Extracellular volume quantification in isolated hypertension - changes at the detectable limits?

Journal of Cardiovascular Magnetic Resonance

Research

Thomas A. Treibel¹  Vimal Patel¹  Viviana Maestrini¹  Sanjay M. Banypersad¹  Daniel M. Sado¹  Anna S. Herrey¹  Andrea Barison²  Steven K. White³  James C. Moon⁴  Steffen E. Petersen⁵  Ceri Davies⁵  Filip Zemrak⁵  Mark J. Caulfield⁵ 

[1] Department of Cardiology, The Heart Hospital, University College London Hospitals NHS Trust, London, UK;Department of Cardiology, The Heart Hospital, University College London Hospitals NHS Trust, London, UK;Fondazione Toscana Gabriele Monasterio and Scuola Superiore Sant’Anna, Pisa, Italy;Department of Cardiology, The Heart Hospital, University College London Hospitals NHS Trust, London, UK;The Hatter Cardiovascular Institute, University College London Hospitals NHS Trust, London, UK;Department of Cardiology, The Heart Hospital, University College London Hospitals NHS Trust, London, UK;The Heart Hospital Imaging Centre, University College London Hospitals NHS Trust, 16-18 Westmoreland Street, W1G 8PH, London, UK;National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK;

关键词: Hypertension;    Left ventricular hypertrophy;    Magnetic resonance imaging;    T1 mapping;    Myocardial fibrosis;   

DOI  :  10.1186/s12968-015-0176-3

 received in 2015-05-18, accepted in 2015-07-21,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundDiffuse myocardial fibrosis (DMF) is important in cardiovascular disease, however until recently could only be assessed by invasive biopsy. We hypothesised that DMF measured by T1 mapping is elevated in isolated systemic hypertension.MethodsIn a study of well-controlled hypertensive patients from a specialist tertiary centre, 46 hypertensive patients (median age 56, range 21 to 78, 52 % male) and 50 healthy volunteers (median age 45, range 28 to 69, 52 % male) underwent clinical CMR at 1.5 T with T1 mapping (ShMOLLI) using the equilibrium contrast technique for extracellular volume (ECV) quantification. Patients underwent 24-hours Automated Blood Pressure Monitoring (ABPM), echocardiographic assessment of diastolic function, aortic stiffness assessment and measurement of NT-pro-BNP and collagen biomarkers.ResultsLate gadolinium enhancement (LGE) revealed significant unexpected underlying pathology in 6 out of 46 patients (13 %; myocardial infarction n = 3; hypertrophic cardiomyopathy (HCM) n = 3); these were subsequently excluded. Limited, non-ischaemic LGE patterns were seen in 11 out of the remaining 40 (28 %) patients. Hypertensives on therapy (mean 2.2 agents) had a mean ABPM of 152/88 mmHg, but only 35 % (14/40) had left ventricular hypertrophy (LVH; LV mass male > 90 g/m2; female > 78 g/m2). Native myocardial T1 was similar in hypertensives and controls (955 ± 30 ms versus 965 ± 38 ms, p = 0.16). The difference in ECV did not reach significance (0.26 ± 0.02 versus 0.27 ± 0.03, p = 0.06). In the subset with LVH, the ECV was significantly higher (0.28 ± 0.03 versus 0.26 ± 0.02, p < 0.001).ConclusionIn well-controlled hypertensive patients, conventional CMR discovered significant underlying diseases (chronic infarction, HCM) not detected by echocardiography previously or even during this study. T1 mapping revealed increased diffuse myocardial fibrosis, but the increases were small and only occurred with LVH.

【 授权许可】

CC BY   
© Treibel et al. 2015