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

  • Cardiac
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Abstract

Objectives

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

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

BP:

Blood pressure

CI:

Cardiac index

CMR:

Cardiac magnetic resonance

ECV:

Extracellular volume fraction

HTN:

Hypertension

LA:

Left atrium

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVEDVi:

Left ventricular end-diastolic volume index

LVEF:

Left ventricular ejection fraction

LVESVi:

Left ventricular end-systolic volume index

LVH:

Left ventricular hypertrophy

MaxDBP:

Maximum diastolic blood pressure

MaxSBP:

Maximum systolic blood pressure

PSIR:

Phase sensitive inversion recovery

ROI:

Region of interest

SV:

Stroke volume

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Author information

Authors and Affiliations

  1. Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China

    Shuli Wang, Minjie Lu, Jinghui Li, Xiuyu Chen, Gang Yin, Tian Lan, Linlin Dai, Yan Zhang, Xiaorong Yin & Shihua Zhao

  2. Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China

    Hongjie Hu

  3. Siemens Shenzhen Magnetic Resonance Ltd., Siemens MRI Center, Shenzhen, Guangdong, People’s Republic of China

    Jing An

  4. Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China

    Lei Song & Aimin Dang

  5. Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, Bethesda, MD, USA

    Minjie Lu, Arlene Sirajuddin & Andrew E. Arai

  6. Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), US Department of Health and Human Services, Bethesda, MD, USA

    Peter Kellman

Authors
  1. Shuli Wang
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  2. Hongjie Hu
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  3. Minjie Lu
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  4. Arlene Sirajuddin
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  5. Jinghui Li
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  6. Jing An
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  7. Xiuyu Chen
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  8. Gang Yin
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  9. Tian Lan
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  10. Linlin Dai
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  11. Yan Zhang
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  12. Xiaorong Yin
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  13. Lei Song
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  14. Aimin Dang
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  15. Peter Kellman
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  16. Andrew E. Arai
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  17. Shihua Zhao
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Corresponding author

Correspondence to Minjie Lu.

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Guarantor

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.

Funding

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.

Methodology

• prospective

• cross-sectional study

• performed at one institution

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Wang, S., Hu, H., Lu, M. et al. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in hypertension and associated with left ventricular remodeling. Eur Radiol 27, 4620–4630 (2017). https://doi.org/10.1007/s00330-017-4841-9

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  • DOI: https://doi.org/10.1007/s00330-017-4841-9

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