PreQC No. pulcj-23-6027 (PQ)

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1Cardiac Care Unit, Cedarcrest hospitals, Gudu, Abuja, Nigeria; 2Division Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife,
Osun State, Nigeria
Correspondence: Akande Blessing Atendikongye, Cardiac Care Unit, Cedarcrest hospitals Gudu, Abuja, Nigeria, e-mail akande.atendi@gmail.com
Received: 28-Decmeber-2022, Manuscript No. pulcj-23-6027; Editor assigned: 1-January-2023, PreQC No. pulcj-23-6027 (PQ); Reviewed: 14-January-2023, QC No.
pulcj-23-6027 (Q); Revised: 16-January-2023, Manuscript No. pulcj-23-6027 (R); Published: 23-Januray-2023, DOI: 10.37532/ pulcj-.22.7(1).1-8.
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Clin. Cardiol. J. Vol 7 No 1 January 2023 1
RESEARCH ARTICLE
Relationship between right ventricular systolic function, mean
pulmonary arterial pressure and left ventricular ejection fraction
in hypertensive heart failure patients seen at the Obafemi
Awolowo university teaching hospitals complex, ile-ife
Akande Blessing Atendikongye1, SA Ogunyemi2, RA Adebayo2, AO Akintomide2, OE Ajayi2, MO Balogun2
INTRODUCTION
eart failure is a major public health problem affecting
approximately 26 million patients worldwide [1, 2].There had
been a tremendous improvement in the prevention, diagnosis and
management of heart failure patients, however, outcome is still
suboptimal [3, 4].Therefore, identification of other predictors of
mortality in heart failure patients is rapidly evolving as an area of
extensive research [4].Studies have shown right ventricular
dysfunction as independent predictors of exercise tolerance and
mortality in heart failure patients [5]. Pulmonary hypertension is also
increasingly recognized as an important predictor of mortality in
heart failure patients [5-7].
There have been conflicting reports about the relationship between
RV function and pulmonary hemodynamics in heart failure patients
and most of these studies were carried out in Caucasians with scarcity
H
Atendikongye AB, Ogunyemi AS, Adebayo RA, et al. Relationship
between right ventricular systolic function, mean pulmonary arterial
pressure and left ventricular ejection fraction in hypertensive heart
failure patients seen at the obafemi awolowo university teaching
hospitals complex, ile-ife. Clin Cardio J. 2023; 7(1):1-8.
ABSTRACT
BACKGROUND:
The role of the Right Ventricle (RV) has been largely
underestimated compared to left ventricle in cardiac diseases.
Nowadays the importance of RV has been recognized as independent
risk factor for mortality in heart failure. Elevated Mean Pulmonary
Arterial Pressure (mPAP) is also a recognized independent predictor in
heart failure patients. There is a scarcity of data evaluating these
relationship in heart failure patients in sub-Sahara Africa. This study
was therefore designed to establish the relationship between RV systolic
function, Left ventricular ejection fraction and mPAP in hypertensive
heart failure patients in Obafemi Awolowo University Teaching
hospitals complex.
METHODOLOGY
: Eighty patients with heart failure secondary to
hypertension and 80 normal controls underwent clinical,
electrocardiographic and echocardiographic evaluation. Indices of right
ventricular systolic function that were measured include Tricuspid
Annular Plane Systolic Excursion (TAPSE), and Right Ventricular
Myocardial Performance Index (RVMPI) and mPAP was derived from
RV outflow tract acceleration time after pulse interrogation at level of
pulmonary valve
RESULTS:
Forty-two (52.5%) and 22 (27.5%) heart failure patients had
right ventricular systolic dysfunction and right ventricular global
dysfunction respectively as measured by TAPSE and RVMPI. Elevated
mean pulmonary artery pressure was found in 38(47.5%) of the
hypertensive heart failure patients. There was no relationship between
the indices of right ventricular systolic function and the estimated mean
pulmonary artery pressures. There were also no significant relationships
between left ventricular ejection fraction and estimated mPAP. The
independent predictor of right ventricular systolic dysfunction was the
LV ejection fraction.
