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



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.



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/m(2) vs concentric LVH: 73±15 mL/m(2) vs concentric remodelling: 55±9 mL/m(2), p<0.05, respectively) and interstitial fibrosis (eccentric LVH: 33±10 mL/m(2) vs concentric LVH: 30±10 mL/m(2) vs concentricremodelling: 19±2 mL/m(2), 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.



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.
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK School of Physiology, Pharmacology and Neurosciences, Faculty of Biomedical Sciences, University of Bristol, University Walk, Bristol, UK.
Jonathan C L
JC
Rodrigues
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Department of Surgical, Microsurgical and Medical Sciences, Institute of Radiology, University of Sassari, Sassari, Piazza D'Armi, Province of Sassari, Italy.
Antonio Matteo
AM
Amadu
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Amardeep Ghosh
AG
Dastidar
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Department of Cardiology, University Hospital of Wales, Cardiff.
Gergley V
GV
Szantho
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Stephen M
SM
Lyen
Department of General Medicine, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Cattleya
C
Godsave
CardioNomics Research Group, Clinical Research Imaging Centre (CRIC) Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Laura E K
LE
Ratcliffe
Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK CardioNomics Research Group, Clinical Research Imaging Centre (CRIC) Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Amy E
AE
Burchell
School of Physiology, Pharmacology and Neurosciences, Faculty of Biomedical Sciences, University of Bristol, University Walk, Bristol, UK CardioNomics Research Group, Clinical Research Imaging Centre (CRIC) Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Emma C
EC
Hart
Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Mark C K
MC
Hamilton
Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK CardioNomics Research Group, Clinical Research Imaging Centre (CRIC) Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Angus K
AK
Nightingale
School of Physiology, Pharmacology and Neurosciences, Faculty of Biomedical Sciences, University of Bristol, University Walk, Bristol, UK CardioNomics Research Group, Clinical Research Imaging Centre (CRIC) Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Julian F R
JF
Paton
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Department of Clinical Radiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Nathan E
NE
Manghat
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Department of Cardiology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Chiara
C
Bucciarelli-Ducci
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004739:England; D005260:Female; D005355:Fibrosis; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology*; D010044:Outpatient Clinics, Hospital; D010641:Phenotype; D011237:Predictive Value of Tests; D062606:Tertiary Care Centers; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling