RV Dysfunction Index Predicts Outcomes in Patients With HFrEF, PH Postdischarge

pulmonary hypertension x ray
PAH, pulmonary hypertension, pulmonary arterial hypertension, CTEPH
Researchers examined the effects of RV dysfunction on the clinical outcomes of patients hospitalized with heart failure with and without pulmonary hypertension.

The use of right ventricular tissue Doppler imaging systolic velocity (RV-TDI s’) to estimate RV dysfunction could predict postdischarge clinical outcomes among individuals hospitalized for heart failure with reduced ejection fraction (HFrEF) and pulmonary hypertension (PH), according to a study published in the Journal of Cardiology.

Researchers sourced data on 573 patients with HFrEF admitted to Tokyo Women’s Medical University Hospital in Japan between July 2013 and November 2017. Study participants were stratified by RV dysfunction, with reduced RV function defined as RV-TDI s’ less than or equal to 9.5 cm/s. Primary endpoints included composite cardiovascular (CV) death and rehospitalization due to heart failure (HF). Kaplan-Meier curves were used to evaluate CV death, HF-related rehospitalization, and their composite, with the log-rank test used to assess intergroup differences.

The patient population had a median age of 66.4±15.8 years, and 72% were men.

According to the Kaplan-Meier curves, individuals with reduced RV function vs patients with preserved RV function experienced significantly higher rates of the primary endpoint at 2 years (45% vs 33%, respectively; log-rank test P =.01). Although this impact was observed among those with PH (P =.001), it was not observed among those without PH (P =.39). After adjustments for gender, age, and other significant covariates, multivariate analysis showed RV-TDI s’ less than or equal to 9.5 cm/s to independently predict the composite endpoint (adjusted hazard ratio, 3.12; 95% CI, 1.44-6.73).

Limitations to this study include a retrospective study design, the use of a single center, a small study sample, a short observation period, the exclusion of certain parameters like HF hospitalization, an inability to evaluate inter/intraobserver reliability for RV-TDI s’, variable timing for transthoracic echocardiography evaluations, a limited number of individuals for RV-TDI early diastolic velocity evaluation, potential differences between echocardiography parameters and real hemodynamics, and potential residual confounding.

“The RV-TDI s’ is a simple and reproducible index of RV function that can be determined during hospitalization, and it may predict [CV] outcomes after the discharge of patients with HFrEF and PH, but not in those without PH,” the study authors wrote.


Saito C, Jujo K, Kametani M, et al. Prognostic impact of right ventricular function affected by pulmonary hypertension in hospitalized heart failure patients. J Cardiol. Published online December 19, 2021. doi:10.1016/j.jjcc.2021.10.008