title: Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults: A High-Resolution 3D MRI Study.
abstract: OBJECTIVE
  This study used high-resolution 3-dimensional cardiac magnetic resonance to define the anatomical and functional left ventricular (LV) properties associated with increasing systolic blood pressure (SBP) in a drug-naïve cohort.
  
  
  BACKGROUND
  LV hypertrophy and remodeling occur in response to hemodynamic stress but little is known about how these phenotypic changes are initiated in the general population.
  
  
  METHODS
  In this study, 1,258 volunteers (54% women, mean age 40.6 ± 12.8 years) without self-reported cardiovascular disease underwent 3-dimensional cardiac magnetic resonance combined with computational modeling. The relationship between SBP and wall thickness (WT), relative WT, end-systolic wall stress (WS), and fractional wall thickening were analyzed using 3-dimensional regression models adjusted for body surface area, sex, race, age, and multiple testing. Significantly associated points in the LV model (p < 0.05) were identified and the relationship with SBP reported as mean β coefficients.
  
  
  RESULTS
  There was a continuous relationship between SBP and asymmetric concentric hypertrophic adaptation of the septum and anterior wall that was associated with normalization of wall stress. In the lateral wall an increase in wall stress with rising SBP was not balanced by a commensurate hypertrophic relationship. In normotensives, SBP was positively associated with WT (β = 0.09) and relative WT (β = 0.07) in the septal and anterior walls, and this regional hypertrophic relationship was progressively stronger among pre-hypertensives (β = 0.10) and hypertensives (β = 0.30).
  
  
  CONCLUSIONS
  These findings show that the precursors of the hypertensive heart phenotype can be traced to healthy normotensive adults and that an independent and continuous relationship exists between adverse LV remodeling and SBP in a low-risk population. These adaptations show distinct regional variations with concentric hypertrophy of the septum and eccentric hypertrophy of the lateral wall, which challenge conventional classifications of LV remodeling.
authors.affiliation: Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom.
authors.forename: Antonio
authors.initials: A
authors.lastname: de Marvao
authors.affiliation: Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom.
authors.forename: Timothy J W
authors.initials: TJ
authors.lastname: Dawes
authors.affiliation: Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; Department of Computing, Imperial College London, South Kensington Campus, London, United Kingdom.
authors.forename: Wenzhe
authors.initials: W
authors.lastname: Shi
authors.affiliation: Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Durighel
authors.affiliation: Department of Computing, Imperial College London, South Kensington Campus, London, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rueckert
authors.affiliation: Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom; National Heart Centre Singapore, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Cook
authors.affiliation: Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom. Electronic address: declan.oregan@imperial.ac.uk.
authors.forename: Declan P
authors.initials: DP
authors.lastname: O'Regan
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009206:Myocardium / Q000473:pathology*; D010641:Phenotype; D011237:Predictive Value of Tests; D058246:Prehypertension / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D012044:Regression Analysis; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult
keywords: cardiac atlas; cardiac magnetic resonance; hypertension; left ventricular hypertrophy; remodeling