Impact of Left Ventricular Mass Index and Geometric Pattern on Right Ventricular Dimensions and Function in Hypertensive Patients Using Dual-Source Computed Tomography

Background Hypertension is a major and highly prevalent cardiovascular risk factor, affecting approximately 30-45% of the general population, with prevalence increasing markedly with age. It predominantly affects the left ventricle; however, its impact on the right ventricle is less well characterized. Understanding the structural and functional interplay between the two ventricles is essential for comprehensive cardiovascular risk assessment. This study aimed to evaluate the impact of left ventricular mass index (LVMI) and geometric pattern on right ventricular dimensions and systolic function in hypertensive patients using dual-source computed tomography (CT). Methods This observational retrospective study included 150 hypertensive patients aged >40 years undergoing CT coronary angiography. LVMI was calculated using semi-automated epicardial and endocardial contouring. Relative wall thickness (RWT) was derived (RWT = 2 × posterior wall thickness/left ventricular internal diameter), with RWT >0.42 considered abnormal for geometric classification. Right ventricular end-diastolic and end-systolic volumes were obtained using semi-automated contour analysis. Right ventricular ejection fraction (RVEF) was calculated from volumetric data, and tricuspid annular plane systolic excursion (TAPSE) was measured using reconstructed images. Results The mean LVMI was 74.45 g/m² (±25.47). Overall, 52% had normal geometry, 25% concentric remodelling, 10% eccentric hypertrophy, and 13% concentric hypertrophy. The mean RVEF was 41.58% (±7.39), and the mean TAPSE was 1.67 cm (±0.35). Mean right ventricular end-systolic and end-diastolic volumes were 86.5 mL (±20.87) and 146.5 mL (±30.45), respectively. LVMI demonstrated significant positive correlations with right ventricular volumes and significant negative correlations with RVEF and TAPSE (p < 0.05 for all). Patients with abnormal geometric patterns had significantly larger right ventricular volumes compared with normal geometry (p < 0.05). Right ventricular systolic function progressively declined from normal geometry to concentric hypertrophy. Post-hoc analysis showed significant differences between most geometric groups, except between eccentric and concentric hypertrophy. Conclusions Left ventricular hypertrophy and abnormal geometric patterns in hypertension are associated with progressive right ventricular dilatation and systolic impairment, suggesting early bi-ventricular involvement in hypertensive heart disease. Early identification of left ventricular remodelling may be crucial to prevent secondary right ventricular dysfunction, a well-established predictor of adverse cardiovascular outcomes.