To access this material please log in or register

Register Authorize

Right ventricular diastolic dysfunction in patients with arterial hypertension: clinico-echocardiographic correlations

Sumun A. N.1, Shushunova O. V.2, Arkhipov O. G.2
1 - Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases" at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002
2 - Federal Budgetary Institution Rehabilitation Center of the RF Social Insurance Fund "Topaz", Leskhoznaya 1, Myski 652840, Kemerovo Region

Keywords: arterial hypertension, heart rate variability, diastolic dysfunction of the right ventricle

DOI: 10.18087/rhfj.2015.1.2022

Background. Arterial hypertension (AH) can result in disorders of LV structure and geometry. The right ventricle (RV) also may be involved in this process. Aim. To study clinical-EchoCG correlations in AH patients with RV diastolic dysfunction. Materials and methods. 127 patients with essential hypertension were evaluated. ECG, color-flow duplex scanning of carotid and iliofemoral arteries, and analysis of heart rhythm variability (HRV) were performed for all patients. Patients were divided into two groups: group 1 with preserved RV function (n=85) and group 2 with RV dysfunction (n=42). Results. The group of patients with diastolic dysfunction contained 2.5 times more smokers (р=0.02). Intima-media thickness (IMT) of common femoral arteries was 19 % greater in these patients (р=0.01). In patients with RV diastolic dysfunction, comparison of EchoCG structural parameters showed a tendency for increased RV wall thickness (p=0.06); a significant increase in RV hypertrophy index (р=0.0086); 6 % reduced tricuspid annular plane systolic excursion (р=0.050); significantly prolonged LV isovolumic relaxation time (IVRT) (р=0.002); reduced early filling velocity (E) (р=0.029) and Е / А (р=0.044); and reduced mitral flow propagation velocity (р=0.018). The RV Tei index was considerably increased compared to the reference group (р=0.0002). The number of patients with increased autonomic sympathetic tone was greater (р=0.024). The multiple logistic regression analysis showed that smoking (OR, 6.54; р=0.01), increased LV IVRT >87 msec (OR, 3.25; р=0.002), increased LV Tei index >0.55 (OR, 4.61; р=0.016), and sympathicotonia (OR, 4.4; р=0.025) were independent factors associated with RV diastolic dysfunction. Conclusion. 33 % of AH patients had RV diastolic dysfunction. The proportion of smokers was greater among AH patients with RV diastolic dysfunction; these patients had greater IMT, higher RV hypertrophy index, and higher rates of carotid stenosis, RV hypertrophy and sympathicotonia. Independent predictors of RV diastolic dysfunction identified by the multiple logistic regression analysis were smoking, sympathicotonia, prolonged LV IVRT and impaired LV performance.
  1. Cicala S, Galderisi M, Caso P et al. Right ventricular diastolic dysfunction in arterial systemic hypertension: analysis by pulsed tissue doppler. Eur J Echocardiogr. 2002 Jun;3 (2):135–42.
  2. Tumuklu MM, Erkorkmaz U, Ocal A. The impact of hypertension and hypertension-related left ventricle hypertrophy on right ventricle function. Echocardiography. 2007 Apr;24 (4):374–84.
  3. Вебер В. Р., Рубанова М. П., Жмайлова С. В., Губская П. М. Ремоделирование левого и правого желудочков сердца при артериальной гипертензии и возможности его медикаментозной коррекции. Российский медицинский журнал. 2009;2:5–9.
  4. Akintunde AA, Akinwusi PO, Familoni OB, Opadijo OG. Effect of systemic hypertension on right ventricular morphology and function: an echocardiographic study. Cardiovasc J Afr. 2010 Sep-Oct;21 (5):252–6.
  5. Todiere G, Neglia D, Ghione S et al. Right ventricular remodelling in systemic hypertension: a cardiac MRI study. Heart. 2011 Aug;97 (15):1257–61.
  6. Панев Н. И., Коротенко О. Ю., Филимонов С. Н. Типы ремоделирования правых и левых отделов сердца у больных хроническим пылевым бронхитом в сочетании с ишемической болезнью сердца и артериальной гипертензией. Бюллетень Восточно-Сибирского научного центра СО РАМН. 2009;1:86–190.
