The Metabolic Footprint on Right Ventricular Function: A Prospective Observational Study

Background & Aim: Diabetes mellitus and hypertension are major contributors to adverse cardiovascular outcomes, significantly elevating the risk of heart failure, vascular disease, and premature mortality. Right ventricular (RV) function, though historically under-evaluated, is increasingly recognized as a critical determinant of cardiac performance, especially in metabolic diseases. This study evaluates and compares RV systolic and diastolic function among normal individuals, patients with DM, and those with both DM and HTN, excluding those with coronary artery disease (CAD). Methods: This prospective observational study included 211 adults aged 30–65 years, categorized into three groups: controls (n = 75), DM (n = 60), and DM with HTN (n = 76). Participants underwent clinical evaluation, laboratory testing (HbA1c, lipid profile), and comprehensive transthoracic echocardiography. RV systolic function was assessed via TAPSE, RV FAC, and tissue Doppler-derived S′ wave. RV diastolic function was evaluated using tricuspid annular E′, A′ velocities, E/E′ ratio, and deceleration time. Data were analyzed using SPSS v25; p < 0.05 was considered statistically significant. Results: TAPSE was reduced in both DM (2 ± 0.18 cm) and DM with HTN (2.01 ± 0.20 cm) groups compared to controls (2.13 ± 0.19 cm, p < 0.001), indicating RV systolic dysfunction. RV wall thickness was highest in the DM with HTN group (6.62 ± 0.99 mm, p < 0.001). TRPG and pulmonary artery pressure were elevated in the DM with HTN group (p = 0.037 and p = 0.025, respectively). A-wave velocity and deceleration time were significantly increased in the DM with HTN group, indicating diastolic dysfunction. Conclusions: Patients with DM and especially those with coexisting HTN exhibit significant subclinical impairments in RV systolic and diastolic function. Early echocardiographic detection of right ventricular dysfunction in diabetic and hypertensive patients enables timely intervention, potentially preventing progression to overt heart failure and pulmonary hypertension.