Key result
Six months of antihypertensive drug therapy in patients with hypertensive heart disease significantly reduced mean extracellular volume (p<0.001) and improved global radial and circumferential strain.
Why the study?
Evaluating fibrosis and hypertrophy is central to post-treatment evaluation in hypertensive heart disease, motivating an analysis of ECV and myocardial strain across varying degrees of systolic dysfunction and post-treatment.
Does antihypertensive treatment with ACEI or ARB improve extracellular volume and myocardial strain in patients with hypertensive heart disease?
Observational (n=88)
No
Does antihypertensive treatment with ACEI or ARB improve extracellular volume and myocardial strain in patients with hypertensive heart disease?
CMR-derived extracellular volume and myocardial strain are sensitive markers for evaluating myocardial abnormalities and monitoring treatment response in hypertensive heart disease.
CMR may track myocardial response to antihypertensives in hypertensive heart disease; hypothesis-generating and requires randomized confirmation before practice change.
Background : Evaluation of tissue fibrosis and myocardial hypertrophy in left ventricular (LV) remodeling is the basis of post-treatment evaluation of hypertensive heart disease（HHD). Extracellular volume (ECV) and myocardial strain parameters can indirectly reflect the changes of both. Our objective was to analyze the characteristics of ECV and strain parameters in LV myocardium of HHD with varying degrees of systolic dysfunction, and to explore the changes of both after treatment for hypertension.Methods: A total of 62 HHD patients were divided into 3 groups according to ejection fraction (EF<30%, 30%≦EF<50%, EF≧50%). Twenty-one of these patients underwent cardiac magnetic resonance（CMR）reexamination more than six months after receiving antihypertensive medication. The initial T1 time and post-enhancement T1 time of each segment were measured, and the ECV was calculated. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) of LV were measured by cvi42 software, and the differences in CMR parameters between different groups and before and after treatment were compared.Results: ①The mean, basal and middle ECV value of HHD groups with different EF were all higher than that of the control group ( p <0.05), but the difference between HHD groups was not statistically significant. ② With the decrease of EF, the absolute value of both the global or local strain decreased. Strain is related to LVMI and ECV. ③In general, ECV, global RS (GRS) and global CS（GCS） improved after treatment, but the improvement of LS impairment in HHD patients is difficult.Conclusions: ECV and myocardial strain parameters are more sensitive to myocardial abnormalities, and ECV, GRS and GCS are more sensitive to treatment. Although it is difficult to improve longitudinal strain impairment in HHD patients, it is more important for prognosis evaluation. ECV and myocardial strain parameters can be used as good makers for long-term monitoring of the efficacy of HHD patients.
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Niu et al. (2020) conducted an observational in Hypertensive Heart Disease (n=88). Antihypertensive drugs (ACEI or ARB) vs. Baseline was evaluated on Mean Extracellular Volume (ECV) (p=<0.001). Six months of antihypertensive drug therapy in patients with hypertensive heart disease significantly reduced mean extracellular volume (p<0.001) and improved global radial and circumferential strain.
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