ASSESSMENT OF RIGHT VENTRICULAR PERFORMANCE AT REST AND WITH EXERCISE IN HYPERTENSIVE PATIENTS WITH LV DIASTOLIC DYSFUNCTION

Abstract

Background: Right ventricular (RV) dysfunction could develop during exercise in
patients with both hypertension and left ventricular diastolic dysfunction and may
contribute to the patient symptoms.
Objective: is to assess RV function ,both at rest and during exercise in patients with
hypertension and left ventricular diastolic dysfunction.
Methods: we included 30 patients with hypertension and resting LV diastolic dysfunction. The
systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic
Excursion) and S ︡, while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure
diastolic function. The global function of the right ventricle was assessed by measuring the right
indexed myocardial performance. The dimensions and pulmonary pressures were also measured.
Results: The following parameters of RV systolic function were increased significantly with
exercise: TAPSE (p = 0.0054), S’ (p= 0.0045). Moreover, the following diastolic parameters of
the RV increased significantly with exercise: E/E’ (p=0.05), A’(p=0.04). The global RV function
showed also significant increase (p=0.0011). The three RV dimensions as well as the pulmonary
artery pressures also increased during exercise, (p 0.000004, 0.001, and 0.00000064 respectively).
In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary
pressures during exercise (P =0.006). The advanced resting grade of LVDD predicted
significantly the presence of advanced grade of RVDD with exercise (P value =0.037).
Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed
structural and functional changes of the right ventricle at rest. However, all patients had RV
functional changes during exercise. pulmonary artery pressures