CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
AFRICA
189
or reduced TAPSE. We have shown that patients in group 2 with
reduced TAPSE were older (
p
=
0.002), had longer duration of
hypertension (
p
=
0.054) and higher prevalence rates of other
indices associated with a poor prognosis. These indices include
higher prevalence rates of moderate to severe dyspnoea (
p
=
0.002), peripheral oedema (
p
<
0.001) and anaemia (0.016). In
addition, group 2 patients also had a shorter PR interval (
p
<
0.001), a longer QT
c
interval (
p
=
0.009), and a higher prevalence
of supraventricular tachycardias (
p
=
0.043), including atrial
fibrillation and flutter (
p
<
0.001).
Previous studies have shown that atrial tachyarrhythmias are
the most common arrhythmias encountered in patients with RV
failure. In the setting of acute RV failure or severe RV dysfunc-
tion, atrial tachyarrhythmias often lead to haemodynamic insta-
bility. Other studies have demonstrated that atrial flutter or atrial
fibrillation is associated with an increased risk of morbidity or
mortality in patients with RV myocardial infarction, pulmonary
hypertension, and congenital heart disease (CHD). Right atrial
dilatation and remodelling and postsurgical scars within the
atria, as in postoperative CHD, represent important substrates for
atrial flutter.
4,21-24
Our study has demonstrated the propensity of
HHD patients with RV systolic dysfunction to arrhythmias, but a
prospective study with a larger sample size would be needed to
corroborate the finding.
The strongest correlate to TAPSE was the septal mitral
annular-plane systolic excursion (
r
=
–0.541;
p
<
0.001). Other
workers have found a strong correlation between TAPSE and RV
ejection fraction,
2
as well as indices of RV diastolic function.
25
In the logistic regression model, age was among the predic-
tors of TAPSE (OR
=
1.035;
p
=
0.002), reconfirming the impor-
tance of age in predicting cardiovascular morbidity and mortality
among persons with high blood pressure.
15
Peripheral oedema is
another clinical variable that was found to predict reducedTAPSE
(OR
=
2.921;
p
=
0.043), and its presence suggests the presence
of RV failure. This finding is important, given that peripheral
oedema is an easy-to-identify physical sign, and its presence
increased the odds of reduced TAPSE almost three-fold.
The limitations of our study include the small sample size of
patients with RV systolic dysfunction, as well as the limitation
that is inherent to the study, which is the use of M-mode and 2D
echocardiography to study the RV. Studies have shown the supe-
riority of magnetic resonance imaging over other techniques for
studying the right ventricle.
26
However, echocardiography still
has acceptable sensitivity, is widely available and affordable, and
therefore has an important role in studying the right ventricle
despite its limitation. In addition, TAPSE is easy to obtain, is
reproducible, and is without significant inter-observer variabil-
ity.
2
To minimise this, all our echocardiograms were performed
by a single individual.
Conclusion
This study found that 29.6% of patients with HHD in Kano had
RV systolic dysfunction in the form of reduced tricuspid annular-
plane systolic excursion. Such patients tended to be older, had
evidence of worse LV systolic function and a higher prevalence
of supraventricular arrhythmias. Several variables were found
to correlate significantly with TAPSE, but the association was
strongest with septal mitral annular-plane systolic excursion.
Predictors of reduced TAPSE included age, peripheral oede-
ma and several echocardiographic variables. The presence of
peripheral oedema increased the odds of reduced TAPSE about
three-fold. We recommend that assessment of RV systolic func-
tion should be carried out routinely in all hypertensive patients
requiring echocardiographic evaluation.
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TABLE 4. CORRELATES OF TAPSE
Variable
TAPSE (mm)
r
p
-value*
Age (years)
+
0.385
< 0.001
Duration of hypertension (years)
–0.202
0.007
Heart rate
–0.263
0.001
PR interval (ms)
+
0.216
0.025
QT
c
interval (ms)
–0.256
0.004
RVOTd (mm)
–0.223
0.002
Left atrium (mm)
–0.232
0.001
LVEDD (mm)
–0.207
0.004
LVESD (mm)
–0.354
<
0.001
LVEF (%)
+
0.462
<
0.001
PV acceleration time (ms)
+
0.440
<
0.001
LV lateral APSE (mm)
+
0.534
<
0.001
Septal APSE (mm)
+
0.541
<
0.001
*
p
-value statistically significant; LVEF: left ventricular ejection
fraction; RVOTd: right ventricular out-flow tract dimension at end-
diastole; TAPSE: tricuspid annular plane systolic excursion; LVEDD:
left ventricular end-diastolic dimension; PV: pulmonary valve.