CONCLUSION:
Right ventricular systolic function is impaired in
patients with heart failure secondary to hypertensive heart disease. There
is no relationship between the indices of right ventricular systolic
function and mean pulmonary artery pressure. Further studies are
needed to assess right ventricular systolic function in Nigerians
Key Words:
Heart failure; Hypertension; Nigeria; Right ventricular dysfunction; Sub-
Saharan Africa

2 Clin. Cardiol. J. Vol 7 No 1 January 2023
of data from sub-Sahara Africa [8-11]. Hypertensive Heart Failure
(HHF) had been reported in many studies in Sub-Sahara Africa as the
commonest cause of heart failure in contrast to ischemic heart disease
and diabetes mellitus as major causes of heart failure in the
Caucasians [12,13]. The advent of reliable and reproducible
echocardiographic measures of RV function such as Tricuspid
Annular Plane Systolic Excursion (TAPSE), RV Myocardial
Performance Index (MPI) 5 had made the assessment of RV function
in cardiac diseases easier and helped identify the important role of
RV in HF subjects [14]. Therefore, we undertook this study to
evaluate right ventricular function, pulmonary hypertension as well as
their relationship in hypertensive heart failure subjects in relation to
their left ventricular ejection fraction.
METHODOLOGY
This study was carried out at the Obafemi Awolowo University
Teaching Hospitals complex, Ile-Ife. Osun State. The study protocol
was approved by the ethics committee of the hospital and each
participant signed an informed consent form in accordance with the
Declaration of Helsinki. The study was cross-sectional in design.
Eighty patients with heart failure secondary to hypertensive heart
disease and 80 apparently healthy controls were recruited using the
simple random technique. The exclusion criteria among subjects with
heart failure included those with heart failure due to aetiology other
than hypertension even if co-existing with hypertension, co-
morbidities such as ischemic heart disease/myocardial infarction,
diabetes mellitus, thyroid disease, chronic kidney disease, anaemia,
asthma and Chronic Obstructive Pulmonary Disease (COPD). Other
exclusion criteria among subjects and controls included pregnancy,
current smokers, significant alcohol use of more than 14 units per
week for women and 21 units per week for men, gout, poor
echocardiographic window and refusal to give consent.
Echocardiographic studies
Trans-thoracic echocardiography was performed using a General
Electronics Vivid T8 cardiac ultrasound system on all subjects and
controls in the left lateral decubitus position and measurements were
taken according to the recommendations of the American Society of
Echocardiography and European Society of Echocardiography.
Measures of right ventricular systolic function evaluated included
Tricuspid Annular Plane Systolic Excursion (TAPSE) which was
acquired by placing an M-mode cursor through the tricuspid annulus,
in the apical four-chamber view, and measuring the amount of
longitudinal excursion of the annulus at peak systole and Right
Ventricular Myocardial Performance Index (RVMPI) which was also
acquired by tissue doppler pulse interrogation of the tricuspid lateral
annulus, in the apical four chamber view and measuring the ratio of
the sum of isovolumic periods( isovolumic relaxation time plus
isovolumic contraction time) to ejection fraction of right
ventricle(RV). TAPSE<1.6 was taken as impaired RV systolic function
and value of RVMPI>0.55 as impaired RV global dysfunction [14,
15].
Pulmonary hypertension was derived from the Mean Pulmonary
Arterial Pressure (mPAP) which is estimated from the Acceleration
Time (AT) during pulse doppler interrogation of the right ventricular
outflow tract just proximal to pulmonary valve at the parasternal
short axis view. mPAP was then calculated using the regression
equation by Dabestani et al, which is 90-(0.6 * AT) [16] .However, in
patients with heart rate>100 beats per min, or<70 beats per min, the
formula was corrected for by multiplying AT by 75, and dividing it by
the heart rate of the patient to improve its accuracy [17] .Value
greater than or equal to 25 mmHg was taken as pulmonary
hypertension [18].
