Right Ventricular Diastolic Dysfunction in Arterial Systemic Hypertension: Analysis by Pulsed Tissue Doppler

Cicala, Silvana; Galderisi, Maurizio; Caso, Pio; Petrocelli, Antonio; D’Errico, Arcangelo; Divitiis, Oreste de; Calabrò, Raffaele

doi:10.1053/euje.2001.0124

Cited by 104 publications

(124 citation statements)

References 32 publications

(50 reference statements)

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“…The 2 ventricles are anatomically united by their common blood supply, muscle fiber anatomy, interventricular septum and pericardium 24 and exhibit interdependence, as already demonstrated in other conditions such as arterial hypertension. 15 Systolic ventricular interdependence was found to be more pronounced in an experimental tachycardia-induced cardiomyopathy models in pigs than in normal hearts. 25 The overall RV function does not depend solely on the function of the right free wall, but also on septal contractility, which is irreversibly impaired in ICM.…”

Section: Discussionmentioning

confidence: 99%

“…14 TDE of the RV has also been studied in various pathological clinical conditions. 15,16 Focusing on the RV in CHF patients, whether the presence of RV dysfunction can be used as a tool to separate DCM from ischemic disease is of clinical interest. The presence of RV systolic dysfunction has been correlated with adverse hemodynamic and humoral responses and survival.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Parcharidou

Giannakoulas

Efthimiadis

et al. 2008

Circ J

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hronic heart failure (CHF) has emerged as the most prevalent cause of mortality, morbidity and hospitalization in industrialized countries over the past years. 1 Despite the advances in medical and invasive treatment of CHF, its incidence is expected to rise in the future because of improved survival rates following acute myocardial infarction (MI), which is the principal etiology of CHF in >70% of patients. 2 Traditionally, great emphasis was put on evaluation of the various etiologic factors of this syndrome. Differentiation between ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (DCM) has important therapeutic implications because the former may gain substantial benefit from coronary revascularization. 3 Conventional echocardiography is commonly used for the evaluation of left ventricular (LV) and right ventricular (RV) function, but does not provide detailed information about myocardial systolic and diastolic properties in the regional segments. Tissue Doppler echocardiography (TDE) is a promising ultrasonographic technique that quantitatively measures the velocity of the myocardium in systole and diastole. 4 Traditionally, the principal target of the cardiologist is the evaluation of the LV function, with little interest in the RV. In spite of the fact that several recent studies have used the TDE technique in the assessment of RV function in various clinical conditions, 5,6 the literature on the RV and its impact on the pathophysiologic processes is limited. However, there is a growing body of evidence that RV function is a powerful predictor of mortality in patients with CHF. 7 We hypothesized that ICM and DCM differ in terms of RV function. Thus, the aim of our study was to investigate the RV function in patients with ICM and DCM using pulsed wave TDE and to compare the TDE parameters of the RV among the patients with ischemic and idiopathic dilated causes of LV dysfunction. Methods Study PopulationWe prospectively studied 82 consecutive patients with CHF who had undergone an echocardiographic examination at the AHEPA Hospital (Thessaloniki, Greece). CHF was defined as the presence of heart failure symptoms plus a dilated (>55 mm in end-diastolic diameter) LV with a depressed (<40%) ejection fraction of uncertain origin. The inclusion criteria were: (a) good quality echocardiographic imaging of tricuspid and mitral annular motion, (b) adequate tricuspid valve regurgitation Doppler signal in order to assess pulmonary artery systolic pressure, (c) sinus rhythm on electrocardiography (ECG), and (d) stable clinical condition. The following were considered as exclusion criteria:

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Parcharidou

Giannakoulas

Efthimiadis

et al. 2008

Circ J

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“…Ferlinz et al [13] studied effects of systemic hypertension on right ventricular (RV) performance in 1980 by comparing catheter derived measurements of RV performance in 10 normal subjects to 20 patients with uncomplicated, asymptomatic essential hypertension (defined as cuff diastolic blood pressure ≥ 100 mm Hg). Cicala et al [14] analyzed right ventricular longitudinal function in arterial systemic hypertension by pulsed tissue Doppler in 30 normotensives and 30 hypertensives, free of cardiac drugs. Akintunde et al [15] intended to describe the impact of left ventricular pressure overload and hypertrophy due to hypertension on right ventricular morphology and function.…”

