A heart that appears normal in pumping efficiency doesn’t always mean every part is functioning properly.
Recent research originating from China reveals that a significant percentage of patients with a common type of heart failure also experience issues with the chamber responsible for pumping blood to the lungs.
The study showed that right ventricular dysfunction was present in 41.7% of patients with heart failure with preserved ejection fraction (HFpEF). In essence, about two out of five individuals examined demonstrated signs that the right side of their heart was under stress.
HFpEF can be confusing because the heart’s primary left ventricle still ejects a normal or near-normal share of blood. The main problem often lies in the stiffening of the heart muscle, which hampers its ability to relax and fill properly between beats.
Symptoms for those with HFpEF can include shortness of breath, fatigue, swelling in the legs, and decreased physical stamina. This condition is becoming increasingly widespread as populations age and health issues like obesity, diabetes, and high blood pressure grow more common.
Cardiologists often focus on the left side of the heart when diagnosing heart failure, but the right ventricle plays a crucial role because it pushes blood through the lungs for oxygenation before returning to the left side.
If the right ventricle begins to fail, the heart faces greater difficulty in moving blood through the pulmonary circulation, which can worsen symptoms and suggest a more complex form of heart disease.
Xin Du from Xiamen Humanity Hospital and colleagues studied 163 individuals diagnosed with HFpEF between January 2022 and January 2024. The research involved reviewing their clinical data and echocardiogram results.
An echocardiogram, also known as an ultrasound of the heart, uses sound waves to generate real-time images, allowing doctors to assess the size of heart chambers, muscle movement, blood flow, and pressures related to heart function.
The team employed various ultrasound metrics to evaluate the right ventricle. Patients were classified as having right ventricular dysfunction if certain measurements indicated reduced contractile effectiveness of the right heart.
Findings revealed that 68 of the 163 patients, or 41.7%, had right ventricular dysfunction. These individuals also showed significantly higher levels of NT-proBNP, a blood marker that tends to increase when the heart is under stress.
Several ultrasound parameters showed a strong correlation with right ventricular issues. Notably, measurements of right heart movement, right ventricular muscle strain, pulmonary artery pressure, left atrial filling pressures, and atrial size were involved.
Among these, right ventricular free wall strain emerged as the most potent predictor. Instead of merely measuring the extent of movement in a specific heart segment, this method examines how the muscle fibers of the right ventricular wall deform during contraction.
The researchers combined six different ultrasound measures into a single predictive model, which yielded even more accurate results. This suggests that assessing multiple aspects of heart function can give clearer insights than relying on a single test.
The findings were published online on June 10, 2026, in BMC Cardiovascular Disorders. The authors argue that integrating several ultrasound measurements with NT-proBNP testing could help detect right ventricular problems earlier and assist clinicians in stratifying patient risk.
Identifying right ventricular dysfunction is critical because it often receives less attention compared to left-sided issues in HFpEF, despite its significance. Early detection can influence follow-up strategies and diagnostic investigations into symptom causes.
However, it’s important to note that this study’s scope was limited to a small group from a specific clinical setting. Patient populations can vary significantly across different hospitals and regions.
Additionally, since the study was observational and based on retrospective data, it can detect correlations but does not confirm causation. Further research is needed to determine whether these ultrasound measures directly influence outcomes or if the prediction model improves survival rates.
The model demonstrated an exceptionally high level of accuracy in the study, but validation through independent studies with new patients is essential to confirm its reliability and prevent overestimation of performance.
Overall, these findings bolster the perspective of viewing HFpEF as a condition affecting the entire heart and circulatory system, rather than focusing solely on the left ventricle. Carefully examining the right heart could reveal critical issues in a sizable portion of patients with preserved ejection fraction.
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Source: Xiamen Humanity Hospital