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123 Comprehensive Cardiovascular MRI for the non-invasive Assessment of Patients with Systemic Hypertension
  1. Klio Konstantinou,
  2. Punam Pabari,
  3. Nilesh Sutaria,
  4. Declan O’Regan,
  5. Sanjeev Bhattacharyya,
  6. Niall Keenan,
  7. Neil Chapman,
  8. Ben Ariff
  1. Imperial College Healthcare

Abstract

Background Hypertensive disease is a major risk factor for cardiovascular morbidity and mortality. Cardiovascular MRI not only provides a non-invasive method for the assessment of potential secondary causes of hypertension (including adrenal, aortic, renal and reno-vascular abnormalities) but can also be a useful tool for the identification of the effects of uncontrolled or long-standing hypertension. The ability of a single comprehensive assessment to identify both potential causes of hypertension and the presence of end-organ damage enhances risk stratification and is now more relevant with the introduction of therapies such as renal denervation. Moreover, as a one-stop assessment, MRI is convenient for patients and potentially cost-effective. We report the findings of hypertension screen cardiovascular MRI scans performed on 193 consecutive patients.

Methods and Results 193 patients (59% male, 41% female; median age 39 [range 17–83] years) underwent hypertension screen MRI scans in our institution between August 2011 and September 2013. Images were acquired on a GE 1.5 T HDXT Platform with an 8 channel cardiac array coil. For the hypertension screen protocol, cardiac and thoracic imaging was performed using standard SSFP cine imaging and supplemented with black blood fast spin imaging. T2 SSFP high resolution fat saturation imaging of the kidneys and adrenals with additional fast spoiled gradient echo sequences of the adrenal glands was used. Standard Gadovist contrast MRA of renal arteries was performed, with the option to include delayed myocardial enhancement. Volumetric analysis was performed using the GE Reportcard. Of the 193 patients, 62 (32%) had increased LV wall thickness, 37 (19%) had elevated LV mass and 4 (2%) had increased LV volumes. Dilated aortic root (≥ 40 mm) was present in 9 (5%) patients. Eight (4%) patients had renal artery stenosis and 12 (6%) had adrenal adenomas requiring biochemical characterisation. There were no patients with aortic coarctations or phaeochromocytomas.

Conclusions MRI provides a rapid, comprehensive method for the identification of causes and effects of hypertension particularly in young patients or those with resistant hypertension.In our population of hypertensive patients investigated with cardiovascular MRI, about one third had evidence of end-organ damage. Early identification of such patients contributes to risk stratification and enables the targeted provision of aggressive treatment. Furthermore MRI can identify patients with suitable anatomy and can be integrated in the work-up of patients being considered for renal denervation. 10% of patients had potential secondary causes of hypertension and should be investigated further before the consideration of specific treatments.

  • cardiovascular MRI
  • hypertension screen
  • secondary hypertension

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