Abstract
Despite increasing recognition of the importance of right ventricular (RV) dysfunction (RVD) in the pathophysiology of left heart disease, our understanding of its epidemiology in heart failure (HF) with preserved ejection fraction (HFpEF) remains incomplete. In part, this is due to complex RV geometry and challenging and inconsistent assessment of RV function. Consequently, the prevalence of RVD in HFpEF varies widely depending on study design and population characteristics; however, on average is observed in one third of HFpEF subjects. In these patients, RVD is most commonly associated with an advanced HF state, pulmonary hypertension, atrial fibrillation, right ventricular pacing, and tricuspid valve regurgitation. Whether these associations are causal remains uncertain. Right ventricular dysfunction is recognized to confer poor outcomes in patients with HFpEF, including increased HF hospitalization and higher overall and cardiovascular mortality. Moreover, the prognostic significance of RVD in HFpEF is independent of, and additive to, the severity of pulmonary hypertension. As greater emphasis is placed on phenotyping subgroups of patients with HFpEF in order to tailor therapeutic strategies, improved characterization of the large subset of HFpEF patients with RVD, with and without antecedent pulmonary hypertension may yield critical insights, which inform novel therapeutic interventions.