The impact of metabolic syndrome, recently diagnosed diabetes and hypertension on right ventricular remodeling. Is there difference between risk factors?

Abstract

The aim of this study was to compare the right ventricular (RV) structure and diastolic function between normotensive and non-diabetic subjects with metabolic syndrome (MS), and new diagnosed diabetic and hypertensive patients. Study included 89 normotensive and non-diabetic subjects with MS which was defined by the presence ≥3 ATP-NCEP-III criteria, 45 diabetic and 117 hypertensive patients, as well as 76 controls with no MS criteria, matched for age and sex. All subjects underwent laboratory blood tests and complete two-dimensional echocardiography including pulsed and tissue Doppler. RV free wall thickness was similar between MS and diabetic patients, but significantly lower than in hypertensive patients (4.6 ± 0.8 versus 4.3 ± 0.7 versus 4.9 ± 0.9 mm; p < 0.01). Tricuspid E/e' ratio was similar between observed groups (5.3 ± 1.2 versus 5.2 ± 1.1 versus 5.7 ± 1.2, p > 0.05). RV systolic function evaluated by tissue Doppler (st) was similar between MS and diabetic participants, but still worse than in hypertensive patients (13.1 ± 2.2 versus 13.5 ± 2.5 versus 12.5 ± 2.4, p < 0.05). Global RV function estimated by Tei index was similar among MS and diabetic patients, and most impaired in hypertensive patients (0.47 ± 0.09 versus 0.45 ± 0.08 versus 0.52 ± 0.1, p < 0.01). Increased fasting glucose level, abdominal obesity and hypertension were independent predictors of biventricular hypertrophy, diastolic dysfunction and global dysfunction in whole population. RV structure and function gradually deteriorated from diabetic patients, across MS subject, to hypertensive patients. Normotensive and non-diabetic subjects with MS had similar level of RV impairment as diabetic patients which emphasize the synergic effects of MS components on cardiac damage.

Relationship between right ventricular remodeling and heart rate variability in arterial hypertension

“…We have also demonstrated that similar changes occur with the left ventricular structure and diastolic function in hypertensive patients. This is in line with our previous findings [10,20,21], and the results of other authors [22][23][24][25]. However, our study provided some new evidence about right ventricular function.…”

Left and right atrial phasic function and deformation in untreated patients with prediabetes and type 2 diabetes mellitus

“…However, only RA conduit and booster function were independently Int J Cardiovasc Imaging associated with HbA1c. Interestingly, in our previous study we did not find any difference in RA size between the diabetic patients and the healthy subjects; however, we did not investigate RA volumes [28]. Our investigation revealed that HbA1c, RV wall thickness, E/e 0 t and RA TotEF were independently associated with RA global longitudinal strain, which we reported earlier in the population of patients with high-normal blood pressure and hypertension [29,30].…”

The association between heart rate variability and biatrial phasic function in arterial hypertension

“…We have previously demonstrated that RA diameters and maximal volume were higher in hypertensive patients. 11,12,27 Using the 2DE strain analysis, we have recently reported impaired RA reservoir and conduit, and enhanced booster function among the hypertensive subjects. 11,12 However, this is the first time that we conducted a comprehensive analysis of phasic function of both atria in hypertensive subjects, using all available 2DE methods.…”