What does this research mean for the field?

In patients with hypertension, eccentric and concentric left ventricular hypertrophy phenotypes have distinct cardiac magnetic resonance profiles and convey the worst prognosis, with eccentric hypertrophy markedly increasing the risk of major adverse cardiovascular events and heart failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2026European Heart Journal - Imaging Methods and PracticeOpen Access

Cardiac magnetic resonance characteristics and prognostic associations of hypertension-mediated left ventricular hypertrophy

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Why the study?

Large population-based longitudinal data comparing the clinical trajectories and CMR characteristics of hypertension-mediated LVH phenotypes are lacking.

Do CMR-defined hypertension-mediated LVH phenotypes (eccentric and concentric LVH) predict major adverse cardiovascular events and heart failure compared to normal LV geometry in hypertensive patients?

Structured PICO

Population

24,463 hypertensive adults (blood pressure ≥130/85 mmHg) from the UK Biobank imaging cohort, without other primary causes of LVH (e.g., hypertrophic cardiomyopathy), median age 66 years, 45.4% female.

Intervention

Hypertension-mediated left ventricular hypertrophy (LVH) phenotypes (LV remodelling, eccentric LVH, concentric LVH) evaluated by cardiac magnetic resonance (CMR)

Comparator

Hypertensive patients with normal left ventricular (LV) geometry defined by CMR

Outcome

Major adverse cardiovascular events (MACE), defined as hospitalization or death due to fatal/non-fatal myocardial infarction, stroke, or ventricular arrhythmiashard clinical

In a large population of hypertensive patients, CMR-defined eccentric and concentric LVH phenotypes are independently associated with significantly worse cardiovascular outcomes, particularly incident heart failure, compared to those with normal LV geometry.

Limitations

Relatively short follow-up period
Potential for residual confounding from unmeasured factors such as hypertension duration, treatment class, kidney function and lifestyle characteristics
Cohort is predominantly of White European ancestry (>97%), which limits generalizability to other ancestries

Implication

Eccentric and concentric LVH signal highest HF risk in hypertensives; leaves open whether CMR phenotyping refines risk stratification.

Abstract

Aims: Hypertension-mediated left ventricular hypertrophy (LVH) phenotypes: normal left ventricle (LV), LV remodelling, eccentric and concentric LVH have been reported using cardiac magnetic resonance (CMR). Although previous smaller studies have explored associations of these phenotypes with select CMR metrics, large population-based longitudinal data comparing their clinical trajectories are lacking. This study aimed to evaluate CMR characteristics across hypertension-mediated LVH phenotypes and their associations with incident cardiovascular outcomes. Methods and results: In the UK Biobank imaging cohort, 24 463 hypertensives were categorized into LVH phenotypes using CMR. Logistic regression models explored the relationship between phenotypes, setting normal LV as the reference, and CMR parameters as exposures. Cox proportional hazard models evaluated associations with incident major adverse cardiovascular events (MACE) and separately heart failure over a median follow-up of 4.9 years. Among the participants, 23 206 had normal LV, 889 LV remodelling, 253 eccentric and 115 concentric LVH. Hypertensives with eccentric LVH had the most impaired LV function using ejection fraction and strain, and those with concentric LVH had the highest T1 values and maximal wall thickness. Hypertensives with eccentric LVH were associated with a 2.5 times higher rate of MACE (HR 2.5, CI: 1.7-3.8) and 9 times higher heart failure event rates (HR 9.0, CI: 5.7-14.2). Hypertensives with concentric LVH had 4.1 times higher heart failure events rates (HR 4.1, CI: 1.8-9.3), and no association with MACE. Conclusion: In this large population study, we found distinct differences in CMR characteristics between hypertension-mediated LVH phenotypes with eccentric and concentric LVH exhibiting the worst prognosis.