Optimal haemodynamic status and prognostic predictors in patients with right ventricular dysfunction: the RIGHT study

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Background Evidence regarding optimal haemodynamic parameters and prognostic predictors in right ventricular dysfunction (RVD) remains limited. The aim of this study was to examine the relationship between haemodynamic parameters and cardiac output (CO) in RVD and to identify clinically relevant prognostic predictors. Methods This retrospective, single-centre cohort study analysed data from patients with heart failure complicated by RVD between 2014 and 2024. RVD was defined as Pulmonary Artery Pulsatility Index <1.85 and right atrial pressure (RAP)/pulmonary artery wedge pressure ratio >0.63. Two substudies were conducted: Study A assessed the relationship between CO and haemodynamic parameters derived from right heart catheterisation (RHC) and Study B evaluated the prognostic value of haemodynamic indices in RVD. The primary outcome of Study B was a composite of all-cause death and heart failure hospitalisation. Results A total of 202 RHC examinations from 155 patients (median age 69 years, 66% male) were analysed. In Study A, cardiac output was highest at an RAP of approximately 10–15 mm Hg and declined beyond this level. CO showed a non-linear association with heart rate in sinus rhythm, reaching its peak at around 80 beats per minute. In Study B, 34 patients experienced the primary outcome during a median follow-up of 1.4 years. Those who experienced the primary outcome had higher RAP and lower pulmonary artery (PA) compliance. In Kaplan-Meier analysis, RAP >10 mm Hg (median) and PA compliance <4.9 mL/mm Hg (median) were associated with the primary outcome (p=0.004 and p=0.005, respectively). On multivariable Cox regression analysis, PA compliance <4.9 mL/mm Hg was a predictor of the primary outcome, while RAP >10 mm Hg was not. Conclusions In patients with RVD, CO was highest at an RAP of 10–15 mm Hg. Among those with sinus rhythm, heart rate showed a non-linear association with CO. Low PA compliance was a predictor of adverse events.

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