A problem affecting the right side of the heart may be far more common in people with a major form of heart failure than many patients realize.
A new study found signs of right ventricular dysfunction in about 42% of people with heart failure with preserved ejection fraction.
Heart failure does not mean that the heart has completely stopped working. It means the heart cannot pump blood or fill with blood well enough to meet the body’s needs, which can cause breathlessness, tiredness, swelling and difficulty exercising.
One common form is heart failure with preserved ejection fraction, often shortened to HFpEF. In this condition, the main pumping chamber on the left side of the heart can still push out a relatively normal percentage of the blood it contains, but the heart may be too stiff to fill properly.
HFpEF is especially common among older adults and people with high blood pressure, obesity, diabetes or other long-term health problems. Because the heart’s pumping percentage can look normal, diagnosing and assessing the condition can sometimes be challenging.
Researchers from Xiamen Humanity Hospital in China wanted to examine another important part of the heart: the right ventricle. This chamber receives blood returning from the body and pumps it toward the lungs to pick up oxygen.
If the right ventricle becomes weak or cannot contract normally, pressure and fluid can build up in the body. Right-sided heart problems can contribute to swelling, reduced exercise ability and poorer outcomes in people who already have heart failure.
The researchers reviewed medical information from 163 patients diagnosed with HFpEF between January 2022 and January 2024. They used heart ultrasound measurements to determine how well each patient’s right ventricle was working.
Two measurements were particularly important for defining right ventricular dysfunction. One measured how far part of the right heart moves when it contracts, while the other measured how strongly the muscular wall of the right ventricle changes shape during a heartbeat.
Using these measurements, the researchers found right ventricular dysfunction in 41.7% of the patients. This means that more than four in every 10 people in the study had evidence that the right side of their heart was not working normally.
Patients with right ventricular dysfunction also had much higher levels of NT-proBNP. This substance is released into the blood when the heart is under increased pressure or strain, and doctors commonly use it to help assess heart failure.
The researchers identified several ultrasound measurements that were independently connected with right ventricular dysfunction. These reflected right-heart contraction, pressure in the blood vessels of the lungs, pressure related to filling of the left heart and changes in the size of the left upper heart chamber.
Among the individual measurements, right ventricular free wall strain performed best for identifying right ventricular dysfunction. This test looks at how much the wall of the right ventricle shortens and changes shape as the heart contracts.
The team also created a model combining six ultrasound measurements. When these measures were considered together, the model was extremely good at separating patients with right ventricular dysfunction from those without it within this study.
The research was published online on June 10, 2026, in BMC Cardiovascular Disorders. The authors suggest that combining several ultrasound measurements with the NT-proBNP blood test may help doctors recognize right-heart problems earlier in people with HFpEF.
The results are clinically interesting because HFpEF is a complicated condition that can affect more than the left side of the heart. Looking carefully at the right ventricle may give doctors additional information about disease severity and help identify patients who need closer monitoring.
However, the study has important limitations. It was retrospective, meaning researchers examined existing patient information rather than following a newly recruited group according to a planned experiment, and the study included only 163 patients.
The prediction model also performed unusually well, with a corrected measure of accuracy of 0.989 after internal testing. Such a strong result is promising, but it needs to be confirmed in larger groups of patients from different hospitals before doctors can know how well the model works in everyday practice.
The study therefore does not establish a new universal screening rule for HFpEF. Instead, it provides evidence that right ventricular dysfunction is common in these patients and supports paying more attention to the right side of the heart when assessing this increasingly important form of heart failure.
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Source: Xiamen Humanity Hospital.
