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

Aims Right ventricular (RV) dysfunction and pulmonary hypertension (PH) are increasingly recognized in heart failure with preserved ejection fraction (HFpEF). The prevalence and prognostic value of RV dysfunction in HFpEF have been widely but variably reported. We therefore conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methods and results English literature until May 2016 was evaluated for prevalence of RV dysfunction [i.e. tricuspid annular plane systolic excursion (TAPSE) < 16 mm, fractional area change (FAC) < 35%, or tricuspid annular systolic velocity (RV S') < 9.5 cm/s)] and PH [i.e. mean pulmonary artery pressure (MPAP) >= 25 mmHg or pulmonary artery systolic pressure (PASP) = 35 mmHg]. Combined hazard ratios (HRs) for outcomes were calculated. A total of 38 studies was included. In studies with stringent HFpEF criteria, prevalence of RV dysfunction was 28% for TAPSE, 18% for FAC, and 21% for RV S'. Prevalence of PH was 68% for both increased MPAP and PASP. TAPSE (HR 1.26/5mm decrease; P < 0.0001), FAC (HR 1.15/5% decrease; P < 0.0001), MPAP (HR 1.26/5 mmHg increase; P < 0.0001), and PASP (1.16/5 mmHg increase; P < 0.0001) were all univariably associated with mortality. HRs for RV S' were not reported. Conclusion RV dysfunction and PH are highly prevalent and are both associated with poor outcome in patients with HFpEF.