CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
480
AFRICA
There were more females (69; 53.9%) than males (59; 46.1%) in
the series. The mean age of all subjects was 51.04
±
14.24
years,
while the mean SBP was 154.91
±
32.39
mmHg and mean DBP
was 94.89
±
18.51
mmHg. Overall, the prevalence of RVDD
almost doubled that of RVSD in the studied subjects (61.72 vs
32.03%,
respectively).
The majority of subjects (54; 42.2%) had NG, while 38 of
them (29.7%) had EH, 29 (22.7%) had CH, and seven (5.5%)
had CR. Subjects with EH had the highest prevalence of RVSD,
the largest cardiac chambers, lowest mean blood pressures, and
highest mean LVMI and PASP. The prevalence of RVDD was
high across the groups, but the differences between them were
not statistically significant (
p
>
0.05).
The pattern of antihypertensive prescriptions is presented in
Table 2, and was similar across the groups (
p
≥
0.05).
Overall,
only 38 subjects (29.7%) had controlled systolic (
<
140
mmHg)
and diastolic (
<
90
mmHg) blood pressures at the time of
recruitment into the study, and blood pressure was controlled in
the majority of subjects with EH (55.3%).
Univariate regression analyses were carried out to test for
variables associated with RVSD or RVDD. Age was found to be
the only variable that was associated with RVDD, with an OR
of 1.032, 95% CI of 1.004–1.060, and
p
-
value of 0.023. Several
variables were found to be significantly (
p
<
0.05)
associated
with RVSD in univariate analyses. These variables were left
atrial dimension, LV end-diastolic dimension (LVEDD) and
volume (LVEDV), LV end-systolic dimension (LVESD) and
volume (LVESV), LVEF and PASP. However, LVEF was the
only variable that was independently associated with RVSD after
controlling for the confounding factors (OR
=
0.943; 95%
CI
=
0.897–0.993;
p
=
0.025).
The correlates for the indices of RVSD and RVDD are
presented in Table 3. The only correlate for the E
m
:
A
m
ratio was
age (
r
=
–0.237,
p
=
0.016),
while several variables were found
to correlate with both TAPSE and S
m
.
In univariate analyses, the main determinants of having NG
in the present series were higher BMI and LVEF, and reduced
RVOTd, left atrial diameter, LVEDD, LVESDandPASP (
p
<
0.01
for each). However, BMI (OR
=
2.011; 95%
CI
=
1.100–3.679;
p
=
0.023)
and LVEF (OR
=
1.273; 95%
CI
=
1.042–1.555;
p
=
0.018)
were the only determinants of NG that maintained their
significance after controlling for other factors.
Discussion
This study describes the pattern of RVSD and RVDD in a
hypertensive population grouped by LV geometric patterns. The
TABLE 3. CORRELATES OF INDICES OF RVSD
AND RVDD INALL SUBJECTS
Variables
TAPSE (mm)
S
m
(
cm/s)
E
m
:
A
m
Age (years)
r
–0.089
<
0.081
–0.237
p
-
value
0.351
0.398
0.016*
BMI (kg/m
2
)
r
<
0.152
<
0.081
+0.000
p
-
value
0.183
0.487
0.999
RVOTd (mm)
r
–0.126
–0.166
<
0.320
p
-
value
0.204
0.103
0.746
LVEDD (mm)
r
–0.230
–0.299
<
0.320
p
-
value
0.014*
0.001*
0.746
LVEF (%)
r
<
0.410
<
0.360
–0.064
p
-
value
<
0.001*
<
0.001*
0.519
LVMI(g/m
2
)
r
–0.189
–0.146
–0.070
p
-
value
0.045*
0.122
0.478
MV E:A ratio
r
<
0.005
–0.173
<
0.064
p
-
value
0.957
0.073
0.521
PASP (mmHg)
r
–0.353
–0.190
<
0.147
p
-
value
<
0.001*
0.059
0.152
All values are expressed as means
±
standard deviations or as numbers with
percentages in parentheses; *
p
-
value is statistically significant.
