Right ventricular (RV) dysfunction has been shown to occur early and has major prognostic implications for patients with pulmonary arterial hypertension (PAH), but in patients with pulmonary hypertension (PH) due to left heart disease (LHD), data is scarce. We aimed to compare the echocardiographic changes of right heart in a group of patients having hypertensive heart disease with pulmonary hypertension (HHDPH) and hypertensive heart disease no pulmonary hypertension (HHDnPH).Design and Method:
This was a cross sectional hospital-based study. 109 participants underwent a detailed structural and functional 2D echocardiographic right heart assessment. PH was defined as an estimated right ventricular systolic pressure at or greater than 35 mmHg. 34 patients with HHDPH were compared to 65 patients with HHDnPH while 10 were excluded due to PH associated with chronic pulmonary disease, chronic thromboembolism & HIV. Data was analyzed using SPSS v. 22.Results:
Overall, the mean age was 59.1 ± 14.3years and 56.6% were female. No age or sex difference was observed between HHDnPH and HHDPH groups. Compared to HHDnPH group, patients with HHDPH had a longer mean duration of hypertension (9.6 vs. 4.8 years, p = 0.001) and presented with lower mean systolic (138.6 ± 23.1 vs 153.8 mmHg, p = 0.02) and diastolic blood pressures (79.4 ± 14.4 vs 92.4 mmHg, p = 0.001). Right ventricular (RVfwt) free wall thickness (0.8 ± 0.2 cm vs 0.6 ± 0.2 cm, p = 0.014), RV basal diameter (4.1 ± 0.7 cm vs 3.6 ± 0.6 cm, p < 0.001), and right atrial area (21.6 ± 8.1 cm2 vs 13.9 ± 3.4 cm2, p < 0.001) were higher in those with HHDPH compared to HHDnPH, while Tricuspid Annular Plane Systolic Excursion (TAPSE) (1.9 ± 0.5 cm vs 2.3 ± 0.5 cm, p < 0.001) was lower in HHDPH.Conclusions:
Our findings suggest that right heart remodeling occurs in parallel with progression of left heart disease and probably worsen with superimposition of pulmonary hypertension. A multicenter study of a larger sample is warranted to confirm these findings.