Analysis of atrioventricular function and myocardial strain in hypertensive heart disease: a CMR-based study

Previous studies on hypertensive heart disease (HHD) mainly focused on the alterations of left ventricle (LV), with insufficient comprehensive evaluation of left atria (LA), right atria (RA) and right ventricle (RV). This study assesses atrial and ventricular morphology, function, and mechanics in HHD using cardiac magnetic resonance (CMR) imaging. This study enrolled 64 HHD patients grouped by left ventricular ejection fraction (LVEF): ≤30% (n = 23), 30% < LVEF < 50% (n = 20), and ≥ 50% (n = 21), as well as 21 age- and sex-matched healthy controls. LAEF parameters were calculated from phasic volume measurements. Atrial global longitudinal strain (GLS) parameters were acquired from the GLS-time curve, which includes reservoir function (total strain, εs), conduit function (passive strain, εe), and booster pump function (active strain, εa). Meanwhile, all other parameters were derived from CMR cine images using CVI42 software. In HHD, LA parameters (LAEF_total, LAEF_passive, LAεS and LAεe) were lower than in controls (p < 0.05). Regarding RV alterations, LVEF ≤ 30% and 30% < LVEF < 50% groups had significantly lower RVEF, global circumferential strain (GCS), and global radial strain (GRS) than the LVEF ≥ 50% and control groups (p < 0.05). RA morphology and function showed no significant differences (p > 0.05). RA total and passive strain were lower in the LVEF ≤ 30% group than in LVEF ≥ 50% and controls (p < 0.05). Chamber morphology, function, and mechanics vary across HHD stages. Strain parameters may offer more reliable risk stratification than traditional metrics.