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Aortic and vascular disease
Original article
Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes
  1. Jonathan C L Rodrigues1,2,
  2. Antonio Matteo Amadu1,3,
  3. Amardeep Ghosh Dastidar1,4,
  4. Gergley V Szantho1,5,
  5. Stephen M Lyen1,6,
  6. Cattleya Godsave7,
  7. Laura E K Ratcliffe8,
  8. Amy E Burchell4,8,
  9. Emma C Hart2,8,
  10. Mark C K Hamilton6,
  11. Angus K Nightingale4,8,
  12. Julian F R Paton2,8,
  13. Nathan E Manghat1,6,
  14. Chiara Bucciarelli-Ducci1,4
  1. 1NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2School of Physiology, Pharmacology and Neurosciences, Faculty of Biomedical Sciences, University of Bristol, University Walk, Bristol, UK
  3. 3Department of Surgical, Microsurgical and Medical Sciences, Institute of Radiology, University of Sassari, Sassari, Piazza D'Armi, Province of Sassari, Italy
  4. 4Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  5. 5Department of Cardiology, University Hospital of Wales, Cardiff
  6. 6Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  7. 7Department of General Medicine, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  8. 8CardioNomics Research Group, Clinical Research Imaging Centre (CRIC) Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Chiara Bucciarelli-Ducci, NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK; C.Bucciarelli-Ducci{at}bristol.ac.uk

Abstract

Objective Myocardial intracellular/extracellular structure and aortic function were assessed among hypertensive left ventricular (LV) phenotypes using cardiovascular magnetic resonance (CMR).

Methods An observational study from consecutive tertiary hypertension clinic patients referred for CMR (1.5 T) was performed. Four LV phenotypes were defined: (1) normal with normal indexed LV mass (LVM) and LVM to volume ratio (M/V), (2) concentric remodelling with normal LVM but elevated M/V, (3) concentric LV hypertrophy (LVH) with elevated LVM but normal indexed end-diastolic volume (EDV) or (4) eccentric LVH with elevated LVM and EDV. Extracellular volume fraction was measured using T1-mapping. Circumferential strain was calculated by voxel-tracking. Aortic distensibility was derived from high-resolution aortic cines and contemporaneous blood pressure measurements.

Results 88 hypertensive patients (49±14 years, 57% men, systolic blood pressure (SBP): 167±30 mm Hg, diastolic blood pressure (DBP): 96±14 mm Hg) were compared with 29 age-matched/sex-matched controls (47±14 years, 59% men, SBP: 128±12 mm Hg, DBP: 79±10 mm Hg). LVH resulted from increased myocardial cell volume (eccentric LVH: 78±19 mL/m2 vs concentric LVH: 73±15 mL/m2 vs concentric remodelling: 55±9 mL/m2, p<0.05, respectively) and interstitial fibrosis (eccentric LVH: 33±10 mL/m2 vs concentric LVH: 30±10 mL/m2 vs concentricremodelling: 19±2 mL/m2, p<0.05, respectively). LVH had worst circumferential impairment (eccentric LVH: −12.8±4.6% vs concentric LVH: −15.5±3.1% vs concentric remodelling: –17.1±3.2%, p<0.05, respectively). Concentric remodelling was associated with reduced aortic distensibility, but not with large intracellular/interstitial expansion or myocardial dysfunction versus controls.

Conclusions Myocardial interstitial fibrosis varies across hypertensive LV phenotypes with functional consequences. Eccentric LVH has the most fibrosis and systolic impairment. Concentric remodelling is only associated with abnormal aortic function. Understanding these differences may help tailor future antihypertensive treatments.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartjnl-2016-309576

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