Data management and analysis
Data was analysed using International Business Machines statistical
software version. Data were presented using descriptive statistics such
as tables. Categorical variables were represented as proportions and
percentages. Normally distributed numerical data was expressed as
mean ± standard deviation; while skewed numerical data was
expressed as median+(Inter-Quartile Range (IQR).
The Shappiro-Wilk's test was used to test for normality. Student's ‘t’
test, or the Mann Whitney's test (non-parametric testing for non-
nominaldata) were used to test for the differences in the continuous
variables between the two groups while chi-squared analysis was used
to test for the differences in the categorical variables between the
groups. Pearson's correlation was used to evaluate the bivariate
relationship between the parameters of RV systolic function, mPAP
and some clinical and echocardiographic indices. A stepwise logistic
regression model was used to determine the independent correlates of
RV systolic dysfunction. A two-tailed p-value of<0.05 was considered
significant.
RESULTS
Eighty subjects with hypertensive heart failure and eighty apparently
healthy subjects were studied.
Demographic characteristics of study participants
Table 1 showed the clinical characteristics of the study subjects. HHF
subjects were matched for age and sex with healthy controls in a ratio
of 1:1.
Body mass index, systolic blood pressure and diastolic blood pressure
were significantly higher in HHF patients compare to control.
Echocardiographic parameters of study subjects
Table 2 shows the echocardiographic parameters in study subjects. All
echocardiographic variables were significantly different between
subjects and controls. The median LV Ejection Fraction (LVEF) was
significantly lower in subjects with HF than controls, while LV End-
Diastolic Diameter (LVEDD) and left atrial diameter were
significantly higher in HF subjects than controls. TAPSE was
significantly lower in HF subjects than in controls while RV MPI and
mPAP were significantly higher in HF subjects than in controls.
TABLE 1
Demographic characteristics of the study participants
Characteristics ( Age in years)
HHF Cases (n=80) n
%
Controls (n=80) N
%
Statistical indices
<55
10
12.5
10
12.5
χ2=0.024
55-64
38
47.5
39
48.8
p =0.986

Clin. Cardiol. J. Vol 7 No 1 January 2023 3
≥ 65
32
40
16
32
Mean ± SD
62.03 ± 6.4
61.33 ±5.8
P=0.474
Gender
Male
38
47.5
38
47.5.
χ2=0.000
Female
42
52.5
42
52.5
p =1.000
Wt (Kg)
70.0 (64.0-80.0)
68 (65.0-72.0)
0.052
Ht (m) (mean ± SD)
1.67 ± 0.1
1.69 ± 0.1
0.021†
BMI (kg/m2)
24.37 (23.39-28.40)
23.50 (22.40-24.68)
<0.001
SBP (mmHg)
120.0 (110.0-140.0)
110.0(100.0-120.0)
<0.001
DBP (mmHg)
80.0(80.0-90.0)
77.5(70.0-80.0)
<0.001
NYHA functional classification
Mild limitation of physical
activity (Class II)
35
43.6
Marked Limitation of physical
activity (Class III)
45
56.3
χ2= Chi square, LR = Likelihood Ratio, SD=Standard Deviation, HHF= Hypertensive Heart Failure, * p Value Statistically Significant
KEY: Wt -Weight; Ht- Height; BMI -Body Mass Index; : SBP-Systolic Blood Pressure; DBP- Diastolic Blood Pressure; TC- Total Cholesterol; FBG- Fasting Blood
Glucose; HDL- High Density Lipoprotein; LDL- Low Density Lipoprotein; TG- Triglyceride. †T test.
RV systolic dysfunction was prominent in HHF subjects at 52.5%
and 27.5% as measured by TAPSE and RVMPI respectively.
Similarly, elevated mean pulmonary arterial pressure was observed in
about 47.5% of HHF subjects. About 53% percent of HHF subjects
in this study were in reduced LVEF (LVEF<40%) (Table 3).
