The Relationship Between Left Ventricular Wall Thickness, Myocardial Shortening, and Ejection Fraction in Hypertensive Heart Disease: Insights From Cardiac Magnetic Resonance Imaging.
Hypertensive heart disease is often associated with a preserved left ventricular ejection fraction despite impaired myocardial shortening. The authors investigated this paradox in 55 hypertensive patients (52±13 years, 58% male) and 32 age- and sex-matched normotensive control patients (49±11 years, 56% male) who underwent cardiac magnetic resonance imaging at 1.5T. Long-axis shortening (R=0.62), midwall fractional shortening (R=0.68), and radial strain (R=0.48) all decreased (P<.001) as end-diastolic wall thickness increased. However, absolute wall thickening (defined as end-systolic minus end-diastolic wall thickness) was maintained, despite the reduced myocardial shortening. Absolute wall thickening correlated with ejection fraction (R=0.70, P<.0001). In multiple linear regression analysis, increasing wall thickness by 1 mm independently increased ejection fraction by 3.43 percentage points (adjusted β-coefficient: 3.43 [2.60-4.26], P<.0001). Increasing end-diastolic wall thickness augments ejection fraction through preservation of absolute wall thickening. Left ventricular ejection fraction should not be used in patients with hypertensive heart disease without correction for degree of hypertrophy.
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 Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK.
Jonathan C L
JC
Rodrigues
Medical School, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK.
Stephen
S
Rohan
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Amardeep Ghosh
AG
Dastidar
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Adam
A
Trickey
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Gergely
G
Szantho
CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Laura E K
LE
Ratcliffe
CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Amy E
AE
Burchell
School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK.|CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Emma C
EC
Hart
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Chiara
C
Bucciarelli-Ducci
NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Mark C K
MC
Hamilton
CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Angus K
AK
Nightingale
School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK.|CardioNomics Research Group, Clinical Research and Imaging Centre, 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.
Nathan E
NE
Manghat
Medical School, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK. david.maciver@tst.nhs.uk.|Department of Cardiology, Musgrove Park Hospital, Taunton, UK. david.maciver@tst.nhs.uk.|Biological Physics Group School of Physics & Astronomy, University of Manchester, Manchester, UK. david.maciver@tst.nhs.uk.
David H
DH
MacIver
D000328:Adult; D000368:Aged; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D016277:Ventricular Function, Left