TY - JOUR
T1 - Synergic effects of renin and aldosterone on right ventricular function in hypertension
T2 - A tissue Doppler study
AU - Gregori, Mario
AU - Giammarioli, Benedetta
AU - Tocci, Giuliano
AU - Befani, Alberto
AU - Ciavarella, Giuseppino Massimo
AU - Ferrucci, Andrea
AU - Paneni, Francesco
PY - 2015
Y1 - 2015
N2 - Background Right ventricular dysfunction (RVD) is associated with poor cardiovascular outcome. The renin- angiotensin-aldosterone system is involved in alterations of the left ventricular geometry and function. Detrimental effects of the renin-angiotensin-aldosterone system on the right ventricular function are being postulated, but data supporting this assumption are still lacking. The aim of the study was to assess the impact of hyperreninemia, hyperaldosteronism or their combination on right ventricular function in hypertensive individuals. Methods Plasma renin activity (PRA) and plasma aldosterone concentrations (PACs) were measured in 116 hypertensive patients, divided as follows: normal PRA and PAC (n=38); high PRA and normal PAC (hypereninemia) (n=26); normal PRA and high PAC (hyperaldosternism) (n=27); high PRA and PAC (HRA) (n=25). Echocardiographic evaluation of the left and right ventricles (RV), including tissue Doppler imaging, was performed. RVD was identified by tissue Doppler Imaging-derived Myocardial Performance Index, calculated with a multisegmental approach. Results Indices of the right ventricular structure and function, as well as the prevalence of RVD, were higher in hyperreninemia and hyperaldosternism groups as compared with the normal group, and a further increase was observed in the HRA patients. Regression models showed a similar risk of RVD in the hyperreninemia and hyperaldosternism patients, regardless of systemic and pulmonary pressure, as well as left ventricular dysfunction. Notably, patients with both hyperreninemia and hyperaldosternism exhibited the strongest association with RVD as compared with patients with only hyperreninemia or hyperaldosternism. Conclusions Isolated hyperreninemia or hyperaldosternism determines a similar impairment of the right ventricular function, whereas their combination is further detrimental. Renin and aldosterone may represent early biomarkers of right ventricular dysfunction in hypertension.
AB - Background Right ventricular dysfunction (RVD) is associated with poor cardiovascular outcome. The renin- angiotensin-aldosterone system is involved in alterations of the left ventricular geometry and function. Detrimental effects of the renin-angiotensin-aldosterone system on the right ventricular function are being postulated, but data supporting this assumption are still lacking. The aim of the study was to assess the impact of hyperreninemia, hyperaldosteronism or their combination on right ventricular function in hypertensive individuals. Methods Plasma renin activity (PRA) and plasma aldosterone concentrations (PACs) were measured in 116 hypertensive patients, divided as follows: normal PRA and PAC (n=38); high PRA and normal PAC (hypereninemia) (n=26); normal PRA and high PAC (hyperaldosternism) (n=27); high PRA and PAC (HRA) (n=25). Echocardiographic evaluation of the left and right ventricles (RV), including tissue Doppler imaging, was performed. RVD was identified by tissue Doppler Imaging-derived Myocardial Performance Index, calculated with a multisegmental approach. Results Indices of the right ventricular structure and function, as well as the prevalence of RVD, were higher in hyperreninemia and hyperaldosternism groups as compared with the normal group, and a further increase was observed in the HRA patients. Regression models showed a similar risk of RVD in the hyperreninemia and hyperaldosternism patients, regardless of systemic and pulmonary pressure, as well as left ventricular dysfunction. Notably, patients with both hyperreninemia and hyperaldosternism exhibited the strongest association with RVD as compared with patients with only hyperreninemia or hyperaldosternism. Conclusions Isolated hyperreninemia or hyperaldosternism determines a similar impairment of the right ventricular function, whereas their combination is further detrimental. Renin and aldosterone may represent early biomarkers of right ventricular dysfunction in hypertension.
KW - Heart failure
KW - Hypertension
KW - Renin-angiotensin system
KW - Right ventricular dysfunction
KW - Tissue Doppler imaging
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U2 - 10.2459/JCM.0000000000000190
DO - 10.2459/JCM.0000000000000190
M3 - Article
C2 - 25233107
AN - SCOPUS:84947030288
VL - 16
SP - 831
EP - 838
JO - Journal of Cardiovascular Medicine
JF - Journal of Cardiovascular Medicine
SN - 1558-2027
IS - 12
ER -