Right Ventricular Function In Patients With Normal And Reduced Ejection Fraction Heart Failure

Objective: To determine the prevalence of right ventricular (RV) dysfunction inheart failure with normal ejection fraction （HFNEF）and heart failure with reducedejection fraction（HFREF）. And to compare the degree of RV function involvementbetween HFNEF and HFREF.Methods: The heart failure with normal ejection fraction group was composed75patients (42men,33women, mean age62.2±15.0y) that were clinically diagnosed heartfailure with normal left ventricular ejection fraction. The heart failure with reducedejection fraction group was composed75patients (55men,20women, mean age63.0±14.3y) that were clinically diagnosed heart failure with reduced left ventricularejection fraction. Normal control group of36healthy volunteers (22men,14women,mean age63.2±14.4y).With GE Vingmed Vivid7ultrasound system, all participantsunderwent a transthoracic echocardiographic study including two-dimensional, colorflow and pulse wave Tissue Doppler, The tricuspid annular plane systolic excursion(TAPSE) was measured with M-mode ultrasound in apical four-chamber view; Thepeak systolic tricuspid annular velocity(S’) and Tricuspid annular early diastolicvelocities (E’) were acquired using Doppler tissue imaging; Tricuspid early diastolicinflow velocities (E) obtained by pulse wave Doppler at the tricuspid leaflet tip in apicalfour-chamber view, and calculate E/E’; right ventricular end-diastolic area(RVEDA)、right ventricular end-systolic area (RVESA)were acquired with apical four-chamberview, and then right ventricular fractional area change(RVFAC) can be calculated fromthem; right ventricular wall thickness were acquired with parasternal long axis view ofleft ventricle.Results:1. The prevalence of right ventricular (RV) dysfunction in HFNEF and HFREF The prevalence of right ventricular systolic dysfunction in HFNEF was33.3%(25/75)、21.3%(16/75) and12.0%(9/75),by using TAPSE、S’and RVFAC criteria,respectively. The prevalence of right ventricular systolic dysfunction in HFREF was94.7%(71/75)、66.7%(50/75) and53.3%(40/75), by using TAPSE、S’ and RVFACcriteria, respectively. The prevalence of right ventricular diastolic dysfunction inHFNEF was30.7%(23/75) and58.7%(44/75), by using E/E’.2. TAPSE、S’ and RVFAC in HFNEF and HFREF and in the control group①compared with the control group,HFNEF group had significant lower TAPSE(20.4mm±1.8mm：16.7mm±2.7mm,P＜0.01),S’ also has a significant difference (14.9cm/s±1.4cm/s：11.8cm/s±2.9cm/s,P＜0.01), RVFAC has not a significant difference(53%±10%：49%±10%, P＞0.05).②compared with the control group,HFREF group had significant lower TAPSE(20.4mm±1.8mm：12.3mm±2.6mm, P＜0.01), S’ also has a significant difference(14.9cm/s±1.4cm/s：8.8cm/s±2.6cm/s, P＜0.01), RVFAC was lower in HFREFgroup(53%±10%：34%±10%,P＜0.05).③c ompared withHFNEF group, HFREF had significantly lower TAPSE and S’(16.7mm±2.7mm：12.3mm±2.6mm, P＜0.01),(11.8cm/s±2.9cm/s：8.8cm/s±2.6cm/s, P＜0.01), RVFAC has a significant difference in HFREF group (49%±10%：34%±10%, P＜0.05).3. E/E’ in normal ejection fraction and heart failure with reduced ejection fractionand control groupCompared with the control group, HFNEF group had significantly higher E/E’(4.4±1.7：5.5±2.1,P＜0.05); HFREF compared with the control group, HFREF groupalso had a higher E/E’(4.4±1.7：6.6±2.6,P＜0.01); E/E’ in HFREF group is higherthan HFNEF group (6.6±2.6：5.5±2.1,P＜0.05).Conclusion: The prevalence of RV systolic and diastolic dysfunctions werecommon in HFNEF. HFNEF had milder degree of RV systolic and diastolicdysfunctions compared with HFREF.