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Evaluation of Right Ventricular Function in Experimental Models of Pulmonary Arterial Hypertension
Published on: June 27, 2025
INFLUENCE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND HEART DYSSYNCHRONY ON THE COURSE OF ARTERIAL HYPERTENSION
V Kapustnik1, I Kostuyk1, B Shelest1
1Kharkiv National Medical University, Ukraine.
Insights
Left ventricular dysfunction and heart dyssynchrony predict worsening arterial hypertension, diabetes mellitus type 2, and obesity. Early detection of these cardiac issues is crucial for managing disease progression and improving patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Hypertension Research
Background:
- Arterial hypertension, diabetes mellitus type 2 (DM2T), and obesity are significant comorbidities.
- Left ventricular (LV) dysfunction and heart dyssynchrony are implicated in cardiovascular disease progression.
- Understanding their role in this patient population is crucial for prognosis.
Purpose of the Study:
- To determine the role of left ventricular dysfunction and heart dyssynchrony in the disease course and prognosis of patients with arterial hypertension, DM2T, and obesity.
- To identify specific echocardiographic parameters indicative of disease progression.
Main Methods:
- Retrospective analysis of clinical and echocardiographic data from 135 patients.
- Assessment of LV diastolic function using Doppler transmitral diastolic flow.
- Evaluation of heart dyssynchrony using M-mode and Doppler (PW/CW).
- Categorization into groups based on disease worsening (exaggerated target-organ damage) over 6 months.
Main Results:
- LV diastolic dysfunction is significantly associated with hypertension progression.
- Abnormal early (E) and late (A) ventricular filling velocities, and a reduced E/A ratio (≤1.0) were more frequent in patients with disease progression.
- Decreased diastolic filling time (≤200 ms) and prolonged isovolumic relaxation time (IVRT ≥201 ms) were also significantly associated with disease progression.
- LV dyssynchrony, particularly when associated with LV hypertrophy, is a strong predictor of a worsening disease course.
Conclusions:
- Diastolic dysfunction is a significant factor in hypertension progression among patients with T2DM and obesity.
- LV dyssynchrony is a valuable predictor of worsening disease course in hypertensive patients with T2DM and obesity.
- Echocardiographic assessment of LV diastolic function and dyssynchrony can aid in risk stratification and management.
Abstract:
The aim of the study is determination of the role of left ventricular dysfunction and heart dyssynchrony in the disease's course and prognosis in patients with arterial hypertension and diabetes mellitus type 2 (DM2T) and obesity. A retrospective analysis of clinical and special exam results was carried out in different groups: 1st group (n = 49), is characterized by worsening course (WC) of the disease, that was estimated 6 months after the beginning of the study; 2nd group (n = 86) without worsening of disease's course. The criterion of worsening course in patients was exaggeration of target-organ damage. The diastolic function of the myocardial infarction was assessed by recording the Doppler transmitral diastolic flow. Heart dyssynchrony was determined in the M-mode and pulse-wave/continuous-wave Doppler (PW/CW). The diastolic function of the LV has significant association with the progression of hypertension. The results of the study show that both slowdown and acceleration of the maximum early ventricular filling velocity (E) were indicative for patients with progression of the disease, and moderate E values was significantly more frequent in the group without progression of the disease. The maximum late ventricular filling velocity parameter (A) (acceleration) was significantly more common in the 1st group (p ≤ 0.001), and the moderate value of A index (≤ 0.71 msec.) was diagnosed more often in the group without progression. Furthermore, the decline of LV relaxation velocity (E/A ≤ 1.0) was detected in the group with disease's progression significantly more often (p ≤ 0.001) compared with the 2nd group, therefore we suppose that it has a pathogenic significance. In addition, a decrease in diastolic filling time ≤ 200 ms, as well as a slowing of the time of isovolumic relaxation of the LV (IVRT ≥ 201 ms) both revealed a pathogenic significance (p ≤ 0,001), which were diagnosed more often (p ≤ 0.001) in the group with disease's progression. Violation of diastolic function is a significant factor of the hypertension progression in patients with T2DM. The presence of LV dyssynchrony that is associated with the LV hypertrophy is a great predictor for the worsening course in hypertensive patients with T2DM and obesity.
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