RIGHT-VENTRICULAR DIASTOLIC DYSFUNCTION IN HEART-FAILURE

Background Left ventricular (LV) diastolic dysfunction is common in he art failure and is an important predictor of prognosis and mortality. Less attention has been paid to right ventricular (RV) diastolic funct ion. In this study, we compared RV diastolic function in a large cohor t of patients with heart failure (HF) with two groups: patients with p ulmonary hypertension and normal LV function (the PHT group) and norma l subjects. Methods and Results Transtricuspid and pulmonary artery fl ow were assessed by mio-dimensional Doppler echocardiography at maximu m inspiration and expiration in 185 subjects: 114 symptomatic HF patie nts (ejection fraction <0.5), 31 PHT patients (pulmonary artery systol ic pressure >40 mm Hg), and 40 normal subjects. A subset was matched f or age and heart rate. The results showed a high prevalence of RV dias tolic abnormalities: HF patients had lower tricuspid E-A ratios, lower peak E-wave velocity, and prolonged RV isovolumic relaxation time (al l P<.0001). Tricuspid E-wave deceleration time was significantly short er only in those who had an LV restrictive filling pattern. The PHT gr oup had similar findings. Compared with a normal range, more than half of the patients had lower tricuspid E-A ratios (HF, 55%; PHT, 69%), a nd 61% of HF and 58% of PHT patients had a prolonged RV isovolumic rel axation time. In the PHT group, RV diastolic parameters (E-wave decele ration rime, E-A ratio, and isovolumic relaxation time) correlated sig nificantly with pulmonary artery systolic pressure (P<.05). In the HF group, however, only tricuspid E-wave deceleration time correlated sig nificantly with pulmonary artery systolic pressure, and HF patients wi th normal pulmonary artery systolic pressures had significantly lower tricuspid E-A ratios and prolonged RV isovolumic relaxation times comp ared with normal subjects. A close correlation existed between individ ual RV and LV diastolic parameters, suggesting that LV diastolic dysfu nction may directly affect RV function, but there was no relation betw een LV size or systolic function and RV diastolic dysfunction. Conclus ions RV diastolic function is frequently abnormal in HF patients, and this is not related to elevated pulmonary artery systolic pressure alo ne, although high pulmonary artery pressure by itself also is associat ed with impaired RV diastolic function. Assessment of the role of righ t ventricular diastolic function in determining the symptoms and progn osis of heart failure is warranted.