Alterations in the Ventricular Filling Pattern Shared by the Two Sides of the Heart in Hypertension

Abstract

The aim of this study was to test whether: hypertension alters the normal pattern of ventricular filling; the left and right ventricles share these alterations; there is a correlation between the structural characteristics (ultrasounds) of the left ventricle and these alterations. The filling pattern of the two ventricles was evaluated by the mitral and tricuspid flow (Doppler echocardiography) in 16 normal individuals (group 0) and in 43 primary hypertensive patients divided into: group 1 = 11 subjects in whom the thickness of both the septum and left ventricular posterior wall was within a normal range (mean + 1 SD of values derived from 145 normal subjects); group 2 = 8 patients whose septal thickness exceeded normal values by more than 1 SD; group 3 = 24 patients with septal and posterior wall thickness exceeding normal values by more than 1 SD. Groups were homogeneous regarding gender, age, heart rate, left ventricular cavity dimensions and systolic function. Mitral peak flow velocity in early diastole (PFVE) was similar in the four groups. Peak flow velocity in late diastole (PFVA) in each of the three hypertensive groups was higher than in group 0; as a consequence, PFVE/PFVA in hypertensives was significantly smaller than in normotensives. The flow pattern through the tricuspid valve was quite similar to this in all hypertensive groups. No correlation was found between the pattern of tricuspid and mitral flow and ventricular septum thickness, left ventricular posterior wall thickness, dimensions, systolic function and wall stress. The only apparent discriminating parameter was the presence or the absence of hypertension. In primary hypertension ventricular filling abnormalities seem to be shared by the two ventricles and to be not the consequence of structural changes of the heart (at least of those detectable by ultrasounds) or of a hemodynamic overload (at least as far as the right ventricle is concerned).