The emerging role of Cardiovascular Magnetic Resonance in the evaluation of hypertensive heart disease

Abstract

BackgroundArterial hypertension is the commonest cause of cardiovascular death. It may lead to hypertensive heart disease (HHD), including heart failure (HF), ischemic heart disease (IHD) and left ventricular hypertrophy (LVH).Main bodyAccording to the 2007 ESH/ESC guidelines, the recommended imaging technique is echocardiography (echo), when a more sensitive detection of LVH than that provided by ECG, is needed. Cardiovascular Magnetic Resonance (CMR), a non-invasive, non-radiating technique, offers the following advantages, beyond echo:a) more reliable and reproducible measurements of cardiac parameters such as volumes, ejection fraction and cardiac mass b) more accurate differentiation of LVH etiology by providing information about tissue characterisation c) more accurate evaluation of myocardial ischemia, specifically if small vessels disease is present d) technique of choice for diagnosis of renovascular, aortic tree/branches lesions and quantification of aortic valve regurgitation e) technique of choice for treatment evaluation in clinical trials.The superiority of CMR against echocardiography in terms of reproducibility, operator independency, unrestricted field of view and capability of tissue characterization makes the technique ideal for evaluation of heart, quantification of aortic valve regurgitation, aorta and aortic branches.ConclusionsCMR has a great potential in early diagnosis, risk stratification and treatment follow up of HHD. However, an international consensus about CMR in HHD, taking under consideration the cost-benefit ratio, expertise and availability, is still warranted.

Sporadic inclusion body myositis: no specific cardiac involvement in cardiac magnetic resonance tomography

“…For arterial hypertension, left ventricular hypertrophy and reduced stroke volumes due to afterload increase are well known [25][26][27].…”

Differential diagnosis of thickened myocardium: an illustrative MRI review

“…Cardiac MR provides a comprehensive non-invasive evaluation of hypertensive heart disease, including accurate and reproducible assessment of global and regional biventricular function, valvular disease and myocardial fibrosis [ 21 , 22 ].…”

“…In hypertensive heart disease, compensatory LV hypertrophy in response to increased afterload is usually concentric and mild (≤ 13 mm) with an increased indexed LV mass, increased chamber volumes and normal or reduced ejection fraction [ 5 , 21 , 23 ]. Diastolic dysfunction and/or heart failure with preserved ejection fraction due to remodelling of the extracellular matrix and increase in LV filling pressures are common in concentric LV hypertrophy [ 21 , 24 ]. Myocardial fibrosis plays an important role in the development of diastolic dysfunction.…”

Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the U.S

“…Cardiac magnetic resonance imaging (CMR) overcomes many of the shortcomings of SPECT, offering improved diagnostic accuracy, clinical utility, and efficiency 15,[17][18][19][20][21][22][23][24][25] . In terms of diagnostic accuracy, meta-analyses have shown CMR to have a sensitivity of 0.90-0.91 and a specificity of 0.79-0.94 in perfusion analysis, showing substantial benefits over SPECT in terms of reducing the number of false negatives 15,26 .…”