Right Ventricular Free Wall Strain and Multiparametric Ultrasound Predictors of RVD in HFpEF

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Summary of  BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-026-06093-0  
Dr. Xin Du  et al.

Points

A retrospective cohort study of 163 HFpEF patients evaluated the overall prevalence and echocardiographic predictors of right ventricular dysfunction between January 2022 and January 2024.
Right ventricular dysfunction was strictly defined as a tricuspid annular plane systolic excursion under 17 mm or a right ventricular free wall strain absolute value under 20%.
Statistical analysis revealed an RVD prevalence of 41.7% among the study cohort, with affected patients presenting with significantly higher plasma NT-proBNP levels.
Six independent echocardiographic metrics including right ventricular free wall strain and systolic pulmonary artery pressure predicted right ventricular dysfunction, with strain showing the highest individual performance.
An integrated multiparametric predictive model incorporating all six echocardiographic parameters achieved an outstanding bootstrap-validated area under the receiver operating characteristic curve of 0.989.

Summary

This retrospective cohort study evaluated the prevalence of right ventricular dysfunction (RVD) and the predictive utility of echocardiographic parameters in 163 patients diagnosed with heart failure with preserved ejection fraction (HFpEF) between January 2022 and January 2024. Right ventricular dysfunction was explicitly defined as a tricuspid annular plane systolic excursion (TAPSE) below 17 mm or an absolute right ventricular free wall strain (RV-FWS) under 20%. The research sought to establish a more robust diagnostic framework for early RVD detection, a complication that significantly exacerbates adverse clinical outcomes in the HFpEF population.

The analysis revealed an RVD prevalence of 41.7% among the 163 HFpEF patients, with the RVD cohort exhibiting substantially higher baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Multivariate regression identified six echocardiographic measures that independently predicted the development of RVD: RV-FWS, systolic pulmonary artery pressure (sPAP), the mean ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e’), left atrial volume index (LAVI), TAPSE, and fractional area change (FAC). Among these individual parameters, RV-FWS demonstrated the highest individual predictive performance. (Note: Specific confidence intervals and hazard ratios were not provided in the source dataset).

By integrating all six independent echocardiographic parameters into a multiparametric predictive model, the researchers achieved excellent discriminatory capability. Following internal validation utilizing the bootstrap method, the combined model yielded a corrected area under the receiver operating characteristic curve (AUC-ROC) of 0.989. These findings indicate that pairing a comprehensive multiparametric echocardiographic approach with NT-proBNP screening significantly improves risk stratification, potentially facilitating timely, precision interventions to optimize patient management in HFpEF care.

Link to the article: https://link.springer.com/article/10.1186/s12872-026-06093-0

References

Du, X., Li, W., Yan, Y., & Zhang, Q. (2026). Prevalence of right ventricular dysfunction and its echocardiographic predictors in patients with heart failure with preserved ejection fraction: A retrospective cohort study. BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-026-06093-0