TABLE 2
Distribution of echocardiographic variables in study
participants
Parameter
Case (n=80)
Control (n=80)
P value
Median (IQR)
Median (IQR)
LAD
4.4(4.2-4.5)
3.3(3.0-3.9)
<0.001*
LVPWD
1.3 ± 0.1
1.0 ± 0.2
<0.001* †
LVEF
38.5(33.0-56.0)
58.0(56.0-62.0)
<0.001*
LVEDD
5.8(5.5-5.9)
4.5(4.2-4.8)
<0.001*
Mitral E/A Ratio
0.88(0.68-2.26)
1.11(0.79-1.37)
0.232
Mitral E/E’
15.2(14.4-18.0)
7.5(6.8-8.7)
<0.001*
RVBD
3.7(2.8-4.1)
3.0(2.5-3.5)
<0.001*
TAPSE
1.4(1.2-1.8)
1.9(1.6-2.2)
<0.001*
RV MPI
0.51 ± 0.1
0.46 ± 0.01
<0.001* †
mPAP
24.7(22.0-48.1)
15.6(9.4-21.4)
<0.001*
Tricuspid Ratio E/A
1.09 ± 0.3
1.14 ± 0.3
0.299 †
LVMI
163.2(142.5-181.8)
76.4(66.0-89.2)
<0.001*
KEY: LAD: Left Atrial Dimension , LVPWD: Left Ventricular Posterior
Wall Thickness In Diastole ,LVEF: Left Ventricular Ejection Fraction ,
LVEDD: Left Ventricular End-Diastolic Dimension, RVBD: Right
Ventricular Basal Dimension , TAPSE: Tricuspid Annular Plane Systolic
Excursion , RV MPI: Right Ventricular Myocardial Performance Index ,
mPAP : Mean Pulmonary Arterial Pressure, LVMI: left Ventricular Mass
Index, ± : Mean ± Standard Deviation, † T test, Mann- Whitney U test for
Median(IQR), * P Value Statistically Significant
TABLE 3
Comparison of right ventricular functional and structural
abnormalities in study participants
Parameter
Cases
Control
Statistical Indices
(n=80)
(n=80)
N
%
N
%
TAPSE
42
52.5
2
2.5
**χ2
P<0.001*
RVMPI
22
27.5
0
0
**χ2
P<0.001*
mPAP
38
47.5
1
1.3
** χ2
P<0.001*
TAPSE: Tricuspid Annular Plane Systolic Excursion, RV MPI: Right
Ventricular Myocardial Performance Index, mPAP: Mean Pulmonary
Arterial Pressure * P Value Statistically Significant.
RV systolic dysfunction in HF subjects
Figure 1 shows the prevalence of RV systolic dysfunction in HF
subjects by TAPSE and RV MPI. Prevalence of RV systolic
dysfunction in HF subjects with preserved EF (LVEF>50%) was
35.7% by TAPSE and 28.6% by RV MPI. The prevalence of RV
systolic dysfunction was highest in HF subjects with LVEF<40%
(66.7% by TAPSE and 28.6% by RV MPI) and subjects with LVEF
between 40%-49% (30.0% by TAPSE and 20.0% by RV MPI) (Table
4)
TABLE 4
Association between right ventricular functional abnormalities,
mean pulmonary arterial pressure in HHF subjects and left
ventricular ejection fraction
Parameter
LVEF
≥ 50
LVEF 40-
49
LVEF<40
Statistical
Indices
n=28(100
%)
n=10(100
%)
n=42(100
%)
TAPSE
10(35.7)
3(30.0)
28(66.7)
**χ2
P=0.014*
RVMPI
8(28.6)
2(20.0)
12(28.6)
**χ2
P=0.848
Elevated
mPAP
14(50.0)
4(40.0)
20(47.6)
**χ2

4 Clin. Cardiol. J. Vol 7 No 1 January 2023
P=0.848
KEY: RVBD: Right Ventricular Basal Diameter, TAPSE: Tricuspid
Annular Plane Systolic Excursion, RVMPI: Right Ventricular Myocardial
Performance Index, AT: Acceleration Time of Pulsed Doppler Interrogation of
Right Ventricular Outflow Tract, **χ2=Fisher’s Exact, *P value is
statistically significant.
