CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
478
AFRICA
Cardiovascular Topics
Right ventricular dysfunction in a hypertensive
population stratified by patterns of left ventricular
geometry
KAMILU M KARAYE, HADIZA SAI’DU, MOHAMMED N SHEHU
Abstract
Introduction:
The aim of this study was to assess the preva-
lence, determinants and correlates of right ventricular (RV)
systolic and diastolic dysfunction (RVSD and RVDD, respec-
tively) in hypertensives, stratified by left ventricular (LV)
geometric patterns.
Methods:
The study was carried out inAminu Kano Teaching
Hospital in Kano, Nigeria, and was cross-sectional in design.
Hypertensive subjects referred for echocardiography were
consecutively recruited after satisfying the inclusion criteria.
RVSD was defined as either tricuspid annular plane systolic
excursion (TAPSE) of
<
16
mm, or peak velocity of the systol-
ic wave (S
m
)
in tissue Doppler imaging (TDI) of the RV lateral
tricuspid annulus of
<
10
cm/s, or both. RVDD was defined
as the ratio of
<
1.0
of the peak velocities of the early (E
m
)
to
late (A
m
)
diastolic waves in the TDI of the RV lateral tricuspid
annulus. Subjects with normal LV geometry (NG) served as
controls, and were compared with those who had eccentric
(
EH) or concentric (CH) LV hypertrophy or concentric LV
remodelling.
Results:
A total of 128 subjects were recruited. Overall, the
prevalence of RVDD almost doubled that of RVSD in the
studied subjects (61.72 vs 32.03%, respectively). Subjects
with EH had the highest prevalence of RVSD (52.63%),
while those with CH had the lowest prevalence (20.69%) (
p
<
0.01).
By contrast, the prevalence of RVDD was high across
the four groups without significant statistical difference; as
high as 68.52% in subjects with NG and as low as 42.86% in
those with CR. LVEF was the only independent determinant
of RVSD after controlling for confounding variables, while
age was the only determinant of RVDD. Likewise, age was
the only correlate for E
m
:
A
m
ratio, while the best correlate for
both TAPSE and S
m
was LVEF.
Conclusion:
The study has revealed that about two-thirds
of the hypertensives had RVDD while about one-third had
RVSD. Subjects with EH had the highest prevalence of
RVSD, while RVDD was common across all the groups. LVEF
and age were the only independent determinants of RVSD
and RVDD, respectively.
Keywords:
hypertension, RV dysfunction, LV geometry, Nigeria
Submitted 16/10/11, accepted 24/2/12
Published online 2/5/12
Cardiovasc J Afr
2012;
23
: 478–482
DOI: 10.5830/CVJA-2012-014
Right ventricular (RV) systolic and diastolic functions have
repeatedly been studied in hypertensive subjects.
1,2
Abnormal
RV function has been found to be an independent, poor
prognostic factor in subjects with heart failure (HF) of various
aetiologies, including hypertension, and is associated with
increased morbidity and mortality.
3
Meluzin
et al.
3
assessed the prognostic power of RV systolic
and diastolic functional parameters derived from Doppler tissue
imaging (DTI) of tricuspid annular motion, and whether their
combination might improve the risk stratification of patients
with heart failure. They found that the combination of RV
systolic and diastolic functional parameters represents a very
powerful tool for risk stratification of patients with symptomatic
heart failure.
3
Abnormal LV geometry is also common in hypertensive
subjects.
4
Consideration of the level of LV mass and the LV
wall thickness/chamber radius ratio [relative wall thickness
Department of Medicine, Bayero University, Kano, Nigeria
KAMILU M KARAYE, MBBS, DIC, MSc, FWACP,
Aminu Kano Teaching Hospital, Kano, Nigeria
KAMILU M KARAYE, MBBS, DIC, MSc, FWACP
HADIZA SAI’DU, MBBS, FWACP
MOHAMMED N SHEHU, MBBS, FWACP
Fig. 1. Determination of LV geometric patterns in subjects
with hypertension.
Concentric
remodelling
Concentric
hypertrophy
Normal
geomety
Eccentric
hypertrophy
Relative wall thickness
>
0.42
≤
0.42
LV mass index
≥
125
g/m
2
<
125
g/m
2
