title: Increased extracellular volume and altered mechanics are associated with LVH in hypertensive heart disease, not hypertension alone.
abstract: OBJECTIVE
  The goal of this study was to assess the relationship among extracellular volume (ECV), native T1, and systolic strain in hypertensive patients with left ventricular hypertrophy (HTN LVH), hypertensive patients without LVH (HTN non-LVH), and normotensive controls.
  
  
  BACKGROUND
  Diffuse myocardial fibrosis in HTN LVH patients, as reflected by increased ECV and native T1, may be an underlying mechanism contributing to increased cardiovascular risk compared with HTN non-LVH subjects and controls. Furthermore, increased diffuse fibrosis in HTN LVH subjects may be associated with reduced peak systolic and early diastolic strain rate compared with the other 2 groups.
  
  
  METHODS
  T1 mapping was performed in 20 HTN LVH (mean age, 55 ± 11 years), 23 HTN non-LVH (mean age, 61 ± 12 years), and 22 control subjects (mean age, 54 ± 7 years) on a Siemens 1.5-T Avanto (Siemens Healthcare, Erlangen, Germany) using a previously validated modified look-locker inversion-recovery pulse sequence. T1 was measured pre-contrast and 10, 15, and 20 min after injection of 0.15 mmol/kg gadopentetate dimeglumine, and the mean ECV and native T1 were determined for each subject. Measurement of circumferential strain parameters were performed using cine displacement encoding with stimulated echoes.
  
  
  RESULTS
  HTN LVH subjects had higher native T1 compared with controls (p < 0.05). HTN LVH subjects had higher ECV compared with HTN non-LVH subjects and controls (p < 0.05). Peak systolic circumferential strain and early diastolic strain rates were reduced in HTN LVH subjects compared with HTN non-LVH subjects and controls (p < 0.05). Increased levels of ECV and native T1 were associated with reduced peak systolic and early diastolic circumferential strain rate across all subjects.
  
  
  CONCLUSIONS
  HTN LVH patients had higher ECV, longer native T1 and associated reduction in peak systolic circumferential strain, and early diastolic strain rate compared with HTN non-LVH and control subjects. Measurement of ECV and native T1 provide a noninvasive assessment of diffuse fibrosis in hypertensive heart disease.
authors.affiliation: Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Sujith
authors.initials: S
authors.lastname: Kuruvilla
authors.affiliation: Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Janardhanan
authors.affiliation: Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Antkowiak
authors.affiliation: Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Keeley
authors.affiliation: Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Nebiyu
authors.initials: N
authors.lastname: Adenaw
authors.affiliation: Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Brooks
authors.affiliation: Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Epstein
authors.affiliation: Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.affiliation: Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia. Electronic address: ms5pc@virginia.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Salerno
mesh_terms: D000328:Adult; D000368:Aged; D005109:Extracellular Matrix / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D016277:Ventricular Function, Left
keywords: T1 mapping; cardiac magnetic resonance; extracellular volume; hypertension; hypertensive heart disease; left ventricular hypertrophy; myocardial fibrosis