Subclinical right ventricular dysfunction in asthma: association with disease severity and control assessed by echocardiography

Asthma is a chronic inflammatory airway disease that may affect the cardiovascular system, particularly the right ventricle (RV). Early subclinical RV dysfunction in asthma remains insufficiently explored. We conducted a retrospective observational study to identify clinical factors associated with subclinical RV dysfunction assessed by transthoracic echocardiography (TTE) in adult asthmatic patients without clinical signs of right heart failure. All participants underwent TTE with conventional RV parameters and RV free wall longitudinal strain (RVFWLS) assessment; body mass index (BMI) was recorded for all participants. RV dysfunction was defined by abnormal RVFWLS, pulmonary artery systolic pressure, RV hypertrophy, or fractional area change. A total of 80 patients were included (mean age 45±15.9 years; 75% women; mean BMI 27.3±4.8 kg/m²). RVFWLS was impaired in 40% of patients, whereas conventional RV indices (tricuspid annular plane systolic excursion, S') remained largely preserved. Pulmonary hypertension was observed in 16.2%. In multivariable analysis, age ≥45 years [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.4-17.0], uncontrolled asthma (OR 9.7, 95% CI 3.4-27.8), and severe asthma (OR 3.8, 95% CI 1.4-10.0) were independently associated with impaired RVFWLS. Pulmonary hypertension was independently associated with late-onset asthma (OR 11.9, 95% CI 1.1-22.2) and severe asthma (OR 10.1, 95% CI 1.5-64.8). Subclinical RV dysfunction is frequent in adult asthmatics, particularly in those with uncontrolled or severe disease. RVFWLS appears to be a sensitive marker of early cardiac involvement related to asthma severity. Targeted echocardiographic evaluation may help identify high-risk patients and support multidisciplinary management.