CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 5, September/October 2010
Cardiovascular Topics
252
AFRICA
Effect of systemic hypertension on right ventricular
morphology and function: an echocardiographic study
AA AKINTUNDE, PO AKINWUSI, OB FAMILONI, OG OPADIJO
Summary
Background:
Hypertension is an important cardiovascular
risk factor worldwide. It is associated with left ventricular
hypertrophy (LVH). Both diastolic and systolic dysfunction
may occur in hypertensive heart disease. The ventricles are
structurally and functionally interdependent on each other.
This was an echocardiographic study intended to describe
the impact of left ventricular pressure overload and hyper-
trophy due to hypertension on right ventricular morphology
and function.
Methods:
One hundred subjects with systemic hyperten-
sion and 50 age- and gender-matched normotensive control
subjects were used for this study. Two-dimensional (2-D),
M-mode and Doppler echocardiographic studies were done
to evaluate the structure and function of both ventricles.
Data analysis was done using the SPSS 16.0 (Chicago, Ill).
Statistical significance was taken as
p
<
0.05.
Results:
Age and gender were comparable between the two
groups. Hypertensive subjects had significantly increased left
ventricular end-diastolic dimensions, posterior wall thickness,
interventricular septal thickness, left atrial dimensions and
left ventricular mass and index. The mitral valve E/A ratio
was reduced among hypertensive subjects when compared
to normal controls (1.15
±
0.75 vs 1.44
±
0.31, respectively;
p
<
0.05). A similar pattern was found in the tricuspid E/A
ratio (1.14
±
0.36 vs 1.29
±
0.30, respectively;
p
<
0.05).
Hypertensive subjects also had reduced right ventricular
internal dimensions (20.7
±
8.0 vs 23.1
±
3.1 mm, respectively;
p
<
0.001) but similar peak pulmonary systolic velocity. The
mitral e/a ratio correlated well with the tricuspid e/a ratio.
Conclusion:
Systemic hypertension is associated with right
ventricular morphological and functional abnormalities.
Right ventricular diastolic dysfunction may be an early clue
to hypertensive heart disease.
Keywords:
hypertension, right ventricular function, echocardi-
ography, systolic dysfunction, diastolic dysfunction.
Submitted 24/8/09, accepted 10/3/10
Cardiovasc J Afr
2010; 21: 252–256
DOI: CVJ-21.007
Hypertension is an important non-communicable disease in
Africa. It is the most important cardiovascular risk factor.
1-4
Left ventricular hypertrophy is often associated with hyperten-
sion and is an adaptive mechanism to maintain or normalise
wall stress, sometimes at the expense of diastolic and long-axis
systolic function.
5
This adaptive mechanism is associated with
changes in left ventricular parameters and in chamber dimen-
sions, geometry and function.
6,7
These changes are progressive
and can ultimately lead to heart failure with systolic and/or
diastolic dysfunction.
8
However, the human heart functions as a
unit that includes the right ventricle.
8,9
The spectrum of changes
in structure, function and shape of the left ventricle ultimately
has an effect on the structure and function of the right ventricle.
The right ventricle is a thin-walled, low-pressure system.
Studies that evaluated left ventricular function abound in the
literature. However, studies about right ventricular structure and
function among hypertensive subjects are rare. The aim of this
study was to evaluate if any possible morphological and/or func-
tional changes might occur in the right ventricle in subjects with
systemic hypertension.
Echocardiography is a very useful and non-invasive diagnostic
tool, which can be used to diagnose ventricular hypertrophy and
various flow and pressure parameters in all cardiac chambers.
Echocardiography in the evaluation of right ventricular function
is important, as right ventricular dysfunction has been shown
to correlate significantly with disease progression in subjects
with chronic obstructive pulmonary disease,
10
dilated cardiomy-
opathy
11
and secondary pulmonary hypertension.
12
Therefore,
we proposed that it is important to document any possible right
ventricular systolic and/or diastolic dysfunction in subjects with
systemic hypertension.
This study was an echocardiographic evaluation of right
ventricular systolic and diastolic function in subjects with
systemic hypertension.
Methods
The study group consisted of 100 adult Nigerian hypertensive
subjects. Fifty age- and gender-matched normotensive subjects
were recruited as controls. Hypertension was diagnosed using
standardised criteria
13
and was defined as the use of antihyperten-
Division of Cardiology, Department of Internal Medicine,
LAUTECH Teaching Hospital, Osogbo, Nigeria
AA AKINTUNDE, FWACP,
PO AKINWUSI, FWACP
OG OPADIJO, FWACP
Division of Cardiology, Department of Internal Medicine,
Olabisi Onabanjo University Teaching Hospital, Sagamu,
Nigeria
OB FAMILONI, FMCP
Cardiology Clinic, Department of Internal Medicine III,
Eberhard Karls University, Tubingen, Germany
AA AKINTUNDE, FWACP
