Abnormal right ventricular mechanics in early systemic hypertension: a two-dimensional strain imaging study

To analyse the relationship between increasing systemic blood pressure (BP) and right ventricular (RV) function as assessed by two-dimensional strain imaging. Longitudinal peak strain and strain rate (SR) were sampled by speckle-tracking methodology at the RV free wall and interventricular septum (IVS) and RV and left ventricular (LV) structure and function were evaluated by conventional echo-Doppler sonography in 89 never-treated, non-obese subjects with office BP values varying from the optimal to mildly hypertensive range. Data were analysed by 24 h systolic BP (SBP) tertiles (cut-offs: 117 and 130 mmHg, n = 29, 30, and 30, respectively), thus partitioning subjects with optimal BP from those with high-normal and mildly increased values. RV peak systolic strain and early diastolic SR decreased in the mid-BP third without further changes in the upper tertile. IVS thickened gradedly by increasing systemic 24 h SBP; posterior wall remodelled to a lesser extent and poorly related to BP load and LV mass index did not change. RV and IVS systolic and diastolic strain indices associated inversely with increasing septal thickness. Conventional right and left indices of global ventricular function, left atrial size, and estimated systolic pulmonary pressure did not differ. Two-dimensional strain-assessed RV function is sensitive to increased systemic BP, even at levels below the conventional diagnostic limits for arterial hypertension. Subclinical RV systolic and diastolic abnormalities paralleled BP-driven septal remodelling, perhaps as a reflection of the crucial role played by IVS in RV function.