Subclinical Echocardiographic Right Heart Changes Across Diastolic Function Continuum in Systemic Arterial Hypertension

Objective: Background: Left heart performance is well characterized throughout the spectrum of hypertensive heart disease and diastolic dysfunction, whereas right heart function remains sparsely described. We aimed to investigate the association between right atrium(RA) mechanics, right ventricle(RV) performance and left ventricle(LV) diastolic function in essential hypertension. Design and method: Hypertensive patients without overt cardiovascular disease were recruited. An extended echocardiographic imaging protocol(Vivid E95, GE) was performed and all subsequent analyses, including RV global strain(GS), RA reservoir strain(RAR), RA conduit strain(RACD), RA contractile strain(RACT) were conducted offline. Basic laboratory tests were performed. To assess diastolic function, a diastolic function index(DFI) was created. Spearman's correlations were used to assess convergent and discriminant validity of the DFI. Multivariate linear regression analysis was applied to identify independent correlates. Statistical analysis was conducted using SPSS software. Results: The study group included 219 patients(age 55.3±13.5 years, 55% females). The relevant factors, including serum concentration of N-terminal prohormone of brain natriuretic peptide(NT-proBNP), septal e’ and E/e’ were log-transformed separately, and then standardized. For each patient, the value of DFI was calculated as the mean of these standardized parameters. DFI was correlated with mitral E wave deceleration time(Spearman's rho=0,235, p<0,001), relative wall thickness(rho=0,249, p<0,001), tricuspid regurgitation wave maximal velocity(rho=0,265, p=0,003) and left atrial reservoir strain(rho=-0,365, p<0,001) but not with left atrial volume index(rho=0,054, p=0,428), tricuspid annular plane systolic excursion(rho=0,107, p=0,121), S’(rho=-0,113, p=0,122), LV global longitudinal strain(rho=-0,070, p=0,315) and LV mass index(rho=-0,082, p=0,315). Multivariate linear regression analysis revealed that RAR(p<0,001), heart rate during echocardiographic examination(p=0,043), hemoglobin concentration(p<0,001) and RACT(p=0,002) were independently correlated with DFI. On the other hand, age(p=0,468), sex(p=0,095), body mass index(p=0,677), serum creatinine level(p=0,948), office systolic blood pressure(p=0,748), RV GS(p=0,064) and RA volume(p=0,277) were not independently correlated with DFI. Conclusions: RA performance is associated with LV diastolic function in hypertensive patients. RAR and RACT, but not RV GS, are independent correlates of worse LV diastolic function, suggesting early RA involvement in hypertensive heart disease.