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

Abstract

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.

The Role of Echocardiography in Evaluating Cardiovascular Diseases in Patients with Diabetes Mellitus

“…To supplement the 2D echocardiography, 3D measurements are recommended as they provide more accurate data for quantification of LV volume, despite the limitations of lower temporal resolution and higher dependency on image quality [ 42 , 43 ]. The 3D echocardiographic modality is also useful for the evaluation of right ventricular volume and function [ 44 ].…”

Right Ventricular Performance in Uncontrolled Hypertensive Patients: 2D vs. 4D Echo Study

“…As the author mentioned, hypertensive patients should be assessed for right heart involvement as well as left heart. 4) Whether these right heart changes occur early, at the same time as left heart changes due to interdependence of the two structures, or whether it is a secondary phenomenon possibly related to pulmonary vascular changes remains to be proven by further studies. For the evaluation of RV involvement in hypertensive patients, 4D echocardiographic assessment is more sensitive and comprehensive than 2D echocardiographic evaluation.…”

“…However, previous studies showed RV dysfunction in untreated or mildly hypertensive patients using mainly 2-dimensional (2D) echocardiographic study. 4) This study represented a real clinical situation because enrolled patients had already been prescribed and taken the medications for at least 30 months.…”