Right ventricular affection in essential hypertension

ABSTRACT

The present study was designed to assess right ventricular affection in systemic hypertension. This study included 60 males subjects, 20 healthy subjects as a control group; 20 hypertensives with mild or no LVH and 20 hypertensives with marked LVH. Thorough clinical examination, 12-lead surface ECG, chest X-ray and Echo-Doppler evaluation of systolic and diastolic functions of both left and right ventricles were done for each subject. This study showed that the thickness of right ventricular anterior wall was increased in the 2 hypertensive groups. Alteration in the systolic function of the right ventricle was represented by the increase in pulmonary maximum velocity [V-wax], and pulmonary ratio of [V[2]/AT]. Changes in right ventricular diastolic function were represented by augmentation of late filling of the right ventricle as indicated by increased tricuspid peak velocity A and time velocity integral of the A wave, In addition, early filling of the right ventricle in patients with less LVH was augmented as indicated by the increase in tricuspid peak velocity E and Peak filling rate normalised to stroke volume. Moreover, A-wave acceleration [AIAT-A] was increased in the 2 hypertensive groups and it was found to be the most sensitive parameter that can detect diastolic dysfunction in hypertensive patients. A direct significant correlation was found between both left and right systolic and diastolic indices in the hypertensives. In conclusion, the present study showed alteration in the structure and functions [systolic and diastolic] of the right ventricle in patients with essential hypertension with or without LVH. This RV affection seems not to be due to PH++ secondary to L.V.F. and it is not related to extent of LVH_.hence, some systemic factors may be involved in its pathogenesis