Heart failure & cardiomyopathies
Pressure Overload is Associated with Right Ventricular Dyssynchrony in Heart Failure with Reduced Ejection Fraction
Authors' conclusion
RV dyssynchrony is associated with RV remodelling, dysfunction, adverse haemodynamics, and greater risk for adverse clinical events.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) and controls undergoing echocardiography, right heart catheterization and gated SPECT
- Participants
- 148 vs 36
- Exposure
- HFrEF vs controls
- HFrEFn = 148
- Controlsn = 36reference
- Outcome
- RV dyssynchrony (phase SD of systolic displacement timing)
Main finding
As reported in the abstract
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Adverse clinical events by RV dyssynchrony tertileT2/T3vs T1 | 1.98 (1.20–3.24) | P = 0.007 | |
| 0.20.5125Hazard ratio (log scale) |
Correlates of RV dyssynchrony in HFrEF
- Correlated with larger RV and left ventricular (LV) volumes, lower RV ejection fraction (RVEF) and LVEF, reduced intrinsic contractility, increased heart rate, higher pulmonary artery (PA) load and impaired RV-PA coupling
- all P ≤ 0.01
- Low RVEF was the strongest predictor of RV dyssynchrony
- Left bundle branch block (BBB) associated with greater RV dyssynchrony than right BBB, regardless of QRS duration
RV dyssynchrony after load modulation
- RV afterload reduction by sildenafil improved RV dyssynchrony
- P = 0.004
- Preload change with passive leg raise had modest effect
- Preload modulation N = 135; afterload modulation N = 15
Original publication
Pressure Overload is Associated with Right Ventricular Dyssynchrony in Heart Failure with Reduced Ejection Fraction. ESC Heart Fail. Published 23 January 2024. doi:10.
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