Section: Resultsmentioning

confidence: 99%

“…Cicala et al [14] found also that systemic hypertension is correlated to RV longitudinal diastolic dysfunction independent of its correlation with RV hypertrophy. Ferlinz et al [13] demonstrated that right-sided circulation is not immune to the effects of systemic hypertension.…”

Section: Aim Of the Current Study Was To Analyze Impact Of Presence Amentioning

confidence: 99%

Relation of RV Function to Presence and Degree of Systemic Hypertension

Abdeltawab¹,

Eweda²,

Mostafa³

et al. 2017

J Cardiovasc Dis Diagn

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Hypertension is an important non-communicable disease in Africa. It is the most important cardiovascular risk factor. The effect of hypertension on left ventricle has been documented for long time, but sparse and consistent evidence shows an impact of hypertension on the right ventricle. The RV can be studied with many imaging and functional modalities. In clinical practice, echocardiography is the mainstay of evaluation of RV structure and function. Aim of this study was to analyze impact of presence and severity of systemic arterial hypertension (HTN) on right ventricular function measured by tissue Doppler echocardiography. For this aim we included sixty consecutive patients from outpatient clinics and thirty healthy age and sex matched individuals and made a full 2D and tissue doppler study for the RV and compared results for non-hypertensives, stage 1 and stage 2 hypertensives. Doppler data obtained at the tricuspid valve showed statistically significant results regarding E, E/A, DT and IVRT correlating the presence and degree of hypertension with RV diastolic function (p<0.001). The current study demonstrated that RV diastolic dysfunction not only is an early marker that is correlated to presence of systemic arterial hypertension but also showed it to be a marker of its severity and degree of control as conveyed by stage of hypertension.

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“…In a study by Nunez et al 22 including 15 healthy normotensive subjects and 35 patients with essential hypertension (15 with normal LV and 20 with echocardiographic LVH), RV wall thickness was almost doubled in hypertensives with LVH as compared with normotensives (7.0 ± 2.1 vs 3.7 ± 0.8 mm), and RV wall thickness was significantly, directly correlated with the LV one in the entire cohort. More recently, a number of studies performed in small series of subjects have shown that RV diastolic dysfunction, as assessed by conventional and tissue Doppler analysis, [23][24][25] as well as RV systolic dysfunction, as assessed by myocardial velocities and strain imaging, are both common conditions in uncomplicated arterial hypertension. 26 Our study, therefore, extends previous evidence to the MS setting by showing that a more pronounced involvement of left and right structures was present in hypertensive patients with the syndrome; these alterations were associated with an impaired diastolic biventricular filling as shown by a reduced mitral and tricuspid E/A ratio as well as a prolonged deceleration time.…”

Section: -Test (For Categorical Variables)mentioning

confidence: 99%

Metabolic syndrome and biventricular hypertrophy in essential hypertension

et al. 2008

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The metabolic syndrome (MS) is associated with structural and functional alterations of the left ventricle (LV); no evidence is available on the impact of the MS on the right ventricle (RV). To assess whether MS, as defined by the ATP III report, is associated with biventricular hypertrophy, a total of 286 hypertensive subjects (mean age 58.7±12.2 years) attending our outpatient clinic underwent the following procedures: (1) physical examination and standard clinic blood pressure (BP) measurement; (2) routine laboratory investigations; (3) M-mode, two-dimensional and Doppler echocardiography. LV hypertrophy (LVH) was defined by LM mass index X51/47 g m À2.7 in men and women, respectively. Right-sided chambers were measured in parasternal long axis at the outflow tract and subcostal view; RV hypertrophy (RVH) was defined by anterior RV wall thickness X6.0/5.5 mm in men and women, respectively. Filling velocities of both ventricles were assessed by pulsed Doppler echocardiography. Structural cardiac alterations were more pronounced in hypertensive men and women with MS than in their non-MS counterparts and involved both ventricles as shown by the differences in continuous variables as well as in prevalence rates of LVH (58 and 48% vs 28 and 30%, respectively, Po0.01) and RVH (48 and 54% vs 25 and 35%, respectively, Po0.01). Both LV and RV filling in MS hypertensives were more dependent on the atrial systole. Our study shows that in human hypertension, structural and functional cardiac changes induced by MS are not limited to the LV but also involve the right one.

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Right Ventricular Diastolic Dysfunction in Arterial Systemic Hypertension: Analysis by Pulsed Tissue Doppler

Cited by 104 publications

References 32 publications

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Relation of RV Function to Presence and Degree of Systemic Hypertension

Metabolic syndrome and biventricular hypertrophy in essential hypertension

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