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ECG strain pattern in hypertension is associated with myocardial cellular expansion and diffuse interstitial

Jonathan C L Rodrigues1,2, Antonio Matteo Amadu1,3, Amardeep Ghosh Dastidar1,4

  • 1NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol BS2 8HW, UK.

European Heart Journal. Cardiovascular Imaging
|June 24, 2016
PubMed

Insights

Hypertension electrocardiogram (ECG) strain patterns indicate advanced left ventricular hypertrophy (LVH) with increased fibrosis and impaired myocardial function. This finding highlights ECG strain as a marker for adverse cardiovascular prognosis in hypertensive patients.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Hypertension Research

Background:

  • Electrocardiogram (ECG) strain patterns in hypertension are linked to poor cardiovascular outcomes.
  • The mechanisms connecting ECG strain to cardiac changes remain unclear.
  • Investigating the association between hypertensive ECG strain, myocardial fibrosis, and impaired strain is crucial.

Purpose of the Study:

  • To determine if hypertensive ECG strain is associated with myocardial interstitial fibrosis.
  • To assess if hypertensive ECG strain correlates with impaired myocardial strain using cardiac magnetic resonance (CMR).
  • To elucidate the underlying mechanisms of adverse prognosis in hypertensive ECG strain.

Main Methods:

  • 100 hypertensive patients and 25 normotensive controls underwent 12-lead ECG and 1.5T CMR.
  • Multi-parametric CMR assessed native T1, extracellular volume fraction (ECV), and myocardial strain.
  • Voxel-tracking software estimated myocardial strain, and statistical analyses identified associations.

Main Results:

  • Hypertensive patients with ECG strain showed higher indexed left ventricular mass (LVM) and ECV compared to those without.
  • ECG strain was associated with significantly impaired circumferential strain.
  • Higher ECV was observed in ECG strain subjects even when compared to hypertensive patients with elevated LVM but no ECG strain.

Conclusions:

  • ECG strain in hypertension signifies advanced left ventricular hypertrophy (LVH).
  • Hypertensive ECG strain is associated with increased interstitial fibrosis.
  • Significant myocardial circumferential strain impairment is linked to ECG strain in hypertensive individuals.
Abstract

Keywords:
ECGfibrosishypertensionhypertrophymyocardial strainremodelling

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