RIGHT VENTRICULAR INVOLVEMENT IN PATIENTS WITH SYSTEMIC ARTERIAL HYPERTENSION AND PRESERVED LEFT VENTRICULAR SYSTOLIC FUNCTION

Abstract

Objective: To analyze the impact of increasing systemic blood pressure (BP) on right ventricular (RV) diastolic, systolic and global function in patients with preserved left ventricular (LV) systolic function. Design and method: The study included 78 subjects, who were divided in 2 groups: the first group involved 39 subjects with grade I-II arterial hypertension (22 women, 17 men; mean age 55.28 ± 7.28 years), the second group included 39 subjects with optimal, normal or high normal BP (20 women, 19 men; mean age 48.08 ± 9.59 years). All subjects underwent careful clinical history and physical examination to reveal risk factors, cardiovascular history and treatments. All participants underwent conventional and pulsed tissue Doppler echocardiography for the assessment of RV and LV functions. We determined tricuspid inflow peak velocity during early (Et) and late (At) filling, their ratio Et/At, early diastolic tissue Doppler velocity of the tricuspid annulus (e′t), the ratio Et/e′t, Et wave deceleration time (DTt), tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), RV myocardial performance index (RIMP) by pulsed and pulsed tissue Doppler. Results: Mean BP values were significantly higher in the first group vs. controls (systolic BP 157 ± 11 mmHg vs. 123 ± 13 mmHg, p < 0.001; diastolic BP 98 ± 5 mmHg vs. 77 ± 7 mmHg, p < 0.001). Mean values of RV diastolic function parameters, as well as mean values of RIMP were significantly changed in the first group vs. controls: Et 47.88 ± 8.21 cm/s vs. 56.76 ± 9.55 cm/s, p = 0.0009; At 63.72 ± 11.87 cm/s vs. 48.6 ± 11.49 cm/s, p < 0.0001; Et/At 0.72 ± 0.04 vs. 1.14 ± 0.44, p < 0.0001; e′t 10.25 ± 2.36 cm/s vs. 13.92 ± 3.87 cm/s, p = 0.0002; Et/e′t 4.84 ± 1.01 vs. 4.34 ± 0.74, p = 0.0251; DTt 232.36 ± 8.76 ms vs. 206.28 ± 15.71 ms, p < 0.0001; RIMP by pulsed (0.47 ± 0.04 vs. 0.38 ± 0.06, p < 0.0001) and pulsed tissue Doppler (0.56 ± 0.04 vs. 0.46 ± 0.06, p < 0.0001). Mean values of TAPSE (20.0 ± 1.29 mm vs. 21.2 ± 1.34 mm, p = 0.200) and mean values of RV FAC (51 ± 11% vs. 52 ± 9 %, p = 0.425) did not differ significantly between the groups. Conclusions: The systematic assessment of RV function plays an important role in patients with arterial hypertension. Diastolic and global function of RV are influenced by the presence of hypertension in patients with preserved LV systolic function.