ABC | Volume 112, Nº3, March 2019

Original Article Baroncini et al Right ventricle and left atrial volume Arq Bras Cardiol. 2019; 112(3):249-257 Table 4 – Echocardiographic parameters in the study group by left ventricular diastolic dysfunction grade and presence of concentric (c) and eccentric (e) left ventricular hypertrophy Variable LVDD n Mean ± standard deviation p-value* RV TAPSE (mm) Grade I 21 21.2 ± 2.5 Grade II 4 21.5 ± 3.5 0.832 RV S' (cm/s) Grade I 21 13.2 ± 1.7 Grade II 4 12.8 ± 1.7 0.604 RVDD (mm) Grade I 21 21.5 ± 3.2 Grade II 4 24.5 ± 1.9 0.085 Left atrial (mm) Grade I 21 35.9 ± 4.6 Grade II 4 44.5 ± 4.4 0.002 LAV (ml/m²) Grau I 21 29.0 ± 5.5 Grau II 4 37.5 ± 8.9 0.017 Variable LVH n Mean ± standard deviation p-value* RV TAPSE (mm) Normal 19 20.8 ± 2.5 0.176 LVH (c/e) 6 22.5 ± 2.8 RV S' (cm/s) Normal 19 13.1 ± 1.7 0.580 LVH (c/e) 6 13.5 ± 1.8 RVDD (mm) Normal 19 21.5 ± 3.3 0.185 LVH (c/e) 6 23.5 ± 2.8 Left atrial (mm) Normal 19 36.3 ± 5.2 0.104 LVH (c/e) 6 40.5 ± 6.0 LAV (ml/m 2 ) Normal 19 29.7 ± 6.2 0.413 *Student’s t-test for independent variables, p < 0.05. RV: right ventricular; TAPSE: tricuspid annular plane systolic excursion with M-mode; RVDD: right ventricular diastolic diameter; LA: left atrium; LAV: left atrial volume geometric and the complex correlation of the right ventricle with the LV septum. This could lead to delayed diagnosis of RV systolic dysfunction, which is generally detected in severe disease states. Therefore, serial analysis of the LAV and of TAPSE and lateral S’ of the right ventricle in patients with LVDD or heart failure with preserved ejection fraction may provide initial evidence of deterioration of the RV function. The other findings of the study were in accordance with literature data. In our study group, LVDD patients were older, showed higher incidence of LVH and greater left atrial size, and higher prevalence of SAH when compared with the control group. 22-24 Patients with altered diastolic function had larger LA, which was positively associated with the degree of diastolic dysfunction. This is in line with the study by El Aouar et al. 16 Regarding the high prevalence of SAH in the study group, it is well known that SAH can cause not only LVH but also RV hypertrophy 25,26 that, in turn, was not assessed in our study. The fact that we did not find significant differences in echocardiographic measures between the groups can be explain by the strict exclusion criteria; it also reflects the fact that the analysis and referral values of echocardiographic parameters used in the assessment of the RV function is a matter of considerable debate in the literature, with wide variability within and between observers. 6,7 In this sense, there is not a gold standard method, but rather a set of group that should be sequentially interpreted considering the clinical conditions of each patient. Thus, subtle changes in the variables used for RV function analysis in our study, as well as their correlation with left atrial enlargement can serve as a basis for future studies in this field. It is pertinent to consider the use of the speckle tracking technique (strain [ ε ] and strain rate [SR or s -1 ]) for assessment of the RV function in future studies. The ε and s -1 indexes evaluate regional and global myocardial deformation with advantages over the use of the strain measure obtained from tissue Doppler, especially a lower variability within and between observers. The use of two-dimensional speckle tracking echocardiography allows the analysis of longitudinal, circumferential and radial strain, with not influence of the angle. 27 Finally, this study has important limitations that should be considered: (1) the small number of the sample; studies involving larger sample sizes would be needed to confirm our findings; (2) the groups were not perfectly matched, especially in terms of age; (3) the lack of adequate or precise information about the time of hypertensive disease and its treatment, as well as on medications used by the patients; and (4) we did not analyze the variables tricuspid annulus diameter and right atrial volume, which could provide more information on the RV remodeling. In addition, patients with LVDD was composed of older individuals compared with the control group. This may have 253