The Usefulness of 4D Echocardiographic Modality for Assessing RV Affection in Uncontrolled Hypertensive Patients

Area of Science:

• Cardiology
• Medical Imaging
• Hypertension Research

Background:

• Right ventricular (RV) contractile performance is crucial in cardiovascular disease prognosis.
• Four-dimensional (4D) echocardiography is increasingly used for evaluating RV volumes and function.
• This study investigates RV contractile performance in hypertensive patients using 2D and 4D echocardiography.

Purpose of the Study:

• To assess and compare the utility of 2D and 4D echocardiography in evaluating right ventricular (RV) contractile performance in patients with essential hypertension.
• To determine the prevalence of RV systolic and diastolic dysfunction in hypertensive individuals using advanced echocardiographic techniques.

Main Methods:

• 150 patients with essential hypertension and 75 healthy volunteers underwent clinical evaluation and echocardiography.
• Echocardiographic assessments included M-mode, tissue Doppler imaging, 2D speckle tracking, and 4D echocardiography.
• Measurements comprised RV volumes, 4D-ejection fraction (EF), 4D-fractional area change (FAC), 4D-tricuspid annular plane systolic excursion (TAPSE), and 4D-septal and free wall (FW) strain.

Main Results:

• Hypertensive patients exhibited significant 2D and 4D-RV systolic and diastolic dysfunction compared to controls.
• 4D echocardiography identified a higher prevalence of RV impairment: 40% showed reduced 4D-TAPSE vs. 15% with 2D-TAPSE.
• 4D strain imaging revealed dysfunction in 42% (septal) and 35% (FW) of hypertensive patients, compared to 25% with 2D-global longitudinal strain (GLS).

Conclusions:

• 4D echocardiography demonstrates a greater incidence of RV involvement in hypertensive patients compared to 2D methods.
• 4D-echocardiography, particularly with 4D-strain imaging, is more beneficial for assessing RV morphology and function in hypertension due to its ability to estimate volumes and function without geometric assumptions.
• The findings suggest 4D echocardiography provides a more sensitive evaluation of RV dysfunction in hypertensive individuals.