Right ventricular performance in essential hypertension after beta-blockade

Multifaced risk factors and clinical impact of a deep Y descent in patients with heart failure irrespective of RV-PA coupling

Background

A deep Y descent in the jugular venous pulse (JVP) is associated with diseases such as a decrease in right ventricular (RV) preload reserve. The present study investigated the relationship between RV-pulmonary arterial (PA) coupling and a deep Y descent, examined risk factors for a deep Y descent and clarified whether a deep Y descent was an independent risk factor for cardiac events irrespective of RV-PA coupling in patients with heart failure (HF).

Methods

We enrolled 350 patients with HF who underwent echocardiography and JVP examination. A deep Y descent was identified by a deeper 'Y' descent than 'X' descent in the JVP waveform. We defined cardiac events of HF as follows: sudden death, death from HF, the emergent infusion of loop diuretics, or hospitalization for decompensated HF.

Results and Conclusions

A deep Y descent and cardiac events were observed in 129 and 83 patients, respectively. The prevalence of a deep Y descent increased with decreases in the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio. Not only the TAPSE/SPAP ratio (odds ratio,0.756 per0.1 mm/mmHg, 95 %confidence interval [CI], 0.660-0.866, p < 0.001), but also age, atrial fibrillation, and the use of beta-blockers were independent factors for a deep Y descent in multivariate logistic model. Multivariate Cox hazard model demonstrated that a deep Y descent was for cardiac events in patients with HF (Hazard ratio,2.682, 95 %CI, 1.599-4.497, p < 0.001) irrespective of the TAPSE/SPAP ratio. The development of therapeutic strategies based on central venous waveform may be needed for patients with HF.

Cardiovascular reactivity to psychosocial stressors. A review of the effects of beta-blockade

Fifty-nine studies examining the effects of beta-blockers on cardiovascular reactivity to psychosocial stressors are reviewed. Across all classifications of beta-blockers, heart rate reactivity was reduced (p less than 0.0001), while there were no significant changes in either systolic or diastolic blood pressure reactivity. Nonselective beta-blockers were more often associated with a reduction in heart rate reactivity than selective blockers (p less than 0.05). There was no evidence that drug lipophilicity or intrinsic sympathomimetic activity differentially affected blood pressure or heart rate reactivity; nor was there evidence that the reactivity of hypertensive subjects was differentially affected by blockade compared to the reactivity of normotensive subjects. While beta-blockers are effective in reducing resting blood pressure, they are not effective agents in reducing blood pressure reactivity to mild psychosocial stressors.

Right ventricular function: methodologic and clinical considerations in noninvasive scintigraphic assessment

Right ventricular function plays an important role in many cardiac disorders. Changes in left ventricular function, right ventricular afterload and preload, cardiac medications and ischemia may affect right ventricular function. Radionuclide ventriculography permits quantitative assessment of regional and global function of the right ventricle. This assessment can be made at rest, during exercise or after pharmacologic interventions. The overlap between right ventricle and right atrium is a major limitation for gated scintigraphic techniques. The use of imaging with newer short-lived radionuclides may permit more accurate and reproducible assessment of right ventricular function by means of the first pass method. Further work in areas related to improvement of techniques and the impact of right ventricular function on prognosis is needed.