E.G. Nesukay, I.I. Giresh Evaluation of the right ventricular function in patients with arterial hypertension using speckle-tracking echocardiography

The aim – to study structural and functional state of the right ventricle in patients with essential hypertension and different levels of left ventricular hypertrophy (LVH) on the basis of longitudinal right ventricular myocardium strain assessment.

Material and methods. The study involved 64 patients with arterial hypertension, average age (55.7±1.1) years. The first group consisted of 17 patients without LVH, the second group included 17 patients with mild LVH, the third group included 15 patients with moderate LVH, and the fourth group consisted of 15 patients with severe LVH. Additionally, patients with LVH were distributed according to the dilatation of the left atrium (LA) into group A – 21 patients without dilatation of the LA, and group B – 26 patients with dilated LA. In all patients we performed echocardiography and speckle tracking echocardiography with analysis of longitudinal global systolic strain of the right ventricular (RV LGSS), and its rate (RV LGSSR) and early diastolic strain rate (SR) of LV (EDSRLV). We calculated E/EDSR ratio for the assessment of LV filling pressure.

Results. Decrease of RV contractile function that was characterized by RV LGSS and RV LGSSR was observed even in patients with mild hypertrophy, being more prominent along with increase of the hypertrophy level. Average RV LGSS in group 2 was 16.8±0.4 % which appeared less compared to group 1 (19.7±0.9 %). RV LGSSR in group 2 (0.82±0.03 s–1) and group 3 (0.83±0.03 s–1) indices were less compared to group 1 (1.02±0.06 s–1). In patients with dilated LA we found decreased contractile function of RV compared to the patients without LA dilatation. RV LGSS and RV LGSSR in group B were less compared to group A.

Conclusion. Impaired RV contractility can be explained by the fact that LA dilation in arterial hypertension occurs due to diastolic dysfunction progression which in turn, influences the RV contractile function. In group with severe LVH we detected direct correlation between indicators of RV deformation and EDSRLV, as also inverse correlation between RV LGSS and E/EDSRLV, confirming influence of LV diastolic function on RV contractility.

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