Figure 1) Prevalence of RV dysfunction in hypertensive heart failure subjects
Correlation of RV echocardiographic variables with clinical and
other echocardiographic variables in HF subjects
Bivariate correlation analysis showed that TAPSE correlated positively
and significantly with LVEF (r=0.419, p<0.001) while RV MPI
showed a significant negative correlation with LVEF (r=−0.270, p<
0.001). TAPSE also significantly correlated negatively with LVEDD (p
=0.014) and LAD (p<0.001) while RV MPI had a significant positive
correlation with LVEDD (r=0.290, p=0.009) as shown in Table 5.
TABLE 5
Correlation between selected echocardiographic parameters
with TAPSE and RVMPI in HHF subjects
Variables
TAPS
E
P
value
RVM
PI
P
value
LVEF
Correlati
on
0.419*
*
<0.00
1
Correlati
on
coefficie
nt
-0.270
*
0.015
coefficie
nt
LVEDD
Correlati
on
-
0.275*
0.014
Correlati
on
0.290
**
0.009
coefficie
nt
coefficie
nt
LAD
Correlati
on
-
0.381*
*
<0.00
1
Correlati
on
-0.036
0.754
coefficie
nt
coefficie
nt
mPAP
Correlati
on
-0.05
0.66
Correlati
on
0.156
0.168
coefficie
nt
coefficie
nt
RVMPI
Correlati
on
-0.051
0.65
Correlati
on
1
NC
coefficie
nt
coefficie
nt
Mitral E/E’
Correlati
on
-
0.243*
0.03
Correlati
on
-0.156
0.168
coefficie
nt
coefficie
nt
Mitral E/A
ratio
Correlati
on
-0.101
0.373
Correlati
on
-0.055
0.625
coefficie
nt
coefficie
nt
Tricuspid E/A
ratio
Correlati
on
0.141
0.213
Correlati
on
-0.086
0.45
coefficie
nt
coefficie
nt
TAPSE
Correlati
on
1
NC
Correlati
on
-0.05
0.66
coefficie
nt
coefficie
nt
RVBD
Correlati
on
-0.105
0.352
Correlati
on
0.103
0.364
coefficie
nt
coefficie
nt
LVMI
Correlati
on
0.231*
0.039
Correlati
on
0.034
0.764
coefficie
nt
coefficie
nt
AT
Correlati
on
0.05
0.66
Correlati
on
-0.228
0.042
coefficie
nt
coefficie
nt
NC=not computed
**Correlation is significant at the 0.01 level (2-tailed)
*Correlation is significant at the 0.05 level (2-tailed)
Predictors of RV systolic dysfunction in Hypertensive heart failure
subjects
On binary logistic regression on predictors of RV dysfunction, LVEF
was the only determimants among co-founders. Similarly, LVEF was
sole predictor of TAPSE on multiple regression analysis (Tables 6 and
7)
Table 6
Binary logistic regression analysis of the association between
TAPSE and measured echocardiographic parameters in HHF
subjects
Characteristic
s
Odds
ratio
Lowe
r
Upper
P
value
[95%
C.I]
LAD
2.078
0.252
17.11
6
0.497
LVEF
1.053
1.001
1.107
0.045*
LVEDD
1.99
0.588
6.729
0.268
P-value = 0.005, LAD = Left Atrial Dimension, LVEF = left ventricular
ejection fraction, LVEDD= left ventricular end-diastolic dimension, * p value
statistically significant
TABLE 7
Multiple regression analysis of the association between TAPSE
and echocardiographic parameters
Characteri
stics
Unstandardized
coefficients
Low
er
Uppe
r
P
value
95%
C.I
LAD
0.164
-
0.26
4
0.552
0.484
LVEF
0.017
0.00
8
0.026
0.001
*
LVEDD
0.079
-
0.14
3
0.301
0.48
p<0.001, LAD = Left Atrial Dimension, LVEF = Left Ventricular Ejection
Fraction, LVEDD= Left Ventricular End-Diastolic Dimension, *P value is
statistically significant
0
5
10
15
20
25
30
LVEF>50 LVEF 40-
49
LVEF <40
prevalence of RV dysfunction
in Hypertensive heart failure
subjects
LVEF%
TAPSE RVMPI

Clin. Cardiol. J. Vol 7 No 1 January 2023 5
DISCUSSION
In this study, about 53% of our subjects with hypertensive heart
failure have impaired RV systolic function. Also, about 48% of
subjects with heart failure secondary to hypertensive heart disease in
this study had elevated mean pulmonary artery pressure which
