摘要
Background: Right ventricular (RV) dysfunction could develop during exercise in</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.05), A’</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.04). The global RV function showed also a significant increase (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.
Background: Right ventricular (RV) dysfunction could develop during exercise in</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.05), A’</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.04). The global RV function showed also a significant increase (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.
