CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 5, September/October 2010
254
AFRICA
lar among the hypertensive subjects and the controls (0.89
±
0.25, 0.61
±
0.16 vs 0.80
±
0.2, 0.64
±
0.26 m/s, respectively;
p
>
0.05). However, the tricuspid early wave velocity was lower
among the hypertensive subjects than among the controls (0.39
±
0.12 vs 0.46
±
0.16 m/s, respectively;
p
<
0.05) while the peak
atrial velocity was higher among the hypertensive subjects, 0.44
±
0.11 vs 0.38
±
0.11 m/s, respectively;
p
<
0.05) (Tables 3, 4).
A significant statistical correlation was found between the
mitral E/A ratio and the tricuspid E/A ratio. A similar associa-
tion was also demonstrated between the peak pulmonary systolic
velocity and the peak aortic systolic velocities (Figs 1, 2).
Discussion
This study demonstrated that right ventricular diastolic dysfunc-
tion accompanies left ventricular diastolic dysfunction that is due
to hypertensive heart disease. This is in agreement with similar
studies done among Caucasian hypertensive subjects.
17,18
Right
ventricular structural changes also occur in hypertensive heart
disease.
In this study, the interventricular septal and posterior wall
thickness, common to both ventricles were significantly thicker
among the hypertensive subjects than in the controls. Left
ventricular end-diastolic dimensions were higher among the
hypertensive subjects than in the controls, while right ventricu-
lar dimensions in diastole were lower among the hypertensive
subjects. Nunez
et al
.
19
has demonstrated that right ventricu-
lar wall hypertrophy occurs in hypertensive subjects. It can
be deduced that the combination of increased thickness of
the posterior wall, interventricular septal dimension and right
ventricular wall thickness will ultimately lead to at least progres-
sive reduction in the right ventricular end-diastolic dimensions
before progressive dilatation may occur in the right heart. The
presence of LVH may also further lead to a compromise of the
right ventricular internal dimension due to an increase in wall
thickness.
An increaseddistension of either ventricle during diastole has
been shown to alter the compliance and geometry of the opposite
ventricleby either a direct mechanical effect (displacement of the
septum)or some other indirect process.
20
The right and leftventri-
cles share common muscle bundles, septum and pericardium.
20-22
TABLE 3. GENDERAND DOPPLER ECHOCARDIO-
GRAPHIC PARAMETERS BETWEEN HYPERTENSIVES
WITH LVHAND THOSEWITHOUT
Variable
Hypertensives
with LVH
(
n
=
40)
Hypertensives
without LVH
(
n
=
60)
p
-value
Gender (M/F)
31/9
34/26
0.032**
Tricuspid E/A
1.21
±
0.41 1.1
±
0.31 0.187
Mean pulm vel (m/s)
0.58
±
0.14 0.63
±
0.16 0.171
Mean peak pulm vel (m/s) 0.86
±
0.21 0.92
±
0.27 0.266
TE (m/s)
0.38
±
0.11 0.43
±
0.13 0.064
TA (m/s)
0.42
±
0.10 0.46
±
0.12 0.09
LAD (mm)
39.5
±
8.8 35.3
±
7.2 0.01**
RVD (mm)
21.5
±
7.8 20.0
±
8.1 0.379
**Statistically significant. LVH: left ventricular hypertrophy, TE:
tricuspid E (early) wave velocity, TA: tricuspid A (late atrial) veloc-
ity, Peak pulm vel: peak pulmonary systolic velocity, Mean pulm vel:
mean pulmonary velocity, Tricuspid E/A: tricuspid E/A ratio, RVD:
right ventricular dimension, LAD: left atrial dimension.
TABLE 4. PATTERN OF LEFTVENTRICULAR
AND DIASTOLIC DYSFUNCTIONAMONG
TREATED HYPERTENSIVES
Class of diastolic dysfunction
Left ventricle
(
n
=
100)
Right ventricle
(
n
=
100)
Normal
18
45
Reversed
52
39
Pseudonormal
20
9
Restrictive
10
7
Fig. 1. Correlation of the mitral and tricuspid early and
atrial pulse Doppler velocities (
r
=
0.405,
p
<
0.001).
Observed
Linear
3.00
2.50
2.00
1.50
1.00
0.50
Tricuspid e/a ratio
Mitral e/a ratio
0.00 1.00 2.00 3.00 4.00 5.00 6.00
Fig. 2. Correlation of the peak pulmonary and aortic
systolic velocities (
r
=
0.555,
p
=
0.002).
Observed
Linear
1.75
1.50
1.25
1.00
0.75
0.50
Peak pulmonary systolic velocity
Peak aortic flow velocity
0.00
1.00
2.00
3.00
4.00