however, had no significant correlation with LV ejection fraction and
RV systolic dysfunction in the study population. The LV ejection
fraction, LV end- diastolic dimension and LAD are associated with
parameters of RV systolic dysfunction while LV ejection fraction is
the only independent determinants of RV systolic dysfunction in this
group of subjects with hypertensive heart failure.
The finding of high prevalence of RVSD in HHF subjects seen in this
study support findings from other studies that reported varying
prevalence of RV systolic dysfunction in subject with heart failure
between 35% and 65% [19, 20].
This study found RV dysfunction using TAPSE and RVMPI in
52.5% and 27.5% respectively. Researchers studied RV systolic
dysfunction in hypertensive heart failure subjects using TAPSE and
RV MPI and found RV dysfunction in 53% and 56% respectively.
The prevalence of TAPSE were comparable in both studies, however,
the high prevalence of abnormal RVMPI reported in their study may
be due to the fact that majority (84%) of subjects with heart failure in
their study had reduced ejection, this study reported subjects in
reduced ejection fraction in about 52% of heart failure subjects. RV
dysfunction has been reported to be more prevalent in subjects with
HFrEF.
A higher prevalence of RV dysfunction of 70% were also reported by
the study by meluzin et al using “Pulsed doppler tissue imaging of the
velocity of tricuspid annular systolic motion among heart failure
patients in Europe” although majority of the patients in their study
were candidates for heart transplantation which means they were in
end-stage heart failure, thus likely to also have more RV systolic
dysfunction than this present study [21, 22].
TAPSE is an easily reproducible measure of RV function and has
been found to correlate with the radionuclide angiographic estimate
of RV global systolic function [23]. However, TAPSE assumes that the
longitudinal displacement of a single segment represents the function
of a three-dimensional RV structure which is angle and load
dependent [24, 25].
Thus, these limitations to the use of TAPSE for assessing RV
function alone necessitates the validation of other methods to serve
as alternatives or further validate results obtained using one method.
RVMPI was shown by researcher to correlate with radionuclide-
derived RVEF.
Researchers found that RVMPI was a strong predictor of clinical
status and survival in subjects with pulmonary hypertension. The LV
Tei index has been well studied in subjects with HF [26]. However,
there is a scarcity of data on the clinical value of RV MPI. Thus, our
study decided to also assess RV function in subjects with HHF using
RVMPI.
Our study found significant relationship between indices of RV
systolic function and LV Ejection fraction. Result from this study
showed that subject in HFrEF (66.7%) had significant RVSD as
measured by TAPSE compared to those in HFpEF (35.7%) and
HFmrEF (30%) respectively. This finding corroborates findings from
other studies that had documented RVSD to be more prevalent in
patient with HFrEF than those in HFpEF. [21, 27, 28].
Puwanant et al in their study on “Right ventricular systolic function
in patients with preserved and reduced ejection fraction heart failure”
found RVSD measured by TAPSE in 40% of HFpEF and 76% in
HFrEF [28]. The higher prevalence reported in their study can be
explained from the different causes of HF in their study, greater than
50% of participants had coronary heart disease, 37% diabetics and
32.5% cardiomyopathy.
