Right ventricular performance in essential hypertension.

Abstract

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 ...

Relation of RV Function to Presence and Degree of Systemic Hypertension

“…There was no significant statistical difference between the three studied groups (non-hypertensives, stage I hypertensives and stage II hypertensives) as regards age, sex, RV function measured by TAPSE, and other echocardiographic data obtained by 2D and M-mode. 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.…”

“…Ferlinz et al [13] demonstrated that right-sided circulation is not immune to the effects of systemic hypertension. The increase in the right-heart pressures among the essential hypertension patients was significantly different from the values in the normotensive controls.…”

Nonischemic changes in right ventricular function on exercise. Do normal volunteers differ from patients with normal coronary arteries?

“…30 This study was unable to confm these data, and despite a highly significant difference in systolic pressure between our groups there was no effect on either resting or exercise right ventricular function. The initial study used singleplane contrast angiography analyzed using a modified area-length formula.…”

O Ventrículo Direito e a Hipertensão Arterial: Aspectos Ecocardiográficos

“…Outro questionamento que se vem fazendo em relação aos hipertensos refere-se à função de ambos os ventrículos. Ferlinz 33 realizou cateterismo cardíaco em 20 indivíduos hipertensos e constatou aumento da pressão no átrio direito, aumento da pressão diastólica final do ventrículo direito, aumento da pressão em artéria pulmonar e em capilar pulmonar, débito cardíaco normal e queda da fração de ejeção do ventrículo direito. Nenhum dos pacientes apresentava evidência clínica, radiológica ou hemodinâmica de disfunção do ventrículo esquerdo, não podendo ser considerada, portanto, a causa do aumento de pressão nas câmaras direitas.…”

“…Sabe-se ainda que a circulação pulmonar responde à noradrenalina e à angiotensina com vasoconstrição pulmonar e aumento da pressão de artéria pulmonar. Desta maneira, a hipertensão arterial exerceria influência no coração, como um todo, reforçando o conceito de que os ventrículos direito e esquerdo representam, fisiologicamente, uma unidade funcional única 33 . Ao contrário do que sugeria Olivari e cols., que a função do ventrículo direito na hipertensão arterial podia ser predita com base no eletrocardiograma (hipertrofia do ventrículo esquerdo sem padrão de strain encontrada em indivíduos com função do ventrículo direito acima do normal e hipertrofia do ventrículo esquerdo com padrão de strain encontrada em indivíduos com disfunção do ventrículo direito) 18 , achados que não foram confirmados pelo estudo de Ferlinz 33 .…”