Determinants of right ventricular failure in patients admitted with acute left heart failure.

The presence of right ventricular (RV) failure in patients with left heart (LH) failure is often underrecognized. 1 The actual prevalence of RV failure resulting from LH failure is unknown. Pulmonary venous hypertension or postcapillary pulmonary hypertension engendered by the failing left ventricle (LV) leads to an increase in RV afterload, which, when sufficiently elevated, precipitates RV failure. It has been shown recently that pulmonary hypertension in patients with LV dysfunction is not independently related to the degree of LV systolic dysfunction but is strongly associated with diastolic dysfunction. 2 These findings were confirmed in a study that compared invasive measurements in patients with postcapillary pulmonary hypertension, and the results demonstrated that patients with pulmonary hypertension had more diastolic abnormalities and had a poor correlation with systolic LV indices. 3 These studies suggest that the degree of diastolic dysfunction may correlate better with pulmonary hypertension and thus RV function. These patients have either isolated LV diastolic dysfunction (nl EF) or combined LV systolic and diastolic dysfunction (low EF). In the latter case, the diastolic component as derived by Doppler echocardiography is superimposed on LV systolic dysfunction. In this study, we aim to delineate the prevalence and determinants of RV failure in patients admitted with acute LH failure.