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Right ventricle in heart failure with preserved ejection fraction
  1. Felix Berglund1,
  2. Pamela Piña2,
  3. César J Herrera2,3
  1. 1 Cardiology, Södersjukhuset Anestesi Intensivvårdsverksamheten, Stockholm, Sweden
  2. 2 Cardiology, CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
  3. 3 Cardiology, Montefiore Center for Heart and Vascular Care, Albert Einstein College of Medicine, New York, United States
  1. Correspondence to Dr César J Herrera, Cardiology, CEDIMAT, Santo Domingo, Dominican Republic; cjherrera{at}


Heart failure with preserved ejection fraction (HFpEF) affects half of all patients with heart failure. While previously neglected, the right ventricle (RV) has sparked interest in recent years as a means for better understanding this condition and as a potential therapeutic target.

Right ventricular dysfunction (RVD) is present in 4%–50% of patients with HFpEF. The RV is intimately connected to the pulmonary circulation, and pulmonary hypertension is commonly implicated in the pathophysiology of RVD. The development of RVD in HFpEF may also be driven by comorbidities, such as chronic obstructive pulmonary disease, obesity, obstructive sleep apnoea and atrial fibrillation. The evaluation of RVD is particularly challenging due to anatomical and structural factors, as well as unique physiological characteristics of this chamber like load and interventricular dependency. Fractional area change, tricuspid annular plane systolic excursion and tricuspid annular systolic velocity are commonly used measurements of RV function. Speckle tracking echocardiography and cardiac magnetic resonance (CMR) are also gaining attention as important tools for the assessment of RV structure, fibre deformation and systolic performance. Further research is needed to confirm the utility and prognostic significance of RV [18F]fluorodeoxyglucose (FDG) positron emission tomography imaging as FDG accumulation is suggested to increase with progressive RVD. Targeted pharmacotherapy with phosphodiesterase inhibitors, guanylate–cyclase stimulators, nitrates and inhaled inorganic nitrites have yet to demonstrate improvement in RVD, compelling the need for evaluation and discovery of novel pharmacological interventions for this entity.

  • heart failure with preserved ejection fraction

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  • Correction notice This article has been corrected since it was published Online First. In Table 1 - Aschauer et al, the definition of RVD was updated to RVEF < 45% by CMR.

  • Contributors All the contributing authors have been closely engaged in the generation of this manuscript, as well as in the critical analysis of its scientific content which they all have fully approved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.