Left atrial enlargement and right ventricular hypertrophy in essential hypertension.

AIM: Diastolic dysfunction related to hypertensive left ventricular hypertrophy (LVH) has been shown to affect right-sided cardiac morphology and haemodynamics. As left atrial enlargement (LAE) is a marker of chronically elevated left ventricular (LV) filling pressure and diastolic dysfunction, we investigated the relationship between LAE and right ventricular hypertrophy (RVH) in systemic hypertension. METHODS: A total of 330 essential hypertensives, categorized according to tertiles of left atrial (LA) diameter indexed to body surface area were considered for the analysis. All subjects underwent a quantitative echocardiographic examination as well as extensive clinical and laboratory investigations. RVH was defined as anterior right ventricular (RV) wall thickness ≥ 6.0/5.5 mm in men and women, respectively, and LVH as LV mass index ≥ 51/47 g/m(2.7) in men and women, respectively. RESULTS: The prevalence of LVH increased across LA diameter tertiles from 21.0% to 50% and that of RVH from 26.3% to 41.8% (p < 0.01for both). This was also the case for biventricular hypertrophy (from 10.0% to 26.0%, p < 0.01). Differences in both LV and RV structure across LA diameter tertiles remained significant after adjusting for age, office systolic/diastolic blood pressure and duration of hypertension. Similar results were obtained when study population was divided according to absolute LA diameter tertiles. CONCLUSIONS: Our findings provide further evidence of an interaction between left and right chambers in systemic hypertension by showing that LAE is associated with RVH. The clinical and prognostic implications of such observation remain be evaluated in future prospective studies.

Is gender responsible for everything? The relationship between sex and right ventricular remodeling in metabolic syndrome.

BACKGROUND: The aim of this study was to examine the impact of metabolic syndrome (MS) on right ventricular (RV) remodeling in different genders. METHODS: The study included 341 subjects (216 subjects with MS and 125 controls). MS was defined by the presence of ≥ 3 ATP-NCEP-III criteria. All subjects underwent complete two-dimensional echocardiography. RESULTS: RV structure, diastolic, and global function were significantly impaired in MS subjects, in both genders. The multiple regression analysis of MS parameters showed that systolic blood pressure (BP) and waist circumference were independently associated with RV wall thickness in women, whereas the only independent predictor in men was systolic BP. The multivariate logistic regression analysis revealed that increased BP, impaired fasting glucose, and dyslipidemia were a combination of MS risk factors related with RV hypertrophy solely in women. Increased systolic BP, impaired fasting glucose, and abdominal obesity were independently associated with tricuspid E/e' in women, whereas increased systolic BP was the only independent predictor in men. Impaired fasting glucose, abdominal obesity, and dyslipidemia were a combination of MS criteria, which was independently associated with RV diastolic dysfunction only in women. CONCLUSIONS: Different parameters of MS are responsible for RV remodeling in women and men. The metabolic parameters of MS are more important for RV remodeling in women.

Gender influence on left ventricular structure and function in metabolic syndrome. Are women at greater risk?

PURPOSE: The aim of this study was to investigate the influence of metabolic syndrome (MS) on left ventricular (LV) structure and function depending on gender. METHODS: The study included 235 never-treated MS subjects and 138 controls. MS was defined as the presence of three or more National Cholesterol Education Program's Adult Treatment Panel III criteria. All the subjects underwent laboratory blood tests and complete two-dimensional, pulsed, and tissue Doppler echocardiography. RESULTS: LV structure, diastolic function, and global function were significantly impaired in all MS subjects. Multivariate analysis of individual MS factors showed that increased blood pressure (BP) and impaired fasting glucose were independently associated with LV hypertrophy in women, whereas the only independent predictor in men was increased BP. The same analysis revealed that the combination of impaired glucose level, abdominal obesity, and dyslipidemia was associated with LV hypertrophy only in women. Higher BP, impaired fasting glucose, and triglycerides level were independently associated with LV diastolic dysfunction in women, whereas higher BP was the only independent predictor in men. The combination of increased BP, fasting glucose, and dyslipidemia was independently associated with LV diastolic dysfunction only in women. CONCLUSIONS: Different MS factors are responsible for LV remodeling in women and men. The metabolic sequence of MS is more important for LV remodeling in women.

Does a nondipping pattern impact the right ventricle in hypertensive patients?

