Narimani-Javid Roozbeh, Mahalleh Mehrdad, Behboodi Kiyarash, Izadpanahi Kasra, Arzhangzadeh Alireza, Nikfar Reza, Hosseini Seyed Ali, Amini-Salehi Ehsan, Shafiei Sasan, Vahidi Hamed, Hosseini Kaveh, Soleimani Hamidreza
Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Echo Res Pract. 2025 May 29;12(1):13. doi: 10.1186/s44156-025-00080-5.
The prognosis of Heart failure with preserved ejection fraction (HFpEF) is significantly impacted by the existence and severity of comorbidities. Recent studies highlight the right ventricle (RV) as a crucial player in heart failure pathophysiology. However, there are still gaps in understanding how right ventricular dysfunction (RVD) affects long-term outcomes in patients with heart failure with preserved ejection fraction (HFpEF).
In this systematic review and meta-analysis, a comprehensive search was conducted to identify studies investigating RVD as the predictor of the composite outcome of All-cause death, cardiac death, and hospitalization for HF in patients with HFpEF published until October 2024. RVD was defined as the deviation of at least one measurement of RV function from the recommended normal range based on modality and the normal ranges established in each study. Time and survival probability were extracted for each Group (HFpEF patients with and without RVD) in each of the Kaplan-Meier curves. Individual patient data were reconstructed by processing the extracted time points, survival probabilities, and the number of patients at risk in a two-stage approach. The restricted mean survival time (RMST) was also calculated as the area under the survival curve for each group.
Seven studies met the inclusion criteria, comprising 1936 individuals, of which 555 patients had RVD. The pooled prevalence of RVD among HFpEF was 41.2% (95% CI: 36.5; 45.9). Patients with RVD had a significantly higher risk of adverse outcomes compared to those without RVD, with an HR of 2.28 (95% CI, 1.95; 2.68, p-value < 0.001) in the eight-year follow-up after the RVD diagnosis. The one-year landmark analysis revealed that the majority of the event-free survival disparity between patients with RVD and those without arises from the first year after an RVD diagnosis. Patients with RVD also had shorter event-free survival. (ΔRMST = -2.127 years, 95% CI, -2.383; -1.872, p-value < 0.001).
The development of RVD in HFpEF is linked to significantly increased composite outcomes of all-cause death and HF hospitalization and shorter event-free survival.
射血分数保留的心力衰竭（HFpEF）的预后受到合并症的存在和严重程度的显著影响。最近的研究强调右心室（RV）是心力衰竭病理生理学中的关键因素。然而，在理解右心室功能障碍（RVD）如何影响射血分数保留的心力衰竭（HFpEF）患者的长期预后方面仍存在差距。
在这项系统评价和荟萃分析中，进行了全面检索，以确定研究RVD作为截至2024年10月发表的HFpEF患者全因死亡、心源性死亡和因心力衰竭住院的复合结局预测因素的研究。RVD被定义为基于检查方式的右心室功能至少一项测量值偏离推荐的正常范围以及各研究中确定的正常范围。在每条Kaplan-Meier曲线中，为每组（有和没有RVD的HFpEF患者）提取时间和生存概率。通过两阶段方法处理提取的时间点、生存概率和处于风险中的患者数量，重建个体患者数据。还计算了每组生存曲线下面积的受限平均生存时间（RMST）。
七项研究符合纳入标准，共1936例个体，其中555例患者有RVD。HFpEF患者中RVD的合并患病率为41.2%（95%CI：36.5；45.9）。与没有RVD的患者相比，有RVD的患者不良结局风险显著更高，在RVD诊断后的八年随访中，风险比（HR）为2.28（95%CI，1.95；2.68，p值<0.001）。一年的标志性分析显示，有RVD和没有RVD的患者之间无事件生存差异的大部分源于RVD诊断后的第一年。有RVD的患者无事件生存期也较短。（ΔRMST = -2.127年，95%CI，-2.383；-1.872，p值<0.001）。
HFpEF中RVD的发生与全因死亡和心力衰竭住院的复合结局显著增加以及无事件生存期缩短有关。
