Author name:
مصطفى عبد الامير حسين زاهد
Supervisor name:
حسن علي الفرحان
Abstract:
Background : Hypertension is a heterogeneous disorder with a number of well defined as well as putative etiologies. It is a major risk factor for stroke and cardiovascular diseases, and is thus associated with significant morbidity and mortality.Arterial systemic hypertension may determine impairment of both left ventricular diastolic and systolic function, due to increased afterload but also to changes of left ventricular geometry and structure producing left ventricular remodelling and hypertrophy.Also the right ventricle might be involved in this process by structural and functional abnormalities. Right ventricular chamber diastolic dysfunction has been shown in uncomplicated arterial hypertension [30, 41, 42, 43]. To date, little information is available about functional changes of right ventricular walls in arterial systemic hypertension. This issue is crucial to better understanding of the mechanisms underlying right ventricular involvement in the hypertensive heart. Pulsed tissue Doppler has been used to analyze myocardial left ventricular wall motion abnormalities in several cardiac pathologies [45 - 50] and also appears suitable for assessing changes of right ventricular longitudinal function due to arterial hypertension.Aims : This study evaluates Right & Left ventricular functional and morphological changes in treated hypertensive patients using selected conventional and Tissue Doppler Echocardiographic methods, and Studies the relationship between changes in both Right & Left Ventricles of heart. Finally to determine the relationship between onset of disease and echocardiographic changes.Methods and Results : We selected one hundred and two treated hypertensive patients and 100 healthy age - and gender - matched controls, both study groups underwent echocardiographic examination using 2D, M Mode, Pulsed Doppler and Tissue Doppler imaging.Examination involved left ventricular septal and posterior wall thicknesses, internal dimensions, left atrial area, ejection fraction and LV mass, also Tissue Doppler derived waves' velocities S' , e', a' and e'\a' ratio. Right ventricular internal basal diastolic dimension, free wall thickness in diastole, right atrial area, TAPSE, PASP, fractional area change(FAC), PW tricuspid inflow waves' velocities e, a, and e\a ratio, Tissue Doppler derived myocardial performance index (MPI), S', e', a', and e'\a' ratio.Hypertensive patients had Higher than controls in : Left Ventricular walls' thicknesses, end diastolic dimension, LV mass, left atrial area, peak velocity S', a', Right Ventricular free wall thickness, Tricuspid inflow TV a wave velocity, right atrial area, PASP, TDI S' and a' waves velocities.Lower Values than controls in Left Ventricular TDI peak velocity of e' wave and e'\a' ratio, Right ventricular Tricuspid inflow PW e wave velocity, e\a ratio, internal diastolic dimension, TDI e' and e'\a' ratio.The systolic function of both ventricles was not reduced.The diastolic function of both left and right ventricles were impaired, the Tissue Doppler derived e'\a' ratios were strongly correlated in both ventricles.There was a strong correlation between LVH and both Tissue Doppler derived RV & LV diastolic dysfunction.By studying correlation of echocardiographic finding with disease duration there was a strong relationship with both LVH and RV tissue Doppler diastolic dysfunction.Conclusion : Systemic arterial hypertension causes morphological and functional changes in both ventricles, initially systolic function of LV and RV are not affected; diastolic dysfunction in LV is considered as one of the earliest functional changes, studying RV revealed diastolic dysfunction which was strongly correlated with LV diastolic dysfunction by using Tissue Doppler imaging, also with LVH were highly correlated with disease duration.
