Relationship between right and left ventricle mass in uncomplicated systemic arterial hypertension: a study with cardiac magnetic resonance

Background: Systemic arterial hypertension (AH) is a common clinical condition associated with an increased risk for cardiovascular disease and death. Little is known about the involvement of the right ventricle at an early stage of the disease. Our aim was: a) to assess the right and left ventricle volumes in hypertensive patients compared to a normotensive group by Cardiac Magnetic Resonance (CMR) b) to evaluate the right and left ventricle mass in hypertensive patients compared to a normotensive group by CMR c) to investigate if a relation between left and right ventricular mass exists. Methods: Using CMR (1.5 Tesla, GE Healthcare, Milwaukee, USA) we evaluated right (RVM) and left ventricles mass (LVM), right (RVEDV) and left (LVEDV) end diastolic volume, right (RVEF) and left (LVEF) ejection fraction in a group of mild to moderate hypertensive patients (n=19, male: 13, mean age: 58±10), without other clinical cardiovascular and systemic disease. As control (C) we included 19 healthy normotensive patients (male: 12, mean age: 46±14). Results: LVM was significantly higher in hypertensive patients than in controls (93±16 g/m2 vs. 62±11 g/m2, p< 0.001), while there were no significantly differences in LVEDV (77±16 ml/m2 vs. 79±14 ml/m2, p=ns), RVEDV (73±16 ml/m2 vs. 74±13 ml/m2, p=ns), LVEF (64±6% vs. 66±8%, p=ns) and RVEF (68±8% vs. 64±7%, p=ns). A statistically significant association was found between LVM and RVM only in the AH group (r=0.75, p<0.001). Hypertensive patients with hypertrophic left ventricle showed an increase in RVM comparing to controls (28±4 vs. 22±4 g/m2, p= 0.006). Conclusions: from these data we conclude that right ventricle is not an innocent bystander but it could be early involved in cardiac remodeling before a pressure overload is established in pulmonary circulation. The lack of significant relationship between LVM and RVM in control group, suggest a role of AH in the mechanism of right ventricle remodeling. However, more studies and investigation are necessary before the clinical importance of this phenomenon can be addressed.