TABLE 2. PATTERN OFANTIHYPERTENSIVE
PRESCRIPTIONSAMONGALL SUBJECTS
Type of antihypertensive
EH
38 (29.7)
CH
29 (22.7)
CR
7 (5.5)
NG
54 (42.2)
CCB
8 (21.1)
5 (17.2)
3 (42.9)
8 (14.8)
Thiazides
7 (18.4)
7 (24.1)
2 (28.6)
12 (22.2)
ACEI/ARB
5 (13.2)
4 (13.8)
0
4 (7.4)
Combinations/others
18 (47.4) 13 (44.8)
2 (28.6)
30 (55.6)
CCB, calcium channel blockers; ACEI, angiotensin converting enzyme
inhibitors, ARB, angiotensin II receptor blockers. All values are expressed as
numbers with percentages in parentheses.
TABLE 1. PATTERN OF RV DYSFUNCTIONAND CHARACTERISTICS OF
SUBJECTS GROUPEDACCORDINGTO LV GEOMETRIC PATTERNS
Characteristics CH (
n
=
29)
EH (
n
=
38)
CR (
n
=
7)
NG (
n
=
54)
RVSD
6 (20.69)
20 (52.63)**
3 (42.86)
12 (22.22)
RVDD
16 (55.17)
23 (60.53)
3 (42.86)
37 (68.52)
TAPSE (mm)
19.35
±
4.33 17.12
±
4.92** 19.52
±
4.47 20.48
±
5.00
S
m
(
cm/s)
15.21
±
4.63 12.61
±
5.31** 15.28
±
5.95 16.30
±
5.56
E
m
:
A
m
0.92
±
0.52
0.95
±
0.59
1.11
±
0.94 0.99
±
0.64
RVOTd (mm)
28.62
±
7.34 29.47
±
5.83** 28.17
±
3.60 26.08
±
4.21
M/F
19/10**
21/17*
2/5
17/37
Age (years)
49.97
±
13.34 52.95
±
15.20 59.67
±
22.21 49.35
±
12.90
BMI (kg/m
2
)
25.01
±
3.88** 25.18
±
4.15** 22.22
±
3.77* 30.14
±
6.88
SBP (mmHg) 173.57
±
35.00 136.31
±
26.48 160.35
±
21.05 153.56
±
28.11
DBP (mmHg) 102.14
±
21.19 83.08
±
14.37* 100.62
±
18.23 97.50
±
16.11
Heart rate/min 89.55
±
35.80 93.50
±
14.36 82.82
±
18.69 85.12
±
16.96
Smoking
2 (6.9)
2 (5.3)
0
4 (7.4)
LA (mm)
39.90
±
7.64** 42.03
±
7.24** 40.14
±
6.87* 34.33
±
6.07
LVEDD (mm) 50.93
±
4.78** 64.95
±
8.87** 46.71
±
13.46 46.85
±
5.74
LVEF (%)
53.13
±
14.55** 32.99
±
15.76** 54.00
±
17.61* 65.36
±
10.10
MV E:A
1.54
±
1.72
1.85
±
1.56
0.68
±
0.26 1.17
±
1.02
PASP (mmHg) 34.59
±
22.18** 47.47
±
33.02** 22.93
±
16.23 22.80
±
14.43
LVMI (g/m
2
) 189.03
±
4015** 192.16
±
57.47** 114.57
±
8.40** 83.91
±
22.52
M/F, male/female; BMI, body mass index; SBP and DBP, systolic and diastolic blood
pressures, respectively; LA, left atrium; LVEDD, LV end-diastolic dimension; LVEF,
left ventricular ejection fraction; MV, mitral valve; E:A, ratio of early to late peak
filling velocities; PASP, pulmonary artery systolic pressure; LVMI, LV mass index;
RVOTd, RV outflow tract proximal dimension at end-diastole.
*
p
-
value statistically significant at
<
0.05
level, for comparisons between subjects
with NG and others.
**
p
-
value statistically significant at
<
0.01
level, for comparisons between subjects
with NG and others.
All values are expressed as means
±
standard deviations, or as numbers with percent-
ages in parentheses.
