Right ventricular function, pulmonary hypertension and incident mortality in heart failure: Insights from a West-African cohort

Ayodipupo S. Oguntade, Okechukwu S. Ogah, Adewole A. Adebiyi, Blessing Oladokun, Solomon Aborisade, Abiodun M. Adeoye, Akinyemi Aje

Abstract

Background: Few studies have assessed the prevalence and independent prognostic relevance of right ventricular dysfunction (RVD) and pulmonary hypertension (PH) in Africans with heart failure (HF) despite the different trajectories of HF in Africans compared to other ethnicities. We investigated the frequency and independent associations of RVD and PH with incident death in Nigerian-Africans with hypertensive HF.
Methods: Present analyses include 118 participants (mean age 57.6 years, 55% men) with ambulatory hypertensive HF. RVD was assessed with pulsed wave Doppler of tricuspid inflow velocities, tissue Doppler imaging of the tricuspid annulus and tricuspid annular plane systolic excursion (TAPSE) while PH was assessed with systolic pulmonary artery pressure during transthoracic echocardiography. Independent predictors of each of RVD and PH were determined using multivariable logistic regression models. Associations between each of RVD, PH and incident death were determined using Kaplan Meier plots and Cox proportional hazards regression models.
Results: The frequency of right ventricular systolic dysfunction (RVSD) was 56.8%, right ventricular diastolic dysfunction (RVDD) was 65.3% while PH was 56.8%. Over a mean follow-up of 2.4 years, each of RVSD, RVDD and PH was associated with higher risk of incident death (adjusted Hazards Ratio (aHR) 2.32 [95% CI: 1.39-3.90]; aHR 2.32 [95% CI:1.31-4.12]; aHR 1.69 [95% CI: 1.02-2.81] respectively). Associations of RVDD and PH with incident death were fully explained by left ventricular function indices, arrhythmia and systolic blood pressure while RVSD remained significantly associated with incident death after accounting for potential mediators. Only RVSD was independently associated with incident death when RVSD, RVDD and PH were mutually adjusted for each other (aHR 1.92 [95% CI: 1.10-3.32]; aHR 1.67 [95% CI: 0.82-3.41]; aHR 1.13 [95% CI: 0.62-2.07] respectively).
Conclusion: RVSD, RVDD and PH are common in hypertensive HF but only RVSD significantly increases the risk of incident death independent of RVDD, PH or left ventricular function.
Abbreviations: aHR: adjusted Hazards Ratio, EDV: end diastolic volume, ESV: end systolic volume, FS: fractional shortening, HF: heart failure, HFPEF: heart failure with preserved ejection fraction, HFrEF: heart failure with reduced ejection fraction, LV: left ventricle, LVEF: left ventricular ejection fraction, LVIDd: LV internal diameter in diastole, LVIDs: LV internal diameter in systole, RV: right ventricle, RVDD: right ventricular diastolic dysfunction, RVSD: right ventricular systolic dysfunction, SBP: systolic blood pressure, SPAP: systolic pulmonary artery pressure, PH: pulmonary hypertension