European Radiology

, Volume 29, Issue 3, pp 1574–1585 | Cite as

Left ventricular extracellular volume fraction and atrioventricular interaction in hypertension

  • Jonathan C. L. RodriguesEmail author
  • Tamas Erdei
  • Amardeep Ghosh Dastidar
  • Gergley Szantho
  • Amy E. Burchell
  • Laura E. K. Ratcliffe
  • Emma C. Hart
  • Angus K. Nightingale
  • Julian F. R. Paton
  • Nathan E. Manghat
  • Mark C. K. Hamilton



Left atrial enlargement (LAE) predicts cardiovascular morbidity and mortality. Impaired LA function also confers poor prognosis. This study aimed to determine whether left ventricular (LV) interstitial fibrosis is associated with LAE and LA impairment in systemic hypertension.


Following informed written consent, a prospective observational study of 86 hypertensive patients (49 ± 15 years, 53% male, office SBP 168 ± 30 mmHg, office DBP 97 ± 4 mmHg) and 20 normotensive controls (48 ± 13 years, 55% male, office SBP 130 ± 13 mmHg, office DBP 80 ± 11 mmHg) at 1.5-T cardiovascular magnetic resonance was conducted. Extracellular volume fraction (ECV) was calculated by T1-mapping. LA volume (LAV) was measured with biplane area-length method. LA reservoir, conduit and pump function were calculated with the phasic volumetric method.


Indexed LAV correlated with indexed LV mass (R = 0.376, p < 0.0001) and ECV (R = 0.359, p = 0.001). However, ECV was the strongest significant predictor of LAE in multivariate regression analysis (odds ratio [95th confidence interval] 1.24 [1.04–1.48], p = 0.017). Indexed myocardial interstitial volume was associated with significant reductions in LA reservoir (R = -0.437, p < 0.0001) and conduit (R = -0.316, p = 0.003) but not pump (R = -0.167, p = 0.125) function. Multiple linear regression, correcting for age, gender, BMI, BP and diabetes, showed an independent decrease of 3.5% LA total emptying fraction for each 10 ml/m2 increase in myocardial interstitial volume (standard β coefficient -3.54, p = 0.002).


LV extracellular expansion is associated with LAE and impaired LA reservoir and conduit function. Future studies should identify if targeting diffuse LV fibrosis is beneficial in reverse remodelling of LA structural and functional pathological abnormalities in hypertension.

Key Points

• Left atrial enlargement (LAE) and impairment are markers of adverse prognosis in systemic hypertension but their pathophysiology is poorly understood.

• Left ventricular extracellular volume fraction was the strongest independent multivariate predictor of LAE and was associated with impaired left atrial reservoir and conduit function.

• LV interstitial expansion may play a central role in the pathophysiology of adverse atrioventricular interaction in systemic hypertension.


Cardiac imaging techniques Magnetic resonance imaging Hypertension Fibrosis Strain 



Analysis of ariance


Body mass index


Cardiovascular magnetic resonance


Diastolic blood pressure


Extracellular volume fraction


End-diastolic volume


European Society of Cardiology


End-systolic volume


Left atrial


Left atrial enlargement


Left atrial volume


Maximal left atrial volume


Minimal left atrial volume


Left atrial volume just prior to left atrial contraction


Left ventricular


Left ventricular hypertrophy


Left ventricular mass


Region of interest


Systolic blood pressure


Steady state free precession


Stroke volume



This work was supported by the Bristol National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at the Bristol Heart Institute. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or Department of Health.

We thank Christopher Lawton, Superintendent Radiographer, and the Bristol Heart Institute CMR radiographers for their expertise in performing the CMRs. JCLR: Clinical Society of Bath Postgraduate Research Bursary 2014 and Royal College of Radiologists Kodak Research Scholarship 2014. ECH and JFRP are funded by the British Heart Foundation.


This study has received funding by The Royal College of Radiologists Kodak Research Scholarship 2014.

Compliance with ethical standards


The scientific guarantor of this publication is Dr Mark Hamilton.

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional review board approval was obtained.


• prospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Jonathan C. L. Rodrigues
    • 1
    • 2
    • 3
    Email author
  • Tamas Erdei
    • 1
  • Amardeep Ghosh Dastidar
    • 1
  • Gergley Szantho
    • 1
  • Amy E. Burchell
    • 4
  • Laura E. K. Ratcliffe
    • 4
  • Emma C. Hart
    • 2
    • 4
  • Angus K. Nightingale
    • 4
  • Julian F. R. Paton
    • 2
    • 4
  • Nathan E. Manghat
    • 5
  • Mark C. K. Hamilton
    • 5
  1. 1.Department of Cardiovascular Magnetic Resonance, Bristol Cardiovascular Biomedical Research Unit, Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
  2. 2.School of Physiology, Pharmacology & Neuroscience, Faculty of Biomedical ScienceUniversity of BristolBristolUK
  3. 3.Department of RadiologyRoyal United Hospitals Bath NHS Foundation TrustBathUK
  4. 4.BHI CardioNomics Research Group, Clinical Research and Imaging Centre-BristolUniversity of BristolBristolUK
  5. 5.Department of Radiology, Bristol Royal InfirmaryUniversity Bristol NHS Foundation TrustBristolUK

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