Precursors of Hypertensive Heart Phenotype Develop in Healthy Adults: A High-Resolution 3D MRI Study

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• 作者：Antonio de Marvao ; PhD^&lowast ; ; Timothy J.W. Dawes ; PhD^&lowast ; ; Wenzhe Shi ; PhD^&lowast ; ; ^&dagger ; ; Giuliana Durighel ; MSc^&lowast ; ; Daniel Rueckert ; PhD^&dagger ; ; Stuart A. Cook ; PhD^&lowast ; ; ^&Dagger ; ; ^§ ; ; ; Declan P. O&rsquo ; Regan ; PhD^&lowast ; ; ^{declan.oregan@imperial.ac.uk" class="auth_mail" title="E-mail the corresponding author}
• 关键词：cardiac atlas ; cardiac magnetic resonance ; hypertension ; left ventricular hypertrophy ; remodeling
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：8
• 期：11
• 页码：1260-1269
• 全文大小：1254 K

文摘

This study used high-resolution 3-dimensional cardiac magnetic resonance to define the anatomical and functional left ventricular (LV) properties associated with increasing systolic blood pressure (SBP) in a drug-naïve cohort.

Background

LV hypertrophy and remodeling occur in response to hemodynamic stress but little is known about how these phenotypic changes are initiated in the general population.

Methods

In this study, 1,258 volunteers (54% women, mean age 40.6 ± 12.8 years) without self-reported cardiovascular disease underwent 3-dimensional cardiac magnetic resonance combined with computational modeling. The relationship between SBP and wall thickness (WT), relative WT, end-systolic wall stress (WS), and fractional wall thickening were analyzed using 3-dimensional regression models adjusted for body surface area, sex, race, age, and multiple testing. Significantly associated points in the LV model (p < 0.05) were identified and the relationship with SBP reported as mean β coefficients.

Results

There was a continuous relationship between SBP and asymmetric concentric hypertrophic adaptation of the septum and anterior wall that was associated with normalization of wall stress. In the lateral wall an increase in wall stress with rising SBP was not balanced by a commensurate hypertrophic relationship. In normotensives, SBP was positively associated with WT (β = 0.09) and relative WT (β = 0.07) in the septal and anterior walls, and this regional hypertrophic relationship was progressively stronger among pre-hypertensives (β = 0.10) and hypertensives (β = 0.30).

Conclusions

These findings show that the precursors of the hypertensive heart phenotype can be traced to healthy normotensive adults and that an independent and continuous relationship exists between adverse LV remodeling and SBP in a low-risk population. These adaptations show distinct regional variations with concentric hypertrophy of the septum and eccentric hypertrophy of the lateral wall, which challenge conventional classifications of LV remodeling.