Subclinical Right Ventricular and Atrial Dysfunction in Heart Failure with Preserved Ejection Fraction: A Speckle Tracking Comparison

Right Heart Dysfunction in Heart Failure with Preserved Ejection Fraction

Abstract

Objective: Functional involvement of the right heart in heart failure (HF) with preserved ejection fraction (HFpEF) has gained increasing attention; however, early functional changes may not be adequately detected using standard echocardiographic techniques. The purpose of this work was to assess ventricular and atrial performance in individuals with HFpEF by combining conventional echocardiographic evaluation with deformation-based strain analysis.
Methods: In this cross-sectional study, patients with HFpEF hospitalized for acute HF between January 2020 and January 2022 were evaluated. All patients had a left ventricular (LV) EF of ≥50% and underwent comprehensive transthoracic echocardiographic assessment. The structure and function of the right ventricular (RV) and right atrium were analysed using conventional echocardiographic measurements, Doppler and tissue Doppler indices, and speckle-tracking–derived strain parameters. Findings were compared with those of an age- and sex-matched control group.
Results: LV dimensions and systolic function were similar between the HFpEF and control groups. In contrast, patients with HFpEF exhibited significantly larger RV diastolic and right atrial end-systolic areas. Conventional RV functional parameters demonstrated limited sensitivity for detecting early dysfunction. Two-dimensional (2D) speckle-tracking echocardiography revealed significantly reduced RV global longitudinal strain and free-wall strain in HFpEF patients. Additionally, right atrial reservoir and contraction strain values were significantly lower, whereas conduit strain values did not differ between groups.
Conclusion: 2D speckle tracking echocardiography enables detection of subclinical RV and right atrial dysfunction in patients with HFpEF, which may not be apparent on conventional echocardiographic assessment. Incorporating myocardial deformation analysis into routine evaluation may provide incremental insight into right heart involvement in this patient population.