Left ventricular myocardial strain responding to chronic pressure overload in patients with resistant hypertension evaluated by feature-tracking CMR

Abstract

Objectives The study aimed to investigate the alterations of myocardial deformation responding to long-standing pressure overload and the effects of focal myocardial fibrosis using feature-tracking cardiac magnetic resonance (FT-CMR) in patients with resistant hypertension (RH). Methods Consecutive RH patients were prospectively recruited and underwent CMR at a single institution. FT-CMR analyses based on cine images were applied to measure left ventricular (LV) peak systolic global longitudinal (GLS), radial (GRS), and circumferential strain (GCS). Functional and morphological CMR variables, and late gadolinium enhancement (LGE) imaging were also obtained. Results A total of 50 RH patients (63 ± 12 years, 32 men) and 18 normotensive controls (57 ± 8 years, 12 men) were studied. RH patients had a higher average systolic blood pressure than controls (166 ± 21 mmHg vs. 116 ± 8 mmHg, p < 0.001) with the intake of 5 ± 1 antihypertensive drugs. RH patients showed increased LV mass index (78 ± 15 g/m2 vs. 61 ± 9 g/m2, p < 0.001), decreased GLS (− 16 ± 3% vs. − 19 ± 2%, p = 0.001) and GRS (41 ± 12% vs. 48 ± 8%, p = 0.037), and GCS was reduced by trend (− 17 ± 4% vs. − 19 ± 4%, p = 0.078). Twenty-one (42%) RH patients demonstrated a LV focal myocardial fibrosis (LGE +). LGE + RH patients had higher LV mass index (85 ± 14 g/m2 vs. 73 ± 15 g/m2, p = 0.007) and attenuated GRS (37 ± 12% vs. 44 ± 12%, p = 0.048) compared to LGE − RH patients, whereas GLS (p = 0.146) and GCS (p = 0.961) were similar. Conclusion Attenuation of LV GLS and GRS, and GCS decline by tendency, might be adaptative changes responding to chronic pressure overload. There is a high incidence of focal myocardial fibrosis in RH patients, which is associated with reduced LV GRS. Clinical relevance statement Feature-tracking CMR-derived myocardial strain offers insights into the influence of long-standing pressure overload and of a myocardial fibrotic process on cardiac deformation in patients with resistant hypertension. Key Points • Variations of left ventricular strain are attributable to the degree of myocardial impairment in resistant hypertensive patients. • Focal myocardial fibrosis of the left ventricle is associated with attenuated global radial strain. • Feature-tracking CMR provides additional information on the attenuation of myocardial deformation responding to long-standing high blood pressure.

Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI

“…In addition to the abnormality of the valvular structure itself, systemic hypertension is an important cause of chronic AR, but such patients do not necessarily receive additional attention in the absence of obvious clinical symptoms 18,19 . In this study, we found that in the absence of AR, hypertensive patients mainly showed a decrease in GLPS and diastolic peak strain rate, which was consistent with previous studies 10,20,21 . When complicated with AR, the radial and circumferential peak strain, as well as the peak systolic strain rates also decreased in patients with hypertension.…”

“…18,19 In this study, we found that in the absence of AR, hypertensive patients mainly showed a decrease in GLPS and diastolic peak strain rate, which was consistent with previous studies. 10,20,21 When complicated with AR, the radial and circumferential peak strain, as well as the peak systolic strain rates also decreased in patients with hypertension. These results suggest that in addition to diastolic dysfunction, LV systolic dysfunction may also occur earlier in hypertensive patients with AR.…”