European Radiology

, Volume 27, Issue 11, pp 4620–4630 | Cite as

Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in hypertension and associated with left ventricular remodeling

  • Shuli Wang
  • Hongjie Hu
  • Minjie LuEmail author
  • Arlene Sirajuddin
  • Jinghui Li
  • Jing An
  • Xiuyu Chen
  • Gang Yin
  • Tian Lan
  • Linlin Dai
  • Yan Zhang
  • Xiaorong Yin
  • Lei Song
  • Aimin Dang
  • Peter Kellman
  • Andrew E. Arai
  • Shihua Zhao



To determine whether extracellular volume fraction (ECV) quantification by cardiac magnetic resonance (CMR) can demonstrate left ventricle (LV) abnormalities and relationship between ECV and LV remodeling in hypertension (HTN) patients


ECV quantification was prospectively performed in 134 consecutive HTN patients and 97 healthy subjects. Individual and regional ECV were compared to the regions on late gadolinium enhancement (LGE) images. Statistical analysis of the relationship between LV global functional parameters and ECV was carried out using Pearson’s correlation, Student’s t test and multiple regressions.


In the HTN group, 70.1% (94/134) were LGE negative and 29.9% (40/134) LGE positive. The mean ECV after adjusting for age, sex, BMI, diabetes, smoking and dyslipidaemia in healthy controls and LGE-negative patients were 26.9 ± 2.67% and 28.5 ± 2.9% (p < 0.001), respectively. The differences in ECV reached statistical significance among the regions of LGE, LGE-Peri, LGE remote and the normal area between the control and LGE-positive subgroup (all p < 0.05). Global ECV significantly correlated with LVEF (r = −0.466, p < 0 .001) and LV hypertrophy (r = 0.667, p < 0.001).


ECV can identify LV abnormalities at an early stage in HTN patients without LGE. These abnormalities may reflect an increase in diffuse myocardial fibrosis and are associated with LV remodeling.

Key points

Diffuse myocardial fibrosis may develop in hypertensive cardiomyopathy before conventional MRI detectable LGE.

ECV can identify myocardial fibrosis at an early stage in hypertensive patients.

Elevated ECV is associated with decreased LV global function and LV remodeling in hypertension.


CMR Extracellular volume fraction Fibrosis Hypertension Remodeling 

Abbreviations and acronyms


Blood pressure


Cardiac index


Cardiac magnetic resonance


Extracellular volume fraction




Left atrium


Late gadolinium enhancement


Left ventricle


Left ventricular end-diastolic volume index


Left ventricular ejection fraction


Left ventricular end-systolic volume index


Left ventricular hypertrophy


Maximum diastolic blood pressure


Maximum systolic blood pressure


Phase sensitive inversion recovery


Region of interest


Stroke volume


Compliance with ethical standards


The scientific guarantor of this publication is Minjie Lu and Shihua Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.


This study was supported in parts by the Research Grant of National Natural Science Foundation of China (81571647, 81370036 and 81620108015), Capital Clinically Characteristic Applied Research Fund (Z151100004015141), Beijing Natural Science Foundation (7152124) and the Fundamental Research Funds for the Central Universities (3332013105). This work was also partially supported by the Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, USA.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• prospective

• cross-sectional study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Shuli Wang
    • 1
  • Hongjie Hu
    • 2
  • Minjie Lu
    • 1
    • 5
    Email author
  • Arlene Sirajuddin
    • 5
  • Jinghui Li
    • 1
  • Jing An
    • 3
  • Xiuyu Chen
    • 1
  • Gang Yin
    • 1
  • Tian Lan
    • 1
  • Linlin Dai
    • 1
  • Yan Zhang
    • 1
  • Xiaorong Yin
    • 1
  • Lei Song
    • 4
  • Aimin Dang
    • 4
  • Peter Kellman
    • 6
  • Andrew E. Arai
    • 5
  • Shihua Zhao
    • 1
  1. 1.Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China
  2. 2.Department of Radiology, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China
  3. 3.Siemens Shenzhen Magnetic Resonance Ltd., Siemens MRI CenterShenzhenPeople’s Republic of China
  4. 4.Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China
  5. 5.Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human ServicesBethesdaUSA
  6. 6.Cardiovascular and Pulmonary BranchNational Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), US Department of Health and Human ServicesBethesdaUSA

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