Key result
Uncontrolled hypertension linked to ~17% lower 4D RVEF versus controls, revealing dysfunction missed by 2D echo.
Why the study?
Right ventricular contractile performance determines prognosis in many cardiovascular disorders, motivating the use of 2D and 4D echocardiographic modalities to evaluate RV performance in hypertensive patients.
Does 4D-echocardiography detect right ventricular dysfunction more frequently than 2D-echocardiography in patients with essential hypertension?
Case-Control (n=225)
No
Does 4D-echocardiography detect right ventricular dysfunction more frequently than 2D-echocardiography in patients with essential hypertension?
4D-echocardiography detects right ventricular dysfunction more frequently than 2D-echocardiography in patients with essential hypertension, likely due to avoiding geometric assumptions.
BACKGROUND: In many cardiovascular disorders, the contractile performance of the right ventricle (RV) is the primary determinant of prognosis. For evaluating RV volumes and function, 4 dimensional (4D)-echocardiography has become common. This research used 2D and 4D modalities to assess RV contractile performance in hypertensive patients. METHODS: A total of 150 patients with essential hypertension were enrolled in this study, along with 75 age and sex-matched volunteers. Clinical evaluation and echocardiographic examination (including M-mode, tissue Doppler imaging, and 2D speckle tracking) were conducted on all participants. RV volumes, 4D-ejection fraction (EF), 4D-fractional area change (FAC), 4D-tricuspid annular plane systolic excursion (TAPSE), 4D-septal and free wall (FW) strain were all measured using 4D-echocardiography. RESULTS: Hypertensive patients showed 2D-RV systolic and diastolic dysfunction (including TAPSE, 2D-right ventricular global longitudinal strain, RV-myocardial performance index and average E/EaRV) and 4D-RV impairment (including right ventricular EF, FAC, RV strain and TAPSE, right ventricular end-diastolic volume and right ventricular end-systolic volume) compared to the control group. We verified the prevalence of RV systolic dysfunction in hypertension patients using the following parameters: 1) 15% of them had 2D-TAPSE < 17 mm vs. 40% by 4D-TAPSE; 2) 25% of them had 2D-GLS < 19% vs. 42% by 4D-septal strain and 35% by 4D FW strain; 3) 35% of hypertensive patients had 4D-EF < 45%; and finally; 4) 25% of hypertensive patients had 2D-FAC < 35% compared to 45% by 4D-FAC. CONCLUSIONS: The incidence of RV involvement was greater in 4D than in 2D-modality trans-thoracic echocardiography. We speculated that 4D-echocardiography with 4D-strain imaging would be more beneficial for examining RV morphology and function in hypertensive patients than 2D-echocardiography, since 4D-echocardiography could estimate RV volumes and function without making geometric assumptions.
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Hamdy et al. (2022) conducted a case-control in Uncontrolled essential hypertension (n=225). Uncontrolled essential hypertension vs. Age and sex-matched healthy volunteers was evaluated on 4D-Right Ventricular Ejection Fraction (4D-RV-EF) (p=0.001). Uncontrolled hypertensive patients demonstrated significantly reduced 4D right ventricular ejection fraction compared to healthy controls (33.6% vs 50.6%), with 4D-echocardiography detecting a higher incidence of systolic dysfunction than 2D modalities.
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