In patients with right ventricular dysfunction, cardiac output was highest at a right atrial pressure of 10-15 mm Hg, heart rate showed a non-linear association with cardiac output peaking at around 80 beats per minute in sinus rhythm, and low pulmonary artery compliance was an independent predictor of adverse events.
Key Findings
Results
Cardiac output was highest at a right atrial pressure of approximately 10-15 mm Hg and declined beyond this level in patients with right ventricular dysfunction.
202 right heart catheterisation examinations from 155 patients were analysed (median age 69 years, 66% male)
RVD was defined as Pulmonary Artery Pulsatility Index <1.85 and right atrial pressure/pulmonary artery wedge pressure ratio >0.63
The relationship between CO and RAP was non-linear, with a peak in the 10-15 mm Hg range
This finding was derived from Study A, which assessed the relationship between CO and haemodynamic parameters derived from right heart catheterisation
Results
Heart rate showed a non-linear association with cardiac output in patients with RVD who were in sinus rhythm, reaching its peak at around 80 beats per minute.
The non-linear association was observed specifically in patients with sinus rhythm, not all patients
CO peaked at approximately 80 beats per minute before declining at higher heart rates
This finding was part of Study A's assessment of haemodynamic parameters and their relationship to cardiac output
Results
Patients who experienced the primary composite outcome had higher right atrial pressure and lower pulmonary artery compliance compared to those who did not.
34 patients experienced the primary outcome (composite of all-cause death and heart failure hospitalisation) during a median follow-up of 1.4 years
Study B evaluated the prognostic value of haemodynamic indices in RVD
Higher RAP and lower PA compliance were both observed in those experiencing the primary outcome
Kaplan-Meier analysis showed RAP >10 mm Hg (median) was associated with the primary outcome (p=0.004)
Kaplan-Meier analysis showed PA compliance <4.9 mL/mm Hg (median) was associated with the primary outcome (p=0.005)
Results
Pulmonary artery compliance below 4.9 mL/mm Hg was an independent predictor of the composite primary outcome on multivariable Cox regression analysis, while right atrial pressure above 10 mm Hg was not.
PA compliance <4.9 mL/mm Hg (median) was identified as an independent predictor of adverse events on multivariable Cox regression
RAP >10 mm Hg did not retain independent predictive value after multivariable adjustment
The primary outcome was a composite of all-cause death and heart failure hospitalisation
Median follow-up was 1.4 years across 155 patients
Methods
This retrospective single-centre cohort study analysed patients with heart failure complicated by right ventricular dysfunction over a 10-year period from 2014 to 2024.
155 patients with a total of 202 right heart catheterisation examinations were included
Median patient age was 69 years and 66% were male
The study was conducted at a single centre and used a retrospective cohort design
Two substudies (Study A and Study B) were embedded within the overall cohort analysis
What This Means
This research suggests that there is an optimal range for a pressure measurement in the right side of the heart — called right atrial pressure — in patients whose right heart is not pumping effectively. Specifically, the heart's ability to pump blood (cardiac output) was best when this pressure was between 10 and 15 mmHg, and got worse at higher levels. The study also found that heart rate matters: for patients in normal heart rhythm, pumping was most efficient at around 80 beats per minute, with performance declining at faster or slower rates. These findings come from a study of 155 patients who underwent a procedure called right heart catheterisation, which directly measures pressures inside the heart and lungs.
The study also identified a measure called pulmonary artery compliance — essentially how elastic or stiff the blood vessels in the lungs are — as a strong predictor of bad outcomes. Patients with lower pulmonary artery compliance (stiffer lung vessels, below 4.9 mL/mmHg) were significantly more likely to be hospitalized for heart failure or die during the roughly 1.4 years of follow-up. Interestingly, while elevated right atrial pressure was associated with worse outcomes in simpler analyses, it did not independently predict outcomes once other factors were accounted for, whereas pulmonary artery compliance did.
This research matters because right heart dysfunction is a serious complication of heart failure, and there has been limited evidence about what haemodynamic targets clinicians should aim for when managing these patients. The findings suggest that keeping right atrial pressure in the 10–15 mmHg range and monitoring pulmonary artery compliance could be clinically meaningful, and that low pulmonary artery compliance may serve as an important marker for identifying patients at highest risk. However, as a single-centre retrospective study, these results will need to be confirmed in larger, prospective investigations.
Nishikawa K, Suzuki S, Terashima T, Minamisawa M, Yoshie K, Aoki T, et al.. (2026). Optimal haemodynamic status and prognostic predictors in patients with right ventricular dysfunction: the RIGHT study.. Open heart. https://doi.org/10.1136/openhrt-2026-004224