Acta Medica Leopoliensia (Dec 2018)
Echocardiographic assessment of the dynamics of right ventricular function in patients with hypertensive heart disease during medical treatmen
Abstract
Aim. Study the functional changes and assess the dynamics of the longitudinal kinetics of the right ventricular myocardium in patients with hypertensive heart disease on the background of treatment. Materials and Methods. It was included 30 patients with hypertensive heart disease second degree and diastolic dysfunction of left ventricle. Individualized treatment was chosen for patients to achieve a normal level of blood pressure during 6 months of study. Echocardiography was performed before the research and after 6 months of antihypertensive treatment. The standard measurements of left heart chambers were performed, left ventricular ejection fraction was measured by method biplane Simpson, left ventricular mass myocardial index was calculated. The sizes of the right ventricular chambers were obtained from apex four-chamber view. From this view index TAPSE was measured and diastolic function of both ventricles was assessed by pulse-wave Doppler imaging. The longitudinal myocardial kinetics of the left and right ventricles was assessed by pulse-wave tissue Doppler imaging, obtaining systolic (peak velocity Sm, contraction time СТm) and diastolic (early velocity Em, atrial velocity Am, ratio Em/Am, deceleration time DTEm and isovolumic relaxation time IVRTm) indexes. Ratio E/Em and tissue myocardial performance index MPIm were calculated. The dynamics of longitudinal right ventricular kinetics was analyzed after 6 months of antihypertensive treatment. Results and Discussion. In study group the mean age of patients was 55,5±5,8 years. Blood pressure before treatment was 161/103±17,9/10,8 mmHg, after 6 months of treatment - 134/83±9,4/7,8 mmHg respectively (p<0,001). The sizes of the left and right atriums, left ventricular myocardial mass index, right ventricular longitudinal size and wall were considerably decreased after treatment by the results of echocardiography. There wasn't significant dynamics of the TAPSE value. By the results of pulse-wave Doppler imaging the first type of diastolic dysfunction was predominated in 83% for the right ventricle. The right ventricular diastolic function improved in parallel with the positive changes in left ventricular diastolic filling after the treatment. Right ventricular early diastolic myocardial velocity Еm (from 0,08±0,013 m/s to 0,11±0,015 m/s, р<0,001) and ratio Em/Am (from 0,70±0,150 to 0,90±0,194, р<0,001) were significantly higher, deceleration time DTEm (from 162±52 ms to 131±37 ms, р <0,001) and isovolumic relaxation time IVRTm (from 26±23 ms to 16±13 ms, р<0,001) were significantly lower by the results of pulse-wave tissue Doppler imaging. Tissue myocardial performance index MPIm was significantly lower (from 0,31±0,117 to 0,25±0,069, р<0,001), that pointed to improvement of global longitudinal right ventricular myocardial kinetics. Reverse right ventricular remodeling under the influence of medicaments that suppress the renin-angiotensin-aldosterone system, helps to improve its diastolic function. Another possible pathogenetic mechanism is the improvement of the endothelial function of the blood vessels of the pulmonary circulation. Conclusions. Longitudinal diastolic function of the right ventricle is improved in patients with hypertensive heart disease after 6 months of antihypertensive treatment. There are the parallel changes of longitudinal right and left ventricular myocardium kinetics, assessed by pulse-wave tissue Doppler imaging, with lowering blood pressure. The indexes of the longitudinal right ventricular myocardium kinetics can be important criteria to assess the development of the early signs of heart failure and the influence of treatment on right ventricular dysfunction.
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