Coronary artery disease causes regional wall motion abnormalities
which may affect indices of RV systolic functions like TAPSE. In
addition, the RV may also be affected by the myopathic process in
patients with cardiomyopathy.
This study also found a high prevalence of impaired RV function in
HHF with Mildly Reduced Ejection Fraction (HFmrEF) at 30%.
There is a dearth of studies assessing this relationship in African
subjects with HFmrEF on echocardiography to compare with.
Impaired RV systolic function has been shown to be major adverse
factor in prognosis of heart failure patients. Therefore, there is need
for increased emphasis on evaluation of right heart in hypertensive
heart failure patients and more efforts at investigation of therapies
directed at the right heart.
This study found no relationship between the indices of RV systolic
function and mean pulmonary arterial pressure. There is conflicting
data on the pulmonary vasculature haemodynamics in hypertensive
subjects [3, 9, 10].
Researchers in their study on “prevalence, prognosis and outcome of
pulmonary hypertension in heart failure subjects” reported no
significant correlation between mPAP and RV fractional shortening
(another measure of RV systolic function) (r=–0.140; p=0.248) [9].
Similarly, researchers in their study on right ventricular systolic
function in HHF subjects found no relationship between PH and
indices of RV systolic function (TAPSE: r=–0.034; p=0.7690; S’: r=
0.074; p=0.5282; RVFAC: r=0.083; p=0.64941 respectively) [6].
Furthermore, researchers in their study on predictors of right
ventricular function in heart failure using TAPSE reported no
association between pulmonary hypertension and TAPSE [8].
However, these findings differ from what was reported in other
studies [11, 12, 29].
Researcher in another study on “right ventricular dysfunction in a
hypertensive population stratified by patterns of left ventricular
geometry” observed that PASP was a correlate of TAPSE. However, S’
(another parameter to assess RV systolic function) had no
relationship with PASP [14]. This finding was however on
hypertensive patient without any evidence of heart failure.
Researcher found an inverse relationship between PAP and RV
ejection fraction. However, it was reported in their study that some
patients had preserved RV function despite elevated PAP. They also
observed that the inverse relationship between PAP and RV
dysfunction was more common in patients with RV dysfunction
arising from RV afterload mismatch seen in dilated and ischemic
cardiomyopathy [8].
This may explain why this present study did not observe any statistical
significant relationship between PAP and RV systolic function
measured using RVMPI and TAPSE as the mechanism of right
ventricular dysfunction in hypertension result more from ventricular
interdependence than changes in pulmonary vasculature [11].
Another possible reason for the failure of this study to demonstrate
significant relationship between mPAP and RV systolic functions may
be attributed to use of diuretic therapy among our HHF patients.

6 Clin. Cardiol. J. Vol 7 No 1 January 2023
Diuretics have been documented to reduce pulmonary arterial
pressure [8].
On binary logistic regression analysis for predictors of RV
dysfunction, factors that were associated with abnormal RV
dysfunction included LVEF, LVEDD and LAD while on multiple
regression analysis; only LVEF was the sole determinants of TAPSE.
Our finding corroborates what was reported by Ojji et al in Nigeria
who also found LVEF as only predictor of RV dysfunction using
TAPSE [14]. This is similar to previous studies in Caucasians by De
Groote P et al in their study on “Right ventricular ejection fraction is
an independent predictor of survival in patients with moderate heart
failure” [30, 31].
CONCLUSION
Similarly, researcher in their study titled “Right ventricular
dysfunction as an independent predictor of short- and long-term
mortality in patients with heart failure” reported LVEF as sole
determinants of TAPSE. However, this differs from what was
reported by researcher in south-western Nigeria where LVEF had no
independent relationship with RV systolic dysfunction. They further
reported that their use of composite values for TAPSE, RVFAC and
S’ could have attributed to the lack of relationship between LVEF
and right ventricular systolic function seen in their study.
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