Key result
In patients with essential arterial hypertension, diffuse myocardial fibrosis was present in 100% of cases and was significantly associated with female gender, older age, and lower body weight.
Why the study?
Assessing diffuse myocardial fibrosis is needed to manage hypertensive heart disease, and cardiac MRI with T1 mapping enables its non-invasive detection.
Cross-Sectional (n=50)
T1 mapping by cardiac MRI identifies diffuse myocardial fibrosis in all patients with essential hypertension, with female gender, older age, and lower body weight associated with more advanced fibrotic changes.
Diffuse myocardial fibrosis appears universal in essential hypertension; hypothesis-generating for demographic influences, requiring prospective validation before clinical consideration.
Background : The assessment of diffuse myocardial fibrosis is necessary to plan the management of patients with various cardiovascular disorders, including hypertensive heart disease. The development of imaging techniques has enabled a non-invasive detection of left ventricular myocardial fibrosis by magnetic resonance imaging (MRI) with T1 mapping. Aim: By cardiac MRI, to identify risk factors for diffuse left ventricular myocardial fibrosis in patients with hypertensive heart disease. Materials and methods : This was a cross-sectional observational study in 50 outpatients with hypertensive heart disease, aged 46 to 82 years (median, 68 [64; 72] years) and bodyweight of 52 to 120 kg (median, 91 [80; 98] kg). Standard cardiac MRI with delayed contrast enhancement was performed with Optima MR450w GEM 1.5T (General Electric, USA). For assessment of diffuse myocardial fibrosis MRI mapping by 2D MOLLI (3-3-5) technique was used. The results were analyzed with Cvi42 software (Circle Cardiovascular Imaging Inc., USA). The potential risk factors included patients’ age, gender, bodyweight, and diastolic heart failure. Results: The mean time of T1 relaxation without contrast enhancement was 1122.64 ±63.67 ms, indicating the presence of myocardial fibrosis in 100% of the patients. Female patients had more advanced diffuse myocardial abnormalities (p < 0.001). In the elderly patients, there was a direct correlation between their age and degree of fibrosis (p = 0.006). There was an inverse correlation between higher bodyweight and increased extracellular volume. Heart rhythm disorders and diastolic heart failure had no impact on the changes in the mapping parameters of the left ventricular myocardium and MRI-assessed cardiac output values. No correlation between the myocardial fibrosis and dyslipidemia/hyperlipidemia was found. There was a direct correlation between the native T1 mapping values and extracellular volume fraction (p = 0.004) and an inverse correlation between low values of post-contrast T1 mapping and increased extracellular volume fraction (p = 0.05). Conclusion: Т1 mapping in patients with essential arterial hypertension allows for detection of diffuse myocardial fibrosis of the left ventricle, which is recognised as a major indicator of myocardial remodeling. Female gender, older age, and bodyweight were the factors associated with more advanced myocardial fibrosis.
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Abramenko et al. (2020) conducted a cross-sectional in Essential arterial hypertension (n=50). Risk factors (age, gender, body weight) was evaluated on Diffuse myocardial fibrosis assessed by T1 mapping and extracellular volume fraction (p=<0.001). In patients with essential arterial hypertension, diffuse myocardial fibrosis was present in 100% of cases and was significantly associated with female gender, older age, and lower body weight.
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