Abstract
BACKGROUND: Incidence rates of right ventricular dysfunction (RVD) are unknown. We examined the rates, risk factors, and heart failure (HF) hospitalization hazard associated with incident RVD and right ventricle-pulmonary artery (RV-PA) uncoupling in patients referred for transthoracic echocardiogram (TTE). METHODS: In this retrospective cohort study, we extracted data from TTEs at Vanderbilt University Medical Cente (2010-2023). We followed patients from their earliest TTE with normal right ventricle function (tricuspid annular plane systolic excursion [TAPSE] ≥17 mm). The primary outcomes were new RVD (TAPSE <17 mm) and RV-PA uncoupling (TAPSE/right ventricular systolic pressure <0.36 mm/mm Hg). We evaluated risk factors for and hazard of HF hospitalization associated with each outcome. We estimated incidence rates using the Poisson distribution and hazard ratios using Cox models adjusted for demographics, comorbidities, and TTE measures. RESULTS: There were 45 753 patients (aged 63 years [interquartile range, 50-72], 45% men, 13% Black) meeting inclusion criteria. Of the patients, 13 735 had a follow-up TAPSE. The incidence rates of RVD and RV-PA uncoupling were 8.2 per person-year (95% CI, 8.0-8.5) and 3.4 per 100 person-years (95% CI, 3.2-3.6), respectively. Incidence rates increased with rising right ventricular systolic pressure. Risk factors for RVD and RV-PA uncoupling were most prominently HF, atrial fibrillation, and other cardiovascular comorbidities. Baseline right ventricular systolic pressure >35 mm Hg associated with TAPSE declined over time. The hazard of HF hospitalization increased with incident RVD (hazard ratio, 2.02 [95% CI, 1.85-2.21]) or when TAPSE declined by ≥5 mm. CONCLUSIONS: RVD incidence is substantial among patients referred for TTE. Clinical monitoring is warranted if right ventricular systolic pressure is >35 mm Hg. Cardiovascular comorbidities drive RVD and RV-PA uncoupling in this population. Incident RVD associates with increased HF hospitalization hazard.