2015


To access this material please log in or register

Register Authorize
2015/№1

Factors influencing the development of right ventricular dysfunction in patients with arterial hypertension

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

Keywords: hyperpiesis, diastolic dysfunction of the right ventricle

DOI: 10.18087/rhj.2015.1.2031

Background. A part of patients with arterial hypertension (AH) develop RV hypertrophy and diastolic dysfunction. It is still unclear what damages the right heart in AH – the hemodynamic factor itself and its consequences or accompanying factors, which facilitate development of both AH and right heart abnormalities. Aim. To study prevalence of RV diastolic dysfunction and to identify factors associated with its presence in patients with AH. Materials and methods. The study included 487 patients with AH (mean age, 58) and 273 individuals without AH as a reference group. EchoCG with examination of ventricular structure parameters was performed, and ventricular systolic and diastolic function was evaluated for all participants. RV diastolic function was evaluated using transtricuspid flow parameters (Ет, Ат, Ет / Ат, and ВЗЕт), tricuspid flow propagation velocity (TFPV), and tissue Doppler indices of tricuspid annular motions (е’т, а’т, е’т / а’т). Results. In AH patients, dimensions of the pulmonary artery (р<0.001) and RV (р=0.009), RV wall thickness (р=0.085), and the Тei index (р=0.045) were greater whereas the Ет / Ат ratio (р=0,027) was lower than in the reference group. TFPVs (р=0.17) and е’т / а’т ratios (р=0.52) did not differ between the groups. Overall, the incidence of RV diastolic dysfunction was higher in AH patients than in the reference group (33.5 and 26.7 %, respectively; р=0.052). Independent factors influencing the development of RV diastolic dysfunction included the presence of CHF, right ventricular dimensions, and signs of LV diastolic dysfunction but not the presence of AH. Conclusion. Patients with AH had lower ratios of early to late transtricuspid flows, higher RV Tei indexes, and greater RV end diastolic dimensions and pulmonary artery diameter. Presence of AH was not an independent predictor of RV diastolic dysfunction. Therefore, AH is only one of factors, such as other diseases and behavioral factors, which facilitates the development of right heart dysfunction.
  1. Cicala S, Galderisi M, Caso P et al. Right ventricular diastolic dysfunction in arterial systemic hypertension: analysis by pulsed tissue doppler. Eur J Echocardiography. 2002;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. 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;1:186–90.
  5. 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;1:73–6.
  6. 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.
  7. 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.
  8. 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.
  9. 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;2 (12):912–20.
  10. 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.
  11. Sokmen A, Sokmen G, Acar G et al. The impact of isolated obesity on right ventricular function in young adults. Arq Bras Cardiol. 2013 Aug;101 (2):160–8.
  12. 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.
  13. Tadic M, Ilic S, Celic V. Right ventricular and right atrial function and deformation in patients with subclinical hypothyroidism: a two- and three-dimensional echocardiographic study. Eur J Endocrinol. 2013 Nov 22;170 (1):77–85.
  14. Karamitsos TD, Karvounis HI, Dalamanga EG et al. Early diastolic impairment of diabetic heart: the significance of right ventricle. Int J Cardiol. 2007 Jan 8;114 (2):218–23.
  15. Parsaee M, Bahmanziari P, Ardeshiri M, Esmaeilzadeh M. Obvious or subclinical right ventricular dysfunction in diabetes mellitus (type II): an echocardiographic tissue deformation study. J Tehran Heart Cent. 2012;7 (4):177–81.
  16. Tadic M, Ivanovic B, Cuspidi C. Metabolic syndrome and right ventricle: an updated review. Eur J Intern Med. 2013 Oct;24 (7):608–16.
  17. Tadic M, Cuspidi C, Sljivic A et al. Effects of the metabolic syndrome on right heart mechanics andStudy. Echocardiography. 2014 May 12. [Epub ahead of print].
  18. Tadic M, Ivanovic B, Celic V, Kocabay G. The impact of metabolic syndrome, recently diagnosed diabetes and hypertension on right ventricular remodeling. Is there difference between risk factors? Clin Exp Hypertens. 2014;36 (5):295–301.
  19. 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.
  20. 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;59 (3):312–6.
  21. Widya RL, Hammer S, Boon MR et al. Effects of short-term nutritional interventions on right ventricular function in healthy men. PLoS One. 2013 Sep 23;8 (9):e76406. function. Can J Cardiol. 2014 Mar;30 (3):325–31.
  22. Gökdeniz T, Erkol A, Kalaycıoğlu E et al. Relation of Epicardial Fat Thickness to Subclinical Right Ventricular Dysfunction Assessed by Strain and Strain Rate Imaging in Subjects with Metabolic Syndrome: A Two-Dimensional Speckle Tracking Echocardiography
  23. Sabit R, Bolton CE, Fraser AG et al. Sub-clinical left and right ventricular dysfunction in patients with COPD. Respir Med. 2010 aug;104 (8):1171–8.
Sumin A.N., Shushunova O.V., Arkhipov O.G. Factors influencing the development of right ventricular dysfunction in patients with arterial hypertension. Russian Heart Journal. 2015;14 (1):50–56

To access this material please log in or register

Register Authorize
Ru En