentioning

confidence: 99%

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Impaired Right Ventricular–Pulmonary Arterial Coupling and Effect of Sildenafil in Heart Failure With Preserved Ejection Fraction

Hussain

Mohammed

Forfia

et al. 2016

Circ: Heart Failure

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Background Right ventricular (RV) dysfunction (RVD) is a poor prognostic factor in heart failure (HF) with preserved ejection fraction (HFpEF). The physiologic perturbations associated with RVD or RV function indexed to load (RV-pulmonary arterial (PA) coupling) in HFpEF have not been defined. HFpEF patients with marked impairment in RV-PA coupling may be uniquely sensitive to sildenafil. Methods and Results In a subset of HFpEF patients enrolled in the RELAX trial, physiologic variables and therapeutic effect of sildenafil were examined relative to the severity of RVD (tricuspid annular plane systolic excursion (TAPSE)) and according to impairment in RV-PA coupling (TAPSE/ pulmonary artery systolic pressure (PASP)) ratio. Prevalence of atrial fibrillation and diuretic use, NT-proBNP levels, renal dysfunction, neurohumoral activation, myocardial necrosis and fibrosis biomarkers and the severity of diastolic dysfunction all increased with severity of RVD. Peak oxygen consumption (pVO2) decreased and ventilatory inefficiency (VE/VCO2 slope) increased with increasing severity of RVD. Many but not all physiological derangements were more closely associated with the TAPSE/PASP ratio. Compared to placebo, at 24 weeks, TAPSE decreased and pVO2 and VE/CO2 slope were unchanged with sildenafil. There was no interaction between RV-PA coupling and treatment effect and sildenafil did not improve TAPSE, pVO2 or VE/VCO2 in patients with PH and RVD. Conclusions HFpEF patients with RVD and impaired RV-PA coupling have more advanced HF. In RELAX patients with RVD and impaired RV-PA coupling, sildenafil did not improve RV function, exercise capacity or ventilatory efficiency. Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT00763867.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impaired Right Ventricular–Pulmonary Arterial Coupling and Effect of Sildenafil in Heart Failure With Preserved Ejection Fraction

Hussain

Mohammed

Forfia

et al. 2016

Circ: Heart Failure

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“…7, 9, 27, 28 In patients free of cardiovascular disease at baseline, greater RV mass is associated with an increased risk of heart failure and cardiovascular mortality. 7 In MESA participants, abnormal RV morphology has been linked to subclinical LV dysfunction, 13 conditions associated with abnormal pulmonary vascular function (obesity, emphysema), 17, 29 as well as biomarkers of inflammation and neurohormonal activation.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Structure and Function Are Associated With Incident Atrial Fibrillation

Chatterjee¹,

Shah²,

Murthy³

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background Right ventricular (RV) morphology has been associated with drivers of atrial fibrillation (AF) risk including left ventricular (LV) and pulmonary pathology, systemic inflammation and neurohormonal activation. The aim of this study was to investigate the association between RV morphology and risk of incident AF. Methods and Results We interpreted cardiac magnetic resonance (CMR) imaging in 4,204 participants free of clinical cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Incident AF was determined using hospital discharge records, study electrocardiograms, and Medicare claims data. The study sample (n=3,819) was 61±10 years old and 47% male with 47.2% current/former smokers. Following adjustment for demographics and clinical factors including incident heart failure, higher RV ejection fraction (RVEF; hazard ratio [HR]: 1.16 per standard deviation [SD], 95% CI: 1.03–1.32, p=0.02) and greater RV mass (HR: 1.25 per SD, 95% CI: 1.08–1.44, p=0.002) were significantly associated with incident AF. After additional adjustment for the respective LV parameter, higher RVEF remained significantly associated with incident AF (HR: 1.15 per SD, 95% CI: 1.01–1.32, p = 0.04) whereas the association was attenuated for RV mass (HR 1.16 per SD, 95% CI: 0.99–1.35, p = 0.07). In a subset of patients with available spirometry (n=2,540), higher RV ejection fraction and mass remained significantly associated with incident AF after additional adjustment for lung function (p=0.02 for both). Conclusions Higher RV ejection fraction and greater RV mass were associated with an increased risk of atrial fibrillation in a multi-ethnic population free of clinical cardiovascular disease at baseline.

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Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta‐analysis

Gorter

Hoendermis

Veldhuisen

et al. 2016

European J of Heart Fail

227

197

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It Is Time to Look at Heart Failure With Preserved Ejection Fraction From the Right Side

Cited by 27 publications

References 37 publications

Impaired Right Ventricular–Pulmonary Arterial Coupling and Effect of Sildenafil in Heart Failure With Preserved Ejection Fraction

Impaired Right Ventricular–Pulmonary Arterial Coupling and Effect of Sildenafil in Heart Failure With Preserved Ejection Fraction

Right Ventricular Structure and Function Are Associated With Incident Atrial Fibrillation

Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta‐analysis

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