Effects of systemic hypertension on right ventricular (RV) performance have not been previously investigated. In this study, 10 normal patients were compared to 20 patients with uncomplicated, asymptomatic essential hypertension (defined as cuff diastolic blood pressure 2 100 mm Hg) after a complete hemodynamic and RV cineangiographic evaluation. The mean intra-arterial pressure in the normal group was 93 ± 11 vs 120 ± 13 mm Hg in the essential hypertension group (p < 0.01). All right-sided pressures were substantially higher in the hypertensive than in the normal patients (mean right atrial pressure: 2 ± 1 mm Hg for normals, 5 ± 3 mm Hg for hypertensives,p < 0.01; RV end-diastolic pressure: 3 ± 2 mm Hg for normals, 5 ± 2 mm Hg for hypertensives, p < 0.05; mean pulmonary artery pressure: 12 ± 3 mm Hg for normals, 17 ± 5 mm Hg for hypertensives, p < 0.01; mean pulmonary capillary wedge pressure: 6 ± 1 mm Hg for normals, 9 ± 3 mm Hg for hypertensives, p < 0.01. Cardiac index in normal and hypertensive patients was nearly identical (2.93 ± 0.80 1/min/m2 in normals, 3.11 ± 0.67 1/min/m2 in hypertensives, NS). In contrast, a markedly lower cineangiographic RV ejection fraction was present in the hypertensive compared with the normal patients (68 ± 6% vs 59 ± 7%, p < 0.01). The lower RV ejection fraction was due to the proportionately greater increase in the RV end-systolic volume index (22 ± 5 mI/M2 for normals, 34 ± 8 mI/m2 for hypertensives, p < 0.01) than in the end-diastolic volume index (69 ± 13 ml/m2 for normals, 82 ± 16 mI/M2 for hypertensives, p < 0.04) in the hypertensive patients. It is concluded that 1) hypertensive patients have higher right-sided pressures than normals, and 2) RV performance in essential hypertension may be characterized by a lower RV ejection fraction than in normal subjects.RIGHT VENTRICULAR (RV) performance in adult heart disease has received only scant attention compared with the efforts designed to study the left ventricular function. The most extensively investigated area of potential RV dysfunction is coronary artery disease, where RV ejection fraction has been measured in patients with and without the right coronary artery occlusion." 2 Furthermore, patterns of RV asynergy have been evaluated in acute3 and chronic4 ischemic coronary disease. Attempts have been also made to determine the extent of RV dysfunction in chronic obstructive pulmonary disease5 and adult congenital heart disease with RV pressure and volume overload,6 and to compare these findings with the results in normal adult population.7 Very little is known, however, about the nature of RV performance when the left ventricle is exposed to a chronic pressure overload that takes place in essential hypertension. Because the distortions of the normal geometry of the two ventricles influence each other's performance,8"16 this study was designed to investigate the impact of chronic left ventricular pressure overload in patients with essential hypertension on RV function and to compare these performance characteristics with ...

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Verapamil, a calcium antagonist, has been used extensively for treatment of cardiac arrhythmias. Concern persists, however, that it may seriously depress myocardial function in cardiac patients. To investigate this possibility, 20 patients with coronary artery disease (CAD) but no heart failure were given intravenous verapamil (0.1 mg/kg bolus, followed by 0.005 mg/kg/min infusion), and studied hemodynamically and angiographically. Verapamil markedly lowered mean aortic pressure (94 +/- 17 to 82 +/- 13 mm Hg, p less than 0.0005) and systemic vascular resistance (1413 +/- 429 to 1069 +/- 235 dyn-sec-cm5, p less than 0.0005). Simultaneously, all indices of left ventricular (LV) performance greatly improved: cardiac index rose from 2.8 +/- 0.6 to 3.1 +/- 0.7 1/min/m2 (p less than 0.0005), mean velocity of circumferential fiber shortening increased from 0.85 +/- 0.39 to 0.97 +/- 0.46 circ/sec (p less than 0.01), and ejection fraction improved from 55 +/- 16 to 61 +/- 18% (p less than 0.01). No significant changes were noted in the heart rate before and after verapamil administration, and verapamil did not worsen the extent of LV asynergy in the majority of patients. In patients with CAD, the intrinsic negative inotropic effect of verapamil is of negligible importance because its potent vasodilatory properties more than compensate for any intrinsic decrease in LV contractility, and thereby improve the overall cardiac function.

While left ventricular (LV) performance in patients with coronary artery disease (CAD) has been extensively investigated, little attention has been given to right ventricular (RV) function in this disease. For this purpose, a new geometric model for RV volume has been developed and RV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI) and ejection fraction (EF) have been determined from biplane RV cineangiograms in 26 patients.Eight patients served as normal (control) subjects (group I). Eighteen patients with obstructive CAD comprised two other groups: six who had no significant disease of the right coronary artery (RCA) (group II) and 12 who had a high grade RCA lesion (group III). The mean values for EDVI, SVI and EF in group I were 76 ± 11 ml/m2, 50 ± 6 ml/m2, and 66 ± 6%. The only significant difference between groups I and II was that SVI was lower in group II tha.n in group I (P < 0.01). No measurements in groups II and III were statistically different from each other. However, markedly subnormal values were found in group III (EDVI: 61 ± 16 ml/m2, SVI: 33 ± 10 ml/m2 and EF: 52 ± 7%); all values being significantly lower (SVI and EF: P < 0.001; EDVI: P < 0.05) than in group I. RV end-diastolic pressure was normal in all patients. These findings may be related to 1) reduced RV compliance, 2) distorted LV geometry, 3) possible RV ischemia or 4) reduced Frank-Starling effect.LEFT VENTRICULAR GEOMETRY, volume and contractile parameters in normal hearts have been analyzed in great detail within the last 15 years.1-9 In addition, the effects of coronary artery disease on left ventricular performance have also been extensively studied.'0-"5 In contrast, much less attention has been given to the performance of the right ventricle in either normal subjects or patients with coronary artery disease. This has been due partially to the fact that the left ventricle was always considered the more important chamber of the heart. The relative neglect of right ventricular performance has been further compounded by difficulties in analyzing the geometry of the right ventricular chamber: while the left ventricular configuration approximately resembles an ellipsoid of revolution (and therefore renders itself to relatively simple mathematical analysis), the right ventricle has always been considered a somewhat Autopsied intact human hearts of various sizes without any significant gross abnormalities were used to prepare casts. A silicone disk, fitted with a cannula for injection of plastic compound, was sutured into the tricuspid valve orifice. The pulmonary artery was clamped just above the pulmonary valve. Dow-Corning Silastic A-RTV Mouldmaking Rubber treated with RTV-4 catalyst was then injected through the cannula. Filling pressure was maintained at approximately 15 cm H20. The filled heart was then suspended by sutures from a small stand, and the compound inside the right ventricle allowed to harden in this suspended state in order to minimize any potential distortion of the ri...

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