Association Between Right Ventricular Echocardiographic Parameters and HFA-PEFF Score in Heart Failure with Preserved Ejection Fraction

OBJECTIVE
Heart failure with preserved ejection fraction (HFpEF) is a leading clinical syndrome, accounting for more than 50% of hospitalizations due to heart failure. The HFA-PEFF algorithm, used for the diagnosis of HFpEF, also has prognostic value. The primary purpose of this work was to explore the relationship between the HFA-PEFF score and right ventricular (RV) echocardiographic parameters.

METHODS
127 patients diagnosed with HFpEF between January 2021 and November 2024, with adequate transthoracic echocardiography (TTE) images, were retrospectively evaluated. Patients were categorized into three prognostic risk groups based on their HFA-PEFF scores: low (0–2), intermediate (3–4) and high (5–6). RV function was assessed using Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular S’ velocity and RV free wall longitudinal strain (RVFW GLS). The relationship between the HFA-PEFF score and RV parameters was evaluated using One-way ANOVA and Spearman correlation analysis.

RESULTS
Patients with high HFA-PEFF scores showed significant deterioration in TAPSE and RV GLS values. A moderate negative correlation was observed between HFA-PEFF score and RVFW GLS (r = 0.50, P < 0.001), while a mild negative correlation was found with TAPSE (r = -0.35, P < 0.001).

CONCLUSION
In HFpEF patients with poor prognosis as identified by the HFA-PEFF score, there was a marked deterioration in RV parameters, particularly RVFW 2D GLS and TAPSE. These findings suggest that incorporating RV parameters into HFpEF diagnostic and prognostic algorithms might provide additional clinical value.