Cardiometabolic Risk Factors Associated With Right Ventricular Function and Compensation in Patients Referred for Echocardiography

BACKGROUND: Pulmonary hypertension and right ventricular (RV) dysfunction are drivers of adverse outcomes; however, modifiable risk factors for RV dysfunction are not well described. We investigated the association between clinical markers of metabolic syndrome and echocardiographic RV function in a large referral population. METHODS AND RESULTS: Using electronic health record data, we performed a retrospective cohort study of patients aged ≥18 years referred for transthoracic echocardiography between 2010 and 2020 with RV systolic pressure (RVSP) or tricuspid annular plane systolic excursion (TAPSE) values. Pulmonary hypertension was defined by RVSP >33 mm Hg and RV dysfunction by TAPSE ≤1.8 cm. Our sample included 37 203 patients of whom 19 495 (52%) were women, 29 752 (83%) were White, with a median age of 63 years (interquartile range, 51–73). Median (interquartile range) RVSP was 30.0 mm Hg (24.0–38.7), and median TAPSE was 2.1 cm (1.7–2.4). Within our sample, 40% had recorded RVSP >33 mm Hg, and 32% with TAPSE <1.8 cm. Increase in RVSP from normal (<33 mm Hg) to mildly elevated (33–39 mm Hg) or elevated (>39 mm Hg) was associated with lower low‐density lipoprotein and high‐density lipoprotein, and higher hemoglobin A1c and body mass index (P<0.001). A decrease in TAPSE between groups of TAPSE >1.8 cm, TAPSE 1.5–1.8 cm, and TAPSE <1.5 cm was associated with increased triglyceride:high‐density lipoprotein ratio and hemoglobin A1c, and decreased body mass index, low‐density lipoprotein, high‐density lipoprotein, and systolic blood pressure (P<0.001). Most associations between cardiometabolic predictors and RVSP and TAPSE were nonlinear with clear inflection points associated with higher pulmonary pressure and lower RV function. CONCLUSIONS: Clinical measures of cardiometabolic function were highly associated with echocardiographic measures of right ventricular function and pressure.