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Gender differences and the association between right ventricular strain and arterial hypertension—A commentary

Dear Editor, We read with great interest the recent paper by Marijana Tadic et al on the association between gender and right ventricular strain and arterial hypertension.1 We acknowledge the authors for citing our paper on the gender differences in angiotensin II and aldosterone secretion in patients with pressure overloaded systemic right ventri‐ cles in the context of their work.2 We would like, however, to stress the substantial difference between subpulmonary (normally located) and systemic right ventricle. In the latter case, the systemic arterial pressure directly affects right ventricle which is located in subaor‐ tic position. It adapts to the pressure overload similarly to normally located left ventricle.3,4 We have actually demonstrated that blood pressure, even within the high normal range, affects systemic right ventricular function.5 Nevertheless, direct comparisons of congen‐ ital heart disease patients and patients with normal anatomy are difficult, due to the fact that patients’ demographic and clinical characteristics, including age and concomitant diseases, are entirely different. While the observed pattern of gender‐related differences in renin‐angiotensin‐aldosterone axis activation in patients with sys‐ temic right ventricles, with relatively low angiotensin II levels and elevated aldosterone levels, resembles changes in the neurohumoral activity and ventricular function observed in hypertensive heart dis‐ ease, the resemblance refers to the changes in the mechanics of the respectively systemic right and left ventricle, but not to the anatom‐ ically correctly located right ventricle, especially if pulmonary artery pressure is not severely elevated (as in case of patients described by Tadic et al).1