RIGHT ventricular dysfunction affects approximately 19–33% of patients with heart failure with preserved ejection fraction (HFpEF) and independently predicts mortality and heart failure hospitalisations, according to a review of 74 studies examining right heart function and clinical outcomes.
The findings highlighted the importance of evaluating both ventricles in HFpEF, challenging the traditional emphasis on left ventricular diastolic dysfunction.
Researchers conducted a structured, PRISMA-informed literature review of studies published between 2015 and 2024, identifying 74 eligible investigations examining right ventricular structure, function and haemodynamics in HFpEF.
Although HFpEF accounts for nearly half of heart failure cases globally, its assessment has historically focused on abnormalities affecting the left ventricle.
However, emerging evidence indicates that right ventricular dysfunction and impaired right ventricular–pulmonary arterial coupling contribute substantially to exercise intolerance, functional decline and adverse clinical outcomes.
The review identified several mechanisms underlying right ventricular impairment, including post-capillary pulmonary hypertension, impaired ventricular relaxation, systemic inflammation and interactions between the ventricles.
Together, these processes may compromise right ventricular performance and contribute to worsening clinical status.
The review highlighted the growing importance of advanced diagnostic techniques for detecting right ventricular dysfunction before overt clinical deterioration.
Speckle-tracking echocardiography can assess myocardial deformation, while four-dimensional flow cardiac magnetic resonance imaging provides additional information about cardiovascular haemodynamics.
Researchers also identified the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure as a useful non-invasive marker of right ventricular–pulmonary arterial coupling.
These approaches may improve recognition of subclinical right heart dysfunction and support more comprehensive risk stratification.
Importantly, the review emphasised that right ventricular dysfunction independently predicts all-cause mortality and heart failure hospitalisations, reinforcing its prognostic significance.
Traditional heart failure therapies have demonstrated limited efficacy in addressing right ventricular dysfunction in HFpEF, prompting interest in alternative treatment strategies.
Emerging approaches discussed in the review included sodium-glucose cotransporter-2 inhibitors, interatrial shunt devices, glucagon-like peptide-1 receptor agonists and targeted pulmonary vasodilators.
These interventions may offer benefits for right ventricular strain and haemodynamic function in selected HFpEF phenotypes, although their clinical roles require further clarification.
The researchers advocated for routine incorporation of right ventricular–pulmonary arterial coupling indices into diagnostic and risk assessment pathways.
Such an approach could support more individualised treatment decisions by accounting for differences in right ventricular function and underlying disease mechanisms.
Overall, the review positioned right ventricular dysfunction as a major prognostic feature of HFpEF and highlighted the potential value of systematic biventricular assessment in improving clinical management.
Reference
Chamoun A et al. Right Ventricular Dysfunction and Ventriculo-Arterial Uncoupling in Heart Failure With Preserved Ejection Fraction: A Phenotype-Specific Review of Mechanisms, Diagnosis, and Therapeutic Strategies. Clin Cardiology. 2026.
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