الفهرس 
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Abstract
Hypertension is commonly associated with Left ventricular diastolic dysfunction. Sparse evidence shows right ventricular functional changes in hypertensive patients with LVDD. These changes can be attributed to the stimulation of the sympathetic system, as well as the renin-angiotensine-aldosterone (RAAS) system, with subsequent LV remodeling and LVH. Genetic mechanisms may modulate the progression of these cardiac changes.
Exercise is a useful technique to magnify many cardiac changes (myocardial ischemia, ventricular functional changes and evaluation of the physical fitness as an initial step in cardiac rehabilitation programs).
Echocardiography (M-mode, conventional pulsed wave Doppler & TDI) is an ideal method of assessment of ventricular systolic and diastolic function.
Aim of the study:
Is to evaluate the right ventricular function in patients with hypertension and left ventricular diastolic dysfunction, at rest and with exercise.
Patients:
The study was conducted on 30 hypertensive patients, non-diabetic, non-ischemic, with normal sinus rhythm, normal left ventricular systolic function and left ventricular diastolic dysfunction. We excluded cases with valvular heart disease or right ventricular pathology, as well as cases with musculoskeletal problems.
Methods:
• All patients were subject to: full History taking, complete clinical examination, standard 12 leads resting ECG, routine labortory investigations.
• Then resting transthoracic echocardiographic was performed using the following modalities and parameters:
- 2D imaging: LAVI, RV dimensions
- M- Mode: LV: EF, EDD, ESD, IVSd, PWd, TAPSE
- PW doppler: LV E/A, RV E/A, PAT
- TDI: LV: Average E/E’, septal E’, lateral E’, RV: S’, E/E’, E’, A’, RIMP.
- Then we performed a symptom limited stress test on treadmill using modified Bruce protocol, with appropriate monitoring & precautions.
- An echocardiographic study performed immediately after the exercise (using the same parameters previously mentioned).
Results:
• Diastolic dysfunction is as biventricular phenomenon as the resting E/A of both ventricles was significantly correlated.
• The presence of LVH predicted significantly the incidence of more advanced grade of resting LVDD (grade II DD rather than GI DD) & the severity of LVH (among cases with LVH): predicted significantly the grade of resting LV DD.
• The presence of LVH predicted significantly the presence of resting RVDD. However, resting RVDD can be present without LVH. The severity of LVH (among cases with LVH) predicted significantly the grade of resting RV DD.
• The resting global RV Function (RIMP) is altered in all patients with resting RVDD.
• The left ventricular diastolic function showed significant worsening during exercise (significant increase of Filling pressures (LV E/E’) and LAVI).
• The right ventricular diastolic function showed significant worsening during exercise (significant increase of RV E/E’, RV A’).
• The global RV Function (RIMP) shows significant increase (worsening) during exercise following the worsening of RVDD (RIMP and LV E/E’ significantly correlated with exercise).
• In patients with LVGIDD and LVGIIDD, the grade of LVDD predicted significantly the incidence of corresponding grade of RVDD during exercise.