Prevalence of right ventricular dysfunction and its echocardiographic predictors in patients with heart failure with preserved ejection fraction: a retrospective cohort study

To determine right ventricular dysfunction (RVD) prevalence in patients with heart failure and preserved ejection fraction (HFpEF); to systematically evaluate predictive values of echocardiographic parameters for RVD. A total of 163 patients diagnosed with HFpEF between January 2022 and January 2024 were retrospectively analyzed. All patients underwent assessment of right ventricular function. RVD was characterized by the presence of either a tricuspid annular plane systolic excursion (TAPSE) below 17 mm or a right ventricular free wall strain (RV-FWS) absolute value under 20%. Baseline clinical characteristics and echocardiographic parameters were collected, including left atrial volume index (LAVI), mean ratio of early mitral inflow velocity to early diastolic mitral annular velocity (mean E/e’), systolic pulmonary artery pressure (sPAP), and right ventricular fractional area change (FAC). The prevalence of RVD among patients with HFpEF was 41.7% (68/163). The RVD group was characterized by substantially higher NT-proBNP levels. Echocardiographic measures including RV-FWS, sPAP, mean E/e’, LAVI, TAPSE, and FAC independently predicted the occurrence of RVD. Among individual parameters, RV-FWS showed the best predictive performance. The combined predictive model incorporating the six aforementioned parameters exhibited excellent discriminatory ability. After internal validation using the bootstrap method, the corrected AUC was 0.989. RV-FWS and sPAP are the strongest independent echocardiographic predictors of RVD. An integrated assessment strategy combining multiparametric echocardiography with NT-proBNP measurement may substantially improve risk stratification of RVD in HFpEF.