Article Text

Pulmonary and right ventricular dysfunction are frequently present in heart failure irrespective of left ventricular ejection fraction
  1. Wouter Robaeys1,2,
  2. Sema Bektas1,
  3. Josiane Boyne1,
  4. Vanessa van Empel1,
  5. Nicole Uszko-Lencer1,3,
  6. Christian Knackstedt1,
  7. Hans-Peter Brunner-La Rocca1
  1. 1 Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
  2. 2 Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
  3. 3 Department of Research and Education, Center of Expertise for Chronic Organ Failure (CIRO+), Horn, The Netherlands
  1. Correspondence to Dr Wouter Robaeys, Department of Cardiology, Maastricht University Medical Center (MUMC), 6202 AZ Maastricht 5800, The Netherlands; wouter.robaeys{at}


Background Heart failure (HF) may influence the lungs and vice versa. However, this interaction and the influence on right ventricular function (RVF) are insufficiently described in patients with HF divided into the recent groups based on left ventricular ejection fraction (LVEF): HF with reduced, midrange and preserved ejection fraction (HFrEF, HFmrEF and HFpEF, respectively).

Methods Overall, 186 consecutive stable patients with HF seen in our outpatient clinic were retrospectively divided into HFrEF (n=70), HFmrEF (n=55) and HFpEF (n=61). Airflow limitation and gas exchange disturbance were measured by spirometry (forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) (%)) and diffusion capacity of the lungs for carbon monoxide (DLCO). Standard echocardiography was performed to measure RV structure (RV diameter) and function (tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP)). Correlations were used to assess possible relations between pulmonary dysfunction and measurements of the RV.

Results None of the investigated parameters differed significantly between the three groups (all p>0.1); FEV1/FVC was 70%±12%, 70%±13% and 74%±10% in patients with HFrEF, HFmrEF and HFpEF (p=0.12) and DLCO was 5.7±1.6, 5.7±1.8 and 5.6±1.6 mmol/min/kPa, respectively (p=0.95). RV structure and function did not differ either (TAPSE/PASP 0.58, 0.60 and 0.57, respectively (p=0.84)). There was a correlation of DLCO with RV function (r=0.34, p<0.001).

Conclusion The investigated cardiopulmonary parameters were comparable in the three HF groups. Diffusion capacity was impaired in more than half of the stable HF population independently of the LVEF and showed a correlation with RV function.

  • heart failure – spirometry – echocardiography

Statistics from


  • Contributors H-PB-LR, CK, VvE, SB and WR planned this research by inventing the research question. H-PB-LR and SB planned this research by making the set-up of this study. H-PB-LR, CK, VvE, JB, NU-L conducted this research by giving critical revisions. H-PB-LR, SB and WR reported the research by writing the manuscript. H-PB-LR and WR made the figures. WR submitted the research. H-PB-LR is the guarantor.

  • Funding This study was funded by GlaxoSmithKline Pharma.

  • Competing interests We report grants from GSK-Pharma during the conduct of this study.

  • Patient consent Obtained.

  • Ethics approval The local medical ethics committee approved this study (METC 12-2-005 (NL39223.068.12)).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.