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. 2015 Nov;8(11):1260-9.
doi: 10.1016/j.jcmg.2015.08.007. Epub 2015 Oct 14.

Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults: A High-Resolution 3D MRI Study

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Free PMC article

Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults: A High-Resolution 3D MRI Study

Antonio de Marvao et al. JACC Cardiovasc Imaging. .
Free PMC article

Abstract

Objectives: 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.

Keywords: cardiac atlas; cardiac magnetic resonance; hypertension; left ventricular hypertrophy; remodeling.

Figures

Figure 1
Figure 1
Statistical Model of How SBP Influences the LV Phenotype High spatial resolution imaging data is used to build a statistical model of how systolic blood pressure (SBP) influences the left ventricular (LV) phenotype. This paradigm allows the adaptations of whole heart structure and function in response to a stimulus to be explored. 3D = 3-dimensional.
Figure 2
Figure 2
Density Plot Showing the Distribution of BP Readings in the Cohort The thresholds applied are those recommended in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure within our cohort (N = 1,258). BP = blood pressure; HTN = hypertension; NT = normotension.
Figure 3
Figure 3
3D Model of the Regional Changes in LV Geometry Associated With SBP A long-axis section of the 3D cardiac magnetic resonance–derived fitted regression model taken at SBP of 100 mm Hg (red filled contour) and 180 mm Hg (black outline) shows how LV geometry varies between these 2 BP. Arrows indicate the relationship between each coefficient and SBP. Abbreviations as in Figure 1.
Figure 4
Figure 4
3D Regression Models of the Association Between SBP and LV RWT in NT, Pre-HTN, and HTN Adults The regression coefficients between SBP and LV relative wall thickness (RWT) are shown for subjects categorized by the thresholds of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Positive coefficients indicate concentric hypertrophy and negative coefficients eccentric hypertrophy. Contour lines indicate significant regions (p < 0.05) before (white border) and after (yellow border) correction for multiple testing, respectively. LV projections are anterior (Ant) and lateral (Lat). Please see Online Video 1. Abbreviations as in Figures 1 and 2.
None
Online Video 1
Figure 5
Figure 5
3D Regression Models of the Association Between SBP and LV Geometry Across the Cohort The regression coefficients between SBP and LV shape are shown for the epicardial (A) and endocardial (B) surfaces. A positive coefficient indicates an outward expansion of the surface and a negative coefficient an inward contraction. Contour lines indicate significant regions (p < 0.05) before (white border) and after (yellow border) correction for multiple testing. Whereas the majority of the LV exhibits eccentric hypertrophy, the septum and anterior wall undergo concentric hypertrophy. Abbreviations as in Figures 1 and 4.
Figure 6
Figure 6
3D Regression Models of the Association Between SBP and Regional End-Systolic WS Across the Cohort The regression coefficients are shown in the endocardial surface with positive coefficients indicating increased wall stress (WS) with rising SBP. Yellow contour lines indicate significant regions (p < 0.05) after correction for multiple testing. In areas of septal concentric hypertrophy, the increase in WS is matched by an increase in WT; however, elsewhere there is a significant increase in WS in response to rising SBP. LV projections are Ant and Lat. Abbreviations as in Figures 1 and 4.

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