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Article . 2025
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Multiparametric Assessment of Right Ventricular Dysfunction in Heart Failure: An Analysis From PARAGON‐HF

Authors: Henri Lu; Riccardo M. Inciardi; Martin Abanda; Amil M. Shah; Maja Cikes; Brian L. Claggett; Narayana Prasad; +7 Authors

Multiparametric Assessment of Right Ventricular Dysfunction in Heart Failure: An Analysis From PARAGON‐HF

Abstract

Background This study aims to characterize right ventricular dysfunction (RVD) in heart failure (HF) with preserved ejection fraction and understand the cumulative prognostic value of abnormal RV echocardiographic parameters in HF with preserved ejection fraction. Methods and Results Data from 809 patients in the PARAGON‐HF (Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor With Angiotensin‐Receptor Blocker Global Outcomes in HF With Preserved Ejection Fraction) echocardiographic substudy (55% women, mean age 74±8 years) were analyzed. Correlates of RVD (defined as tricuspid annular plane systolic excursion <1.7 cm, fractional area change <35% or absolute RV free wall longitudinal strain <20%) were identified using multivariable logistic regression models. We further assessed the prognostic value of the number of abnormal RV parameters (0, 1, ≥2) on total HF hospitalizations (HFH) and cardiovascular death, total HFH, first HFH or cardiovascular death, all‐cause death, and cardiovascular death. RVD was identified in 461 (57%) patients. Correlates of RVD included older age, higher heart rate, atrial fibrillation/flutter, greater left ventricle wall thickness, higher N‐terminal pro‐B‐type natriuretic peptide levels, lower systolic blood pressure, and lower left ventricle absolute global longitudinal strain. These results were consistent across sexes, except atrial fibrillation/flutter and LV wall thickness, which were associated with a higher risk of RVD in men but not in women. Participants with ≥2 abnormal RV parameters had a significantly higher adjusted risk of total HFH and cardiovascular death (rate ratio, 2.13 [95% CI, 1.13–4.01]), first HFH or cardiovascular death, all‐cause death, and cardiovascular death. Conversely, an isolated abnormal RV parameter was not associated with a worse outcome. Conclusions RV measures may underestimate the burden of RVD in HF with preserved ejection fraction when considered in isolation. Clinicians should consider multiple dimensions to comprehensively assess RV function in patients with HF with preserved ejection fraction.

Keywords

heart failure with preserved ejection fraction, Male, Stroke Volume / physiology, Ventricular Dysfunction, Right, Humans; Female; Male; Heart Failure/physiopathology; Heart Failure/mortality; Aged; Ventricular Dysfunction, Right/physiopathology; Ventricular Dysfunction, Right/diagnostic imaging; Stroke Volume/physiology; Ventricular Function, Right/physiology; Prospective Studies; Aged, 80 and over; Prognosis; Echocardiography; Angiotensin Receptor Antagonists/therapeutic use; Middle Aged; Predictive Value of Tests; Hospitalization/statistics & numerical data; echocardiography; heart failure with preserved ejection fraction; right ventricular dysfunction; sacubitril/valsartan, heart failure, Angiotensin Receptor Antagonists, Hospitalization / statistics & numerical data, Predictive Value of Tests, Heart Failure / physiopathology, echocardiography, Diseases of the circulatory (Cardiovascular) system, Humans, Prospective Studies, Original Research, Aged, Heart Failure, Aged, 80 and over, Ventricular Dysfunction, Right / diagnostic imaging, Ventricular Dysfunction, Right / physiopathology, Angiotensin Receptor Antagonists / therapeutic use, Stroke Volume, Middle Aged, Prognosis, Hospitalization, Ventricular Function, Right / physiology, Echocardiography, sacubitril/valsartan, RC666-701, Ventricular Function, Right, right ventricular dysfunction, Female, Heart Failure / mortality

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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