OBJECTIVE: The purpose of this study was to determine the influence of a nondipping arterial blood pressure pattern on the right ventricular (RV) structure, diastolic, and global function in recently diagnosed hypertensive patients. METHODS: This cross-sectional study included 189 recently diagnosed hypertensive patients. All participants underwent 24 h ambulatory blood pressure monitoring and a complete two-dimensional echocardiography examination. We determined the ratio of early diastolic transtricuspid and septal areas of the tricuspid annulus flow velocities (E/e')t, as well as appropriate time intervals for the estimation of the Tei index. RV hypertrophy was defined by RV wall thickness of at least 6.0 mm in men and at least 5.5 mm in women. RESULTS: The dipping blood pressure pattern was found in 107 (57%) participants, whereas the nondipping pattern was present in 82 (43%) hypertensive patients. The RV wall thickness as well as the (E/e')t ratio (5.12 ± 1.03 vs. 5.81 ± 1.12, P < 0.001) and the RV Tei index (0.42 ± 0.08 vs. 0.48 ± 0.11, P < 0.001) were increased in the nondippers (4.2 ± 0.84 vs. 4.7 ± 0.87 mm, P < 0.001). Analyses revealed that 24 h, daytime, and night-time systolic blood pressure, the nondipping status, and the left ventricular mass index were independently associated with RV wall thickness (P < 0.001 for all). The same parameters, along with RV wall thickness, were identified as independent predictors of RV diastolic function [(E/e')t] and RV global function (RV Tei index), respectively. CONCLUSION: RV structure, diastolic, and global functions were significantly impaired in nondipper hypertensive patients. A nondipping blood pressure pattern represents one of the independent predictors of RV diastolic and global function as well as RV hypertrophy.

Which factors impact myocardial function in systemic sclerosis?

BACKGROUND: The aim of our study was to determine clinical and echocardiographic parameters, which impacted the left (LV) and right ventricular (RV) diastolic and global function in patients with systemic sclerosis (SSc). METHODS: The study included 50 SSc patients and 48 age-matched healthy volunteers. All the patients underwent clinical examination, serological tests, pulmonary function testing, and complete two-dimensional echocardiography, which included pulsed and tissue Doppler. We determined the ratio of early diastolic transtricuspid/transmitral and the lateral area of the tricuspid/mitral annulus flow velocities (E/e';(lateral) ). RV and LV global ventricular function was estimated by the Tei index. Pulmonary vascular resistance (PVR) was calculated by using echocardiographic parameters. RESULTS: Tricuspid inflow E/A ratio was decreased in the SSc group (P < 0.001), also as e'/a' ratio (P < 0.001), whereas E/e'(tricuspid) was increased (P = 0.001). The RV Tei index was increased in SSc patients (P < 0.001). PVR was significantly higher than in controls (P < 0.001). The multivariate analysis showed that brain natriuretic peptide (BNP) level (ß= 0.403, P = 0.016), diffusion capacity for carbon monoxide (DLCO; ß= 0.361, P = 0.025), RV systolic pressure (ß= 0.449, P = 0.011), and PVR (ß= 0.507, P < 0.001) were independently associated with RV diastolic function (tricuspid E/e'(lateral) ). Similar results were achieved for the RV Tei index. Multiple regression showed that BNP level (ß= 0.337, P = 0.029), DLCO (ß= 0.405, P = 0.011), and PVR (ß= 0.449, P = 0.022) were independently associated with LV diastolic function (mitral E/e'(lateral) ). Similar results were obtained for the LV Tei index. CONCLUSION: Our study revealed some new noninvasive parameters (BNP, DLCO, and PVR), which are useful for everyday clinical practice for determining of early myocardial involvement in SSc. (Echocardiography, ****;**:1-11).

Are all criteria of metabolic syndrome equally harmful?

OBJECTIVE: The metabolic syndrome (MS) is associated with subclinical damage of different organs.The aim of this study was to determine which risk factors of MS were independently associated with left ventricular structure and function (diastolic and global). METHODS: The study included 204 subjects with MS and 88 control subjects with no risk factors. The metabolic syndrome was defined by the presence of three or more of ATP-NCEP III criteria. All subjects underwent laboratory blood tests, and complete two-dimensional echocardiography which also included tissue Doppler. The echocardiography was used to assess left ventricular (LV) structure (LVmass/Ht2.7), systolic (LVEF, Ssepptal, Slateral) and diastolic function, by pulse-wave Doppler (E/A ratio) and tissue Doppler imaging (E/e'average), and global function (Tei index). Appropriate time intervals for the estimation of the Tei index were obtained by tissue Doppler. RESULTS: The LV mass index, E/e'average and Tei index were significantly higher in the MS group, whereas there was no difference in LV systolic function. Multiple regression analysis showed that LVmass/Ht2 was independently associated with systolic blood pressure (beta = 0.41, P < 0.001) and waist circumference (beta = 0.22, P = 0.016).The same analysis revealed that E/e'verage was independently associated with systolic blood pressure (3 = 0.35, P < 0.001), waist circumference (beta = 0.24,P = 0.004) and triglycerides level (3 = 0.21,P = 0.012); while theTei index was independently associated with systolic blood pressure (beta = 0.42, P < 0.001) and fasting glucose (beta = 0.31, P < 0.001). CONCLUSION: MS impairs left ventricular structure and diastolic and global function. Systolic blood pressure was the only MS criterion which was, at the same time, independently associated with LVmass/Ht27, E/e'averag3, and the Tei index.