Determinants of Right Ventricular Function Worsening in Advanced HFrEF: Longitudinal Echocardiography and Invasive Hemodynamics Study

PURPOSE Hemodynamic and clinical determinants of right ventricular (RV) dysfunction in heart failure with reduced EF (HFrEF) are poorly understood and were studied mostly on cross-sectional data. We hypothesized that examining changes of RV function and hemodynamic load over time will provide better insight into mechanisms of RV function worsening. METHODS From HFrEF patients examined in our cardiac transplant center in the past 10 years, we retrospectively identified patients who underwent twice right heart catheterization, clinical labs and echocardiography with RV function assessment. We examined hemodynamic and clinical factors associated with worsening or stable RV function using correlations and logistic regression (LR) analysis. RESULTS In 147 HFrEF patients (age 53±9 y, body mass index-BMI: 27±4, 85% males, LV EF: 20±5%), 83% had PH (mPA over 25mmHg) and 56% had moderate/severe RV dysfunction. After median of 412 d (IQR: 182-686), 60 (41%) had RV function worsening, defined as negative change in Tricuspid annular plane systolic excursion (negative Δ TAPSE). SSRI antidepressant use at baseline was associated with RV worsening. The regression of RV load (RV systolic pressure) to RV function (TAPSE) at both visits had negative slope (r=-0.16, p=0.05) and p=0.05) and were superimposable. Strong correlates of RV function decline were the increase of RV arterial elastance (log Ea, PA systolic pressure/stroke volume), serum creatinine, BNP, LV end-diastolic diameter and LA area, and the reduction of PA compliance (PAC, PA SV/PP) or body mass index (Figure). In multivariate LR model (chi2 31) using parameters above, only the increase in log RV Ea, LV-end-diastolic diameter and the reduction in BMI were independently predictive of RV function worsening. CONCLUSION Oscillatory RV load, progressive LV dilatation and body weight loss (cardiac cachexia) were independently associated with progressive RV dysfunction in advanced HFrEF.