Biventricular and aortic function in systemic hypertension: A speckle tracking echocardiographic study

Purpose. The aim of the present study was to assess whether systemic arterial hypertension is associated with abnormal right ventricular (RV) structure and function as assessed by three-dimensional speckle tracking echocardiography and how those changes are related to left ventricular (LV) strain, left ventricular hypertrophy (LVH) and aortic (Ao) function. Methods. We examined 115 hypertensive (mean age, 65±16 years; 52% male) and 115 healthy adults (mean age, 68±13 years; 54% male). Patients were divided into two groups: patients with LVH (Group I, LVMI>115g/m2 men, LVMI>95g/m2 women) and patients without LVH (group II). LV longitudinal (LS), circumferential and radial strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). Global area strain (GAS) was obtained as the percentage variation in the surface area defined by the longitudinal and circumferential strain vectors. RV free-wall longitudinal strain (LS) was determined by 3DSTE. Aortic (Ao) distensibility and stiffness index (SI) were calculated using accepted formulae. Global peak circumferential ascending thoracic aorta strain (Ao-S) by two-dimensional speckle tracking echocardiography was determined as an average of multiple segments of arterial wall deformation. The corrected aortic strain was calculated as the global aortic strain /pulse pressure. Data analysis was performed offline (GE EchoPAC). Results. Overall, Ao-SI was increased (r=0.74, p=0.003) and Ao-S was decreased (r=0.79, p=0.002) in hypertensive patients compared with controls. Ao-SI had a negative correlation with Ao-S (r=-0.76, p<0.001). Ao-S correlated with LV and RV longitudinal strain (r=0.62,p=0.02, and r=0.58,p<0.05, respectively) and LV and RV area strain (r=0.66,p=<0.01, and r=0.53,p<0.05, respectively). RV-LS and LV-GAS were lower in Group 1 patients compared to Group 2 (r=0.81, p<0.001), and lower in Group 2 patients compared to controls (r=0.59, p=0.02). There was a positive correlation between LV and RV LS (r=0.52, p<0.05). RV-LS was independently associated with Ao-S (β=0.37, p=0.01), LV-GAS (β=0.32, p=0.027) and LV-LS (β=0.26, p=0.034) in the whole hypertensive population. Conclusions. In systemic hypertension there is a complex interaction between LV strain, RV strain and Ao strain. Reduced RV strain can occur even in the absence of LV hypertrophy.