Synergic effects of renin and aldosterone on right ventricular function in hypertension

Gregori, Mario; Giammarioli, Benedetta; Befani, Alberto; Ciavarella, Giuseppino Massimo; Ferrucci, Andrea; Paneni, Francesco

doi:10.2459/jcm.0000000000000190

Cited by 5 publications

(3 citation statements)

References 34 publications

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“… 21) These bio-humoral mechanisms (most notably RAAS) are related to eccentric and concentric LVH patterns 23) as well as the major effect of RAAS on RV remodeling. 24) The interaction of the sympathetic nervous system, the RAAS, and insulin sensitivity, which causes LV and RV hypertrophy, diastolic dysfunction, and deformation impairments, may explain the connection between LV geometry and RV remodeling. The interdependence of the ventricles is especially important in explaining this connection.…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of 4D Echocardiographic Modality for Assessing RV Affection in Uncontrolled Hypertensive Patients

Hamdy

Habib

Mohamed

et al. 2022

J Cardiovasc Imaging

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BACKGROUND In many cardiovascular disorders, the contractile performance of the right ventricle (RV) is the primary determinant of prognosis. For evaluating RV volumes and function, 4 dimensional (4D)-echocardiography has become common. This research used 2D and 4D modalities to assess RV contractile performance in hypertensive patients. METHODS A total of 150 patients with essential hypertension were enrolled in this study, along with 75 age and sex-matched volunteers. Clinical evaluation and echocardiographic examination (including M-mode, tissue Doppler imaging, and 2D speckle tracking) were conducted on all participants. RV volumes, 4D-ejection fraction (EF), 4D-fractional area change (FAC), 4D-tricuspid annular plane systolic excursion (TAPSE), 4D-septal and free wall (FW) strain were all measured using 4D-echocardiography. RESULTS Hypertensive patients showed 2D-RV systolic and diastolic dysfunction (including TAPSE, 2D-right ventricular global longitudinal strain, RV-myocardial performance index and average E/EaRV) and 4D-RV impairment (including right ventricular EF, FAC, RV strain and TAPSE, right ventricular end-diastolic volume and right ventricular end-systolic volume) compared to the control group. We verified the prevalence of RV systolic dysfunction in hypertension patients using the following parameters: 1) 15% of them had 2D-TAPSE < 17 mm vs. 40% by 4D-TAPSE; 2) 25% of them had 2D-GLS < 19% vs. 42% by 4D-septal strain and 35% by 4D FW strain; 3) 35% of hypertensive patients had 4D-EF < 45%; and finally; 4) 25% of hypertensive patients had 2D-FAC < 35% compared to 45% by 4D-FAC. CONCLUSIONS The incidence of RV involvement was greater in 4D than in 2D-modality trans-thoracic echocardiography. We speculated that 4D-echocardiography with 4D-strain imaging would be more beneficial for examining RV morphology and function in hypertensive patients than 2D-echocardiography, since 4D-echocardiography could estimate RV volumes and function without making geometric assumptions.

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Section: Discussionmentioning

confidence: 99%

The Usefulness of 4D Echocardiographic Modality for Assessing RV Affection in Uncontrolled Hypertensive Patients

Hamdy

Habib

Mohamed

et al. 2022

J Cardiovasc Imaging

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“…This might be linked to the influence on the right ventricular systolic function via the helical muscle bundle, interventricular septum, and pericardium shared by the two ventricles, which increases with the LVMI ( 16 ). In addition, the SBP might affect the right ventricular free wall longitudinal strain as follows: when the blood pressure is elevated, various vasoactive substances mediated by activating the renin-angiotensin-aldosterone system could induce fibrosis and degeneration of the pulmonary vascular wall and intima, further affecting the right ventricular systolic function ( 29 , 30 ). Soylu et al ( 31 ) found a remarkably higher plasma aldosterone level in patients with concentric hypertrophy compared with patients with normal geometric and concentric remodeling, which might lead to different right ventricular myocardial mechanics for different left ventricular geometric patterns.…”

Section: Discussionmentioning

confidence: 99%

The impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with hypertension: A two-dimensional speckle tracking and three-dimensional echocardiographic study

Xue

Kang²,

Qin³

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThis study aimed to evaluate the impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with essential hypertension via two-dimensional speckle tracking and three-dimensional echocardiography.MethodsA total of 248 elderly people with essential hypertension were divided into four groups based on the left ventricular mass index (LVMI) and relative wall thickness (RWT): the normal geometric, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups. Moreover, 71 participants were recruited as the control group. These participants were examined by two-dimensional speckle tracking and three-dimensional echocardiography to obtain the right ventricular strain parameters, three-dimensional volume, and function parameters.ResultsThe right ventricular strain parameters decreased gradually from the normal geometric group to the concentric hypertrophy group (P < 0.05), and the strain parameters in the concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups were lower than those in the control and normal geometric groups (P < 0.05). The right ventricular three-dimensional echocardiographic parameters only changed in the eccentric hypertrophy group (P < 0.05) and the concentric hypertrophy group (P < 0.05) in the form of an increase in volume and a decrease in function. Multivariate linear regression analysis showed that the right ventricular free wall longitudinal strain was independently associated with the systolic blood pressure (SBP), LVMI, and RWT (P < 0.05) and was primarily affected by the LVMI (normalized β = 0.637, P < 0.05).ConclusionThe systolic function of the right ventricular myocardium declined in the elderly with essential hypertension due to impaired myocardial mechanics. The right ventricular strain parameters could indicate mechanical damage in the concentric remodeling group earlier than the right ventricular three-dimensional volume and function parameters. The right ventricular free wall longitudinal strain was primarily subject to the LVMI.

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“…Hyperaldosteronism might further aggravate right ventricular dysfunction, which has been shown in studies with conventional echocardiography, when measured as right ventricular myocardial performance index (RIMP) and tricuspid annular plane systolic excursion (TAPSE) [ 57 , 58 ]. Right ventricular–pulmonary arterial uncoupling can be assessed as the ratio of TAPSE to pulmonary arterial systolic pressure.…”

Section: Right Cardiac Evaluationmentioning

confidence: 99%

Strain Imaging for the Early Detection of Cardiac Remodeling and Dysfunction in Primary Aldosteronism

Chen

Tian

et al. 2022

Diagnostics

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Speckle tracking echocardiography is a novel technique to quantify cardiac function and deformation. It has been applied in a series of cardiovascular diseases for the evaluation of early cardiac impairment. We recently used this technique to investigate cardiac structure and function in patients with primary aldosteronism. Cardiac damage usually occurs earlier in patients with primary aldosteronism than those with primary hypertension, probably because aldosterone hypersecretion is more commonly observed in the former than the latter patients. In this article, we will review the imaging studies, especially with speckle tracking echocardiography, for the detection of early cardiac dysfunction in primary aldosteronism as a disease model.

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Synergic effects of renin and aldosterone on right ventricular function in hypertension

Abstract: Isolated hyperreninemia or hyperaldosternism determines a similar impairment of the right ventricular function, whereas their combination is further detrimental. Renin and aldosterone may represent early biomarkers of right ventricular dysfunction in hypertension.

Cited by 5 publications

References 34 publications

The Usefulness of 4D Echocardiographic Modality for Assessing RV Affection in Uncontrolled Hypertensive Patients

The Usefulness of 4D Echocardiographic Modality for Assessing RV Affection in Uncontrolled Hypertensive Patients

The impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with hypertension: A two-dimensional speckle tracking and three-dimensional echocardiographic study

Strain Imaging for the Early Detection of Cardiac Remodeling and Dysfunction in Primary Aldosteronism

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