ECG strain pattern in hypertension is associated with myocardial cellular expansion and diffuse interstitial fibrosis: a multi-parametric cardiac magnetic resonance study

Jonathan C L Rodrigues, Antonio Matteo Amadu, Amardeep Ghosh Dastidar, Bethannie McIntyre, Gergley V Szantho, Stephen Lyen, Cattleya Godsave, Laura E K Ratcliffe, Amy E Burchell, Emma C Hart, Mark C K Hamilton, Angus K Nightingale, Julian F R Paton, Nathan E Manghat, Chiara Bucciarelli-Ducci

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Abstract

AIMS: In hypertension, the presence of left ventricular (LV) strain pattern on 12-lead electrocardiogram (ECG) carries adverse cardiovascular prognosis. The underlying mechanisms are poorly understood. We investigated whether hypertensive ECG strain is associated with myocardial interstitial fibrosis and impaired myocardial strain, assessed by multi-parametric cardiac magnetic resonance (CMR).

METHODS AND RESULTS: A total of 100 hypertensive patients [50 ± 14 years, male: 58%, office systolic blood pressure (SBP): 170 ± 30 mmHg, office diastolic blood pressure (DBP): 97 ± 14 mmHg) underwent ECG and 1.5T CMR and were compared with 25 normotensive controls (46 ± 14 years, 60% male, SBP: 124 ± 8 mmHg, DBP: 76 ± 7 mmHg). Native T1 and extracellular volume fraction (ECV) were calculated with the modified look-locker inversion-recovery sequence. Myocardial strain values were estimated with voxel-tracking software. ECG strain (n = 20) was associated with significantly higher indexed LV mass (LVM) (119 ± 32 vs. 80 ± 17 g/m(2), P < 0.05) and ECV (30 ± 4 vs. 27 ± 3%, P < 0.05) compared with hypertensive subjects without ECG strain (n = 80). ECG strain subjects had significantly impaired circumferential strain compared with hypertensive subjects without ECG strain and controls (-15.2 ± 4.7 vs. -17.0 ± 3.3 vs. -17.3 ± 2.4%, P < 0.05, respectively). In subgroup analysis, comparing ECG strain subjects to hypertensive subjects with elevated LVM but no ECG strain, a significantly higher ECV (30 ± 4 vs. 28 ± 3%, P < 0.05) was still observed. Indexed LVM was the only variable independently associated with ECG strain in multivariate logistic regression analysis [odds ratio (95th confidence interval): 1.07 (1.02-1.12), P < 0.05).

CONCLUSION: In hypertension, ECG strain is a marker of advanced LVH associated with increased interstitial fibrosis and associated with significant myocardial circumferential strain impairment.

Original languageEnglish
Pages (from-to)441-450
Number of pages10
JournalEuropean Heart Journal - Cardiovascular Imaging
Volume18
Issue number4
Early online date22 Jun 2016
DOIs
Publication statusPublished - Apr 2017

Structured keywords

  • CRICBristol

Keywords

  • fibrosis
  • hypertension
  • hypertrophy
  • remodelling
  • myocardial strain
  • ECG

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    Rodrigues, J. C. L., Amadu, A. M., Ghosh Dastidar, A., McIntyre, B., Szantho, G. V., Lyen, S., Godsave, C., Ratcliffe, L. E. K., Burchell, A. E., Hart, E. C., Hamilton, M. C. K., Nightingale, A. K., Paton, J. F. R., Manghat, N. E., & Bucciarelli-Ducci, C. (2017). ECG strain pattern in hypertension is associated with myocardial cellular expansion and diffuse interstitial fibrosis: a multi-parametric cardiac magnetic resonance study. European Heart Journal - Cardiovascular Imaging, 18(4), 441-450. https://doi.org/10.1093/ehjci/jew117