Right ventricle may be involved in regional diastolic dysfunction earliest in primary hypertension patients

Impaired ventricular diastolic function is common in hypertensive patients and is one of the major causes of heart failure. Both left and right ventricle diastolic dysfunction have been reported, but the order of involvement is not clear.

A total of 161 primary hypertensive patients and 40 healthy volunteers were enrolled. Pulsed wave tissue Doppler was used to measure regional diastolic dysfunction (defined as early peak diastolic [Em] and late diastolic [Am] velocity ratios (Em/Am) < 1) at right ventricular tricuspid valve annulus lateral side (RAVP1), right ventricular tricuspid valve annulus septum side (RAVP2), left ventricular mitral valve annulus septum side (LAVP1) and left ventricular mitral annulus lateral side (LAVP2).

The prevalence of regional diastolic dysfunction at RAVP1, RAVP2, LAVP1, and LAVP2 was all higher in the hypertensive group (P < .001 for all). In both the hypertensive group and the control group, more cases were presented with RAVP1 diastolic dysfunction, while the least number of cases had LAVP2 diastolic dysfunction. In patients with stage 1 hypertension, most cases had RAVP1, or RAVP1 and RAVP2/LAVP1 diastolic dysfunction, while in patients with more advanced hypertension stages, significantly more cases had both RAVP1 and LAVP2, or all four locations diastolic dysfunction (P < .001). A similar trend was observed in patients with longer hypertension duration (duration of 6-9.9 years and 10-18 years compared with 2-5.9 years of duration, P < .001).

With a more advanced stage and longer duration of hypertension, the range of regional diastolic dysfunction increased, showing a trend from the right ventricular wall, to the septum and left the ventricular wall. In primary hypertension, regional diastolic dysfunction in the right ventricle might happen earlier than that in the septum and the left ventricle.