Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Right ventricular performance in arterial hypertension
Medical Clinic and Policinic B, University of Düsseldorf Germany
Address for correspondence. T. Neubaur, MD, Medical Clinic and Policlinic B, University of Düsseldorf, Moorenstr. 5,4000 Düeldorf 1, Germany
To investigate right ventricular function, 24 patients with arterial hypertension and five normotensive controls underwent equilibrium radionuclide ventriculography with simultaneous right heart catheterization. In normal subjects, left ventricular ejection fraction was 57±2% at rest and 71±5% on effort, and right ventricular ejection fraction (RVEF) averaged 51±5% at rest and 65±2% during exercise. Pulmonary vessel resistance (PVR) was 56±37 dyn. s. cm–5 at rest and 46 ±10 dyn.s.cm–5 on effort. Hypertensive patients were divided into three groups according to their left ventricular function: group 1 (n = 10) had normal left ventricular ejection fraction (LVEF) at rest and on effort (57±9%; 65±6%), in this group, right ventricular systolic reserve was reduced (RVEF52±7% at rest, ns; RVEF 57±7% on effort, P<0·01 compared to controls). Pulmonary vessel resistance during exercise averaged 78±24dyn.s.cm–5, which was significantly higher compared to controls (P<0·01). In group 2, left ventricular contractions were normal at rest (60±6%, ns) but deteriorated during exercise to 56±8% (P<0·001, compared to controls). These patients also showed a lack of right ventricular augmentation at ejection fraction (54 ±8% at rest, ns; 56±8% under exercise, P<0·05). PVR was significantly enhanced during exercise (88±40 dyn.s.cm–5, P<0·05 compared to controls). Group 3 patients had abnormal left ventricular ejection fractions at rest (44± 7%, P<0·01) and on effort (47 ±8%, P<0·001), and right ventricular function was also depressed (42±11% at rest, P<0·1; 46±12%during exercise, P<0·05). PVR was elevated significantly on effort (100±47 dyn.s.cm–5, P<0·05). In hypertensive patients, RVEF at rest correlated well with LVEF, but not with PVR. During exercise, RVEF correlated with LVEF and with increasing values of PVR. In contrast, there was no correlation between LVEF and SVR at rest or on effort.
Conclusion: (1) In hypertensive heart disease the left as well as the right ventricules are affected (2) At rest, right ventricular ejection fraction correlates with left ventricular ejection fraction, on effort it is also influenced by pulmonary vascular resistance.
Key Words: Arterial hypertension • right ventricle