Right ventricular systolic and diastolic parameters based on pressure-volume loop theory in heart failure.

Background: This study aimed to assess the clinical utility of right ventricular (RV) systolic and diastolic parameters derived from the RV pressure waveform obtained through right heart catheterization (RHC) based on pressure-volume (PV) loop theory in patients with heart failure (HF).

Methods: The study included patients hospitalized for advanced HF who underwent RHC at our institution. RV end-systolic elastance (Ees), RV arterial elastance (Ea), RVEes/Ea ratio and RV diastolic stiffness coefficient (β) were calculated from RV pressure waveforms. The prognostic value of these parameters was evaluated for the primary outcome defined as all-cause mortality or urgent HF-related hospitalization.

Results: A total of 254 patients were analyzed, including 141 with a left ventricular ejection fraction (LVEF) <40% and 113 with LVEF ≥40%. Among the RV systolic and diastolic parameters, a low RVEes/Ea ratio (<0.55) (hazard ratio [HR], 4.1; 95% confidence interval [CI], 2.4-6.9; p < 0.001) and an elevated RVβ (≥0.025) (HR, 4.8; 95% CI, 2.5-9.0; p < 0.001) were associated with a higher risk of the primary outcome. In those with LVEF <40%, a low RVEes/Ea ratio was a stronger independent predictor of the primary outcome (HR, 3.5; 95%CI, 1.6-7.5; p = 0.002), whereas in those with LVEF ≥40%, elevated RVβ was the more significant independent risk factor (HR, 3.0; 95%CI, 1.1-8.2; p = 0.029), even after multiple adjustments for covariate factors.

Conclusion: RV waveform evaluation based on PV loop theory was effective in predicting prognosis in HF patients, irrespective of LVEF.