  7. Cuspidi C, Sala C, Muiesan ML et al. Right ventricular hypertrophy in systemic hypertension: an updated review of clinical studies. J Hypertens. 2013 May;31 (5):858–65.
  8. Pedrinelli R, Canale ML, Giannini C et al. Right ventricular dysfunction in early systemic hypertension: a tissue Doppler imaging study in patients with high-normal and mildly increased arterial blood pressure. J Hypertens. 2010 Mar;28 (3):615–21.
  9. Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23 (7):685–713.
  10. Cheng CC, Huang WC, Chiou KR et al. Tricuspid flow propagation velocity predicts exercise tolerance and readmission in patients with systemic lupus erythematosus. J Am Soc Echocardiogr. 2009 Apr;22 (4):411–7.
  11. Galderisi M, Severino S, Caso P et al. Right ventricular myocardial diastolic dysfunction in different kinds of cardiac hypertrophy: analysis by pulsed Doppler tissue imaging. Ital Heart J. 2001 Dec;2 (12):912–20.
  12. Cuspidi C, Negri F, Tadic MV et al. Left atrial enlargement and right ventricular hypertrophy in essential hypertension. Blood Press. 2014 Apr;23 (2):89–95.
  13. Cuspidi C, Negri F, Giudici V et al. Prevalence and clinical correlates of right ventricular hypertrophy in essential hypertension. J Hypertens. 2009 Apr;27 (4):854–60.
  14. Akintunde AA, Adebayo PB, Aremu AA, Opadijo OG. Carotid atherosclerosis and right ventricular diastolic dysfunction in a sample of hypertensive Nigerian patients. Croat Med J. 2013 Dec;54 (6):555–60.
  15. Barutcu I, Esen AM, Kaya D et al. Effect of acute cigarette smo­king on left and right ventricle filling parameters: a conventional and tissue Doppler echocardiographic study in healthy participants. Angiology. 2008 Jun-Jul;59 (3):312–6.
  16. Karakaya O, Barutcu I, Esen AM et al. Acute smoking-induced alterations in Doppler echocardiographic measurements in chronic smokers. Tex Heart Inst J. 2006;33 (2):134–8.
  17. Leggio M, Cruciani G, Sgorbini L et al. Obesity-related adjunctive systo-diastolic ventricular dysfunction in patients with hypertension: echocardiographic assessment with tissue Doppler velocity and strain imaging. Hypertens Res. 2011 Apr;34 (4):468–73.
  18. Kroeker CA, Shrive NG, Belenkie I, Tyberg JV. Pericardium modulates left and right ventricular stroke volume to compensate for sudden change in atrial volume. Am J Physiol Heart Circ Physiol. 2003 Jun;284 (6):H2247–54.
  19. Pedrinelli R, Dell’Omo G, Talini E et al. Systemic hypertension and the right sided cardiovascular system: a review of the available evidence. J Cardiovasc Med (Hagerstown). 2009 Feb;10 (2):115–21.
  20. Gregori M, Tocci G, Giammarioli B et al. Abnormal regulation of renin angiotensin aldosterone system is associated with right ventricular dysfunction in hypertension. Can J Cardiol. 2014 Feb;30 (2):188–94.
  21. Вебер В. Р., Рубанова М. П., Жмайлова С. В. и др. Влияние дофамина на ремоделирование левого и правого желудочков сердца в эксперименте. Рациональная фармакотерапия в кардиологии. 2009;5 (1):73–6.
  22. Барбараш О. Л., Рутковская Н. В., Смакотина С. А. и др. Пора­жение легких у пациентов с гипертонической болезнью. Кардио­логия. 2010;50 (3):31–6.
  23. Tadic M, Cuspidi C, Suzic-Lazic J et al. Is there a relationship between right-ventricular and right atrial mechanics and functional capacity in hypertensive patients? J Hypertens. 2014 Apr;32 (4):929–37.
  24. Sant'Anna MP, Mello RJ, Montenegro LT, Araújo MM. Left and right ventricular hypertrophy at autopsy of hypertensive individuals. Rev Assoc Med Bras. 2012 Jan-Feb;58 (1):41–7.
  25. Pagourelias ED, Efthimiadis GK, Parcharidou DG et al. Prognostic value of right ventricular diastolic function indices in hypertrophic cardiomyopathy. Eur J Echocardiogr. 2011 Nov;12 (11):809–17.
Sumin A. N., Shushunova O. V., Arkhipov O. G. Right ventricular diastolic dysfunction in patients with arterial hypertension: clinico-echocardiographic correlations. Russian Heart Failure Journal. 2015;16 (1):22–30

To access this material please log in or register

Register Authorize
Ru En