Pulmonary hemodynamics and right ventricular function in hypertension.

Abstract

Pulmonary and systemic hemodynamics in 16 hypertensive subjects (group I) with left ventricular (LV) hypertrophy (ECG and echo criteria) and in 17 hypertensive subjects with ECG signs of LV strain (group II), were compared with those in 14 normal individuals. An augmented pulmonary arteriolar resistance (PAR) in group I and to a larger extent in group II accounted for the pulmonary pressure elevation in both groups. Increase in PAR was unrelated to pulmonary blood flow and volume, pleural pressure, arterial PO2, PCO2 and pH, and could not be explained entirely by the left ventricular end-diastolic pressure changes. In group I, left (L.MSEJR) and right (R;MSEJR) mean systolic ejection rate, stroke index (SI) and mean velocity of circumferential fiber shortening (VCF) were enhanced in spite of the heightened pressure load on both sides of the heart. In group II, a large reduction of SI, L.MS.EJR, R.MSEJR and VCF, as well as the relationship between ventricular filling pressures and SI, documented a compromised performance of both ventricles, Findings indicate that: systemic hypertension is associated with elevation of pulmonary arterial pressure and of PAR which is not necessarily a consequence of impairment in LV function; LV hypertrophy is associated with enhanced performance of either ventricle; in coincidence with development of ECG signs of LV strain, the performance of both sides of the heart deteriorates. A functional interdependence of the two ventricles is suggested.

Effect of systemic hypertension on right ventricular morphology and function

“…This is in agreement with similar studies done among Caucasian hypertensive subjects 17,18. Right ventricular structural changes also occur in hypertensive heart disease.…”

“…This suggests that hypertension and left ventricular hypertrophy influence both ventricles. Right ventricular hypertrophy has been demonstrated among subjects with systemic hypertension 17-19…”

“…Several studies have shown that left ventricular diastolic dysfunction occurs early in hypertension 17,19,24,25. Left ventricular diastolic dysfunction is associated with the reduction of the early E wave and the subsequent increase in the amplitude of the atrial A wave.…”

Right atrial function in hypertensive patients: effects of antihypertensive therapy

“…7 In particular, the relationship between increase in blood pressure, left ventricular hypertrophy and RA function is still uncertain. Furthermore, an abnormal right ventricular (RV) relaxation may determine RA contribution to RV filling, whereas it is controversial whether RA dysfunction is a consequence of increased afterload itself or rather of changes in right or left ventricular structure or function that may occur in patients with arterial hypertension.…”

“…In coincidence with development of severe left ventricular hypertrophy and diastolic dysfunction, the performance of both sides of the heart may deteriorate. 7 Under these circumstances the status of RA function is an important determinant of RV performance and haemodynamic compromise. 8 The RV and RA function has been assessed in experimental and clinical conditions.…”