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01-03-2019 | Cardiac

Left ventricular extracellular volume fraction and atrioventricular interaction in hypertension

Authors: Jonathan C. L. Rodrigues, 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

Published in: European Radiology | Issue 3/2019

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.

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Title: Left ventricular extracellular volume fraction and atrioventricular interaction in hypertension
Authors: Jonathan C. L. Rodrigues
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
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 3/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5700-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Left ventricular extracellular volume fraction and atrioventricular interaction in hypertension

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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