Cardiac magnetic resonance assessment of left ventricular phenotypes and prognostic implications in hypertensive heart disease

Background: Previous studies have demonstrated an association between left ventricular (LV) phenotypes assessed by echocardiography and clinical outcomes in patients with hypertensive heart disease (HHD).However, data evaluating LV phenotypes using cardiac magnetic resonance (CMR)-the reference standard for quantification of LV volume, mass, and function-remain limited.This study aimed to assess the prognostic value of CMRderived LV phenotypes in patients with HHD.Methods: We included 756 consecutive patients with hypertension who were referred for clinically indicated CMR at an academic hospital in Thailand between 2011 and 2019.Four LV phenotypes were defined using LV mass index (LVMI), LV mass-to-volume ratio, and LV enddiastolic volume index (LVEDVI).Patients were followed for major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, hospitalization for heart failure, and stroke.Results: The mean age was 70 10 years, and 47% of patients were male.At baseline, 42.3% had controlled blood pressure, 37.0% had grade 1 hypertension, and 20.7% had grade 2-3 hypertension.The mean LVEF was 70.9 9.7%.Over a median follow-up of 7.1 years (interquartile range 4.1-9.2),153 MACE occurred.Annualized MACE rates were highest in patients with eccentric hypertrophy (5.8 per 100 patient-years), followed by concentric hypertrophy (3.5), concentric remodeling (2.7), and normal geometry (1.5).After multivariable adjustment, concentric remodeling (adjusted hazard ratio HR, 2.22; 95%confidence interval CI, 1.30-3.81;P = 0.004), concentric hypertrophy (adjusted HR, 2.81; 95% CI, 1.77-4.46;P < 0.001), and eccentric hypertrophy (adjusted HR, 2.40; 95% CI, 1.40-4.14;P = 0.002) remained independently associated with MACE.In addition, the combined inclusion of LVEDVI and LVMI, as well as LV phenotypes, provided incremental prognostic value beyond the baseline model (incremental 2 =23.29,P < 0.001 and 23.60, P < 0.001, respectively).Conclusions: CMR-based LV phenotyping was associated with prognosis in patients with HHD, with abnormal LV phenotypes demonstrating higher risks of MACE compared with normal geometry.These findings indicate that CMR may have a complementary role in risk assessment among patients with hypertension.