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We aimed to assess the proportion of right ventricular systolic dysfunction (RVD) in HFpEF and the relation to clinical outcomes. As part of a single-centre, prospective, observational study, 183 subjects (135 HFpEF, and 48 age- and sex-matched controls) underwent extensive characterization with CMR. transthoracic echocardiography, blood sampling and six-minute walk testing. Patients were followed for the composite endpoint of death or HF hospitalization. RVD (defined as right ventricular ejection fraction\u2009&lt;\u200947%) controls was present in 19% of HFpEF. Patients with RVD presented more frequently with lower systolic blood pressure, atrial fibrillation, radiographic evidence of pulmonary congestion and raised cardiothoracic ratio and larger right ventricular volumes. During median follow-up of 1429\u00a0days, 47% (n\u2009=\u200964) of HFpEF subjects experienced the composite endpoint of death (n\u2009=\u200922) or HF hospitalization (n\u2009=\u200942). RVD was associated with an increased risk of composite events (Log-Rank p\u2009=\u20090.001). In multivariable Cox regression analysis, RVD was an independent predictor of adverse outcomes (adjusted Hazard Ratio [HR] 3.946, 95% CI 1.878\u20138.290, p\u2009=\u20090.0001) along with indexed extracellular volume (HR 1.742, CI 1.176\u20132.579, p\u2009=\u20090.006) and E\/E\u2019 (HR 1.745, CI 1.230\u20132.477, p\u2009=\u20090.002). RVD as assessed by CMR is prevalent in nearly one-fifth of HFpEF patients and is independently associated with death and\/or hospitalization with HF.<\/jats:p>\n                  <jats:p>The trial was registered retrospectively on ClinicalTrials.gov (Identifier: NCT03050593). The date of registration was February 06, 2017.<\/jats:p>","DOI":"10.1007\/s10554-020-01953-y","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T02:08:22Z","timestamp":1596161302000},"page":"255-266","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Prevalence of right ventricular dysfunction and prognostic significance in heart failure with preserved ejection fraction"],"prefix":"10.1007","volume":"37","clinical-trial-number":[{"clinical-trial-number":"nct03050593","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6739-5607","authenticated-orcid":false,"given":"Prathap","family":"Kanagala","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayanth R.","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anvesha","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal N.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav S.","family":"Gulsin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain B.","family":"Squire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leong L.","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerry P.","family":"McCann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,31]]},"reference":[{"issue":"5","key":"1953_CR1","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1016\/0735-1097(94)00511-N","volume":"25","author":"TG Di Salvo","year":"1995","unstructured":"Di Salvo TG, Mathier M, Semigran MJ et al (1995) Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. 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