Background and Aim

Dysfunction of left ventricular function and accompanying compensatory mechanism in systemic hypertension is well–evidenced. However, much less investigation is done on clinical significance of right ventricular function in systemic hypertension. The two ventricles are anatomically–bound and interdependent on each other, so there is absolute possibility of right ventricular disruption along with left ventricular dysfunction. Thus, aim of the study is to compare right and left ventricular filling dynamics between hypertensive patients and age matched normotensive patients through echocardiography.

Methods

It was a prospective, observational, analytical, single–centre study which enrolled 70 patients with essential systemic hypertension and 40 normal control patients. The study was conducted at Medical and Cardiology Department of Medical College, Pariyaram, Kerala India between August 2012 and August 2013. Blood pressure was determined according to the recommendation of American Heart Association. Complete M–mode, two–dimensional and Doppler echocardiographic studies were performed. Parameters such as left ventricle inner diameter in diastole (LVIDd), left ventricular inner diameter in systole (LVIDs), interventricular septum in diastole (IVSd), left ventricular posterior wall thickness in diastole (LVPWd), right ventricle inner diameter in diastole (RVIDd) and  right ventricle anterior wall diameter in diastole (RVAWDd) were measured. Mitral and tricuspid inflow filling parameters were also recorded. Right ventricular systolic function was assessed by measuring tricuspid annular motion (TAM) and mean pulmonary artery pressure (MPAP) was also calculated.

Results

Among patients with systemic hypertension, 63% were males and among 40 normal control patients, 62% were males. Mean age and body mass index were not statistically different between both the groups. Hypertensive patients demonstrated significantly higher dimensions of interventicular septum in diastole (1.4 ± 0.4 cm vs. 0.9 ± 0.3 cm) and left ventricular posterior wall in diastole (1.1 ± 0.3 cm vs. 0.8 ± 0.3 cm) when compared to normal subjects. Right ventricular internal diameter in diastole was higher in hypertensive (3.5 ± 0.4 cm vs. 1.9 ± 0.4 cm) and is statistically significant compared to normotensive. Right ventricular anterior wall diameter in diastole was significantly higher in hypertensives (0.5 ± 0.3 vs. 0.3 ± 0.3 cm). Among right ventricular diastolic filling parameters, peak atrial velocity (A wave) was significantly higher in hypertensive as compared to normotensives (0.4 ± 0.1 m/s vs. 0.3 ± 0.1 m/s).  E/A ratio was significantly lower in patients with hypertension (1.2 ± 0.29 vs 1.5 ± .26) than normotensives. E deceleration time (EDT) was also higher in hypertensive than normotensive subjects (190 ± 15 msec vs. 160 ± 14 msec). Tricuspid annular motion (TAM) was almost similar among both hypertensive and normotensive subjects (2.43 ± 2.6 vs. 2.53 ± 3.0), while mean values of non–invasively estimated mean pulmonary artery pressures (MPAP) showed higher values in patients with hypertension (17.72 ± 5.2 mm Hg vs. 15.08 ± 4.8 mm Hg).

Conclusion

Hypertensive patients have significantly abnormal right ventricular filling dynamics and mitral inflow parameters when compared to normotensives. Thus, we can say that right ventricular diastolic dysfunction can be impaired in systemic arterial hypertension similar to left ventricular diastolic function.