Right atrial and ventricular strain in heart failure with preserved ejection fraction: Correlation with N-terminal pro-brain natriuretic peptide

Abstract Background Right ventricular (RV) dysfunction is frequently observed in heart failure with preserved ejection fraction (HFpEF). N-terminal pro-brain natriuretic peptide (NT-proBNP) is a neurohormone released in response to ventricular strain with elevated serum levels supporting the diagnosis of HFpEF and RV dysfunction. Objectives To evaluate the relationship between right ventricular and right atrial (RA) strain assessed by speckle-tracking echocardiography (STE) and serum NT-proBNP levels in patients with HFpEF. Methods This single-center, prospective case-control study included 39 HFpEF patients and 20 age-and sex-matched healthy controls. RA and RV function were assessed by 2D transthoracic echocardiography and speckle-tracking strain (STE), with RV GLS calculated from a six-segment model. Strain values are reported as absolute numbers, and serum NT-proBNP was measured by ELISA. Results The HFpEF group showed significantly impaired RV global longitudinal strain (16.79 ± 3.96% vs. 25.35 ± 1.89% for the controls) and RA strain (20.94 ± 8.78% vs. 39.95 ± 2.03% for the controls), with p < 0.001 for both. Serum NT-proBNP levels were markedly higher in HFpEF patients (610 ± 15.6 pg/mL vs. 103 ± 7 pg/mL for controls, p < 0.001), with a diagnostic cutoff of 383 pg/mL achieving 96% sensitivity and 94% specificity. NT-proBNP was strongly inversely correlated with RV GLS (r = -0.737) and RA strain (r = -0.739), with p < 0.001 for both. Conclusions Right ventricular and right atrial dysfunction assessed by STE is prevalent in HFpEF and correlates strongly with NT-proBNP levels. These findings support the combined use of right heart strain parameters and NT-proBNP for improved assessment and risk stratification in HFpEF.