Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life StudyReportar como inadecuado




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Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy LVH has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening MWCS. Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional 3D myocardial strain, is unknown. Methods and Results: Cardiac Magnetic Resonance CMR tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals 116 ± 40 versus 63 ± 6 g-m2, P = 0.002. Neither echocardiographic fractional shortening 32 ± 6 versus 33% ± 3%, LVEF 63% versus 64% or mean end-systolic stress 175 ± 27 versus 146 ± 28 g-cm2 were significantly different, yet global MWCS was decreased by both echocardiography 13.4 ± 2.8 versus 18.2% ± 1.5%, P < 0.001 and MR 16.8 ± 3.6 versus 21.6% ± 3.0%, P < 0.005. 3D MR MWCS was lower at the base versus apex P = 0.002 in LVH and greater in lateral and anterior regions versus septal and posterior regions P < 0.001, contributing to the higher mean global MWCS by MR than echo. MR longitudinal strain was severely depressed in LVH patients 11.0 ± 3.3 versus 16.5% ± 2.5%, P < 0.001 and apical twist was increased 17.5 ± 4.3 versus 13.7 ± 3.7, P < 0.05. Importantly, both circumferential and longitudinal shortening correlated with LV relative wall thickness R > 0.60, P = 0.001 for both. Conclusions: In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.

KEYWORDS

Hypertension, Left Ventricular Hypertrophy, Magnetic Resonance Imaging, Cardiac Mechanics, Heart Wall Motion, 3D

Cite this paper

Biederman, R. , Young, A. , Doyle, M. , Devereux, R. , Kortright, E. , Perry, G. , Bella, J. , Oparil, S. , Calhoun, D. , Pohost, G. and Dell’Italia, L. 2015 Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study. Journal of Biomedical Science and Engineering, 8, 213-225. doi: 10.4236-jbise.2015.83021.





Autor: Robert W. W. Biederman1*, Alistair A. Young2, Mark Doyle1, Richard B. Devereux3, Eduardo Kortright4, Gilbert Perry2,5, Jonathan N

Fuente: http://www.scirp.org/



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