Right Heart Dysfunction in Heart Failure With Preserved Ejection Fraction: The Impact of Atrial Fibrillation

Thomas M. Gorter, Joost P. van Melle, Michiel Rienstra, Barry A. Borlaug, Yoran M. Hummel, Isabelle C. van Gelder, Elke S. Hoendermis, Adriaan A. Voors, Dirk J. van Veldhuisen, Carolyn S.P. Lam

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background: Right ventricular (RV) dysfunction and atrial fibrillation (AF) frequently coexist in heart failure with preserved ejection fraction (HFpEF). The mechanisms underlying the association between AF and RV dysfunction are incompletely understood. Methods and Results: We identified 102 patients. RV function was assessed with the use of multiple echocardiographic parameters, and dysfunction was present if ≥2 parameters were below the recommended cutoffs. RV function, right atrial (RA) reservoir strain, and RA emptying fraction were compared between AF and sinus rhythm. We included 91 patients with sufficient echocardiographic quality: 45 (50%) had no history of AF, 14 (15%) had earlier AF while in sinus rhythm, and 32 (35%) had current AF. The prevalence of RV dysfunction varied across subgroups (never AF, earlier AF, and current AF: 20%, 43% and 63%, respectively; P =.001). AF was associated with RV dysfunction (odds ratio [OR] 4.70 [95% confidence interval [CI] 1.82–12.1]; P =.001) independently from pulmonary pressures. In patients in sinus rhythm with earlier AF, RA emptying fraction was lower compared with patients without AF history (41 vs 60%; P =.002). Earlier AF was also associated with reduced RA reservoir strain (OR 4.57 [95% CI 1.05–19.9]; P =.04) independently from RV end-diastolic pressure. Conclusions: Atrial fibrillation is strongly related to reduced RV and RA function in HFpEF independently from pulmonary pressures.

Original languageEnglish (US)
Pages (from-to)177-185
Number of pages9
JournalJournal of Cardiac Failure
Issue number3
StatePublished - Mar 2018


  • Atrial fibrillation
  • HFpEF
  • Right ventricular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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