A normal-looking heart pumping percentage does not always mean that every part of the heart is working well.
New research from China shows that a large share of patients with a common form of heart failure also have problems with the chamber that pumps blood to the lungs.
The study found right ventricular dysfunction in 41.7% of patients with heart failure with preserved ejection fraction, or HFpEF. In other words, roughly two out of every five patients studied had signs that the right side of the heart was struggling.
HFpEF can be confusing because the heart’s main left pumping chamber still squeezes out a normal or near-normal proportion of its blood. The problem is often that the heart muscle has become stiff and does not relax and fill normally between beats.
People with HFpEF may experience shortness of breath, fatigue, swelling in the legs and difficulty being physically active. The condition is increasingly important as populations age and health problems such as obesity, diabetes and high blood pressure become more common.
Doctors often pay close attention to the left side of the heart when investigating heart failure. But the right ventricle is also essential because it pumps blood through the lungs, where the blood receives oxygen before returning to the left side of the heart.
When the right ventricle begins to fail, the heart may have more difficulty moving blood through this system. That can add to symptoms and may signal a more complicated form of heart disease.
Xin Du of Xiamen Humanity Hospital and colleagues studied 163 people with HFpEF. The patients had been diagnosed between January 2022 and January 2024, and the researchers reviewed their clinical information and heart ultrasound results.
Heart ultrasound, also called echocardiography, uses sound waves to create moving images of the heart. It allows doctors to examine the size of heart chambers, the movement of heart muscle, blood flow and pressures associated with heart function.
The researchers used several ultrasound measures to study the right ventricle. Patients were considered to have right ventricular dysfunction when specific measurements showed that the right heart was moving or contracting less effectively than expected.
The analysis identified right ventricular dysfunction in 68 of the 163 patients, representing 41.7% of the group. Those patients also had substantially higher levels of NT-proBNP, a blood marker that tends to rise when the heart is under stress.
Several heart ultrasound measurements were strongly connected with right ventricular problems. They included measures of right-heart movement, right ventricular muscle strain, pressure in the artery carrying blood to the lungs, left-heart filling pressure and the size of the left atrium.
One measurement called right ventricular free wall strain was the strongest individual predictor. Rather than simply measuring how far one part of the heart moves, this method examines how the muscle of the right ventricular wall changes shape while contracting.
The researchers achieved even better results when they combined six different ultrasound measures into one prediction model. This supports the idea that examining several features of heart function may provide a clearer picture than relying on a single measurement.
The study was published online June 10, 2026, in BMC Cardiovascular Disorders. The authors believe that combining multiple ultrasound measurements with NT-proBNP testing could improve early detection and help doctors separate patients into different levels of risk.
This could matter because right ventricular dysfunction may otherwise receive less attention in a disease often discussed in terms of left-heart function. Identifying it earlier could potentially influence how closely patients are followed and how doctors investigate the causes of their symptoms.
Still, the study should not be taken to mean that 41.7% of every HFpEF population worldwide has right ventricular dysfunction. The research involved a relatively small group of patients from a particular clinical setting, and patient characteristics can differ considerably between hospitals and countries.
The study was also observational and based on previously collected information. That means it can identify useful connections between measurements and right-heart dysfunction, but it cannot prove that any one measurement causes the problem or that using the prediction model will improve survival.
Another issue is that the combined model showed exceptionally high accuracy in the study. Although the researchers used internal statistical testing to check the model, independent studies involving new patients are needed to make sure its performance is not overestimated.
Overall, the findings strengthen the case for looking at HFpEF as a disease involving the entire heart and circulation rather than focusing only on the left ventricle. The research suggests that careful assessment of the right heart may uncover important problems in a substantial number of patients who otherwise have a preserved pumping percentage.
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Source: Xiamen Humanity Hospital
