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. 2016 Nov;18(11):1119-1127.
doi: 10.1111/jch.12849. Epub 2016 Jun 17.

The Relationship Between Left Ventricular Wall Thickness, Myocardial Shortening, and Ejection Fraction in Hypertensive Heart Disease: Insights From Cardiac Magnetic Resonance Imaging

Jonathan C L Rodrigues  1   2 , Stephen Rohan  3 , Amardeep Ghosh Dastidar  1 , Adam Trickey  4 , Gergely Szantho  1 , Laura E K Ratcliffe  5 , Amy E Burchell  5 , Emma C Hart  2   5 , Chiara Bucciarelli-Ducci  1 , Mark C K Hamilton  1 , Angus K Nightingale  5 , Julian F R Paton  2   5 , Nathan E Manghat  1 , David H MacIver  6   7   8
Affiliations

The Relationship Between Left Ventricular Wall Thickness, Myocardial Shortening, and Ejection Fraction in Hypertensive Heart Disease: Insights From Cardiac Magnetic Resonance Imaging

Jonathan C L Rodrigues et al. J Clin Hypertens (Greenwich). 2016 Nov.

Abstract

Hypertensive heart disease is often associated with a preserved left ventricular ejection fraction despite impaired myocardial shortening. The authors investigated this paradox in 55 hypertensive patients (52±13 years, 58% male) and 32 age- and sex-matched normotensive control patients (49±11 years, 56% male) who underwent cardiac magnetic resonance imaging at 1.5T. Long-axis shortening (R=0.62), midwall fractional shortening (R=0.68), and radial strain (R=0.48) all decreased (P<.001) as end-diastolic wall thickness increased. However, absolute wall thickening (defined as end-systolic minus end-diastolic wall thickness) was maintained, despite the reduced myocardial shortening. Absolute wall thickening correlated with ejection fraction (R=0.70, P<.0001). In multiple linear regression analysis, increasing wall thickness by 1 mm independently increased ejection fraction by 3.43 percentage points (adjusted β-coefficient: 3.43 [2.60-4.26], P<.0001). Increasing end-diastolic wall thickness augments ejection fraction through preservation of absolute wall thickening. Left ventricular ejection fraction should not be used in patients with hypertensive heart disease without correction for degree of hypertrophy.

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Conflict of interest statement

Dr Bucciarelli‐Ducci is a consultant for Circle Cardiovascular Imaging Inc., Calgary, Canada.

Figures

Figure 1
Figure 1
Scatter graphs for hypertensive patients and normotensive controls showing the relationship of midwall fractional shortening to long‐axis shortening (A), radial strain to midwall fractional shortening (B), and radial strain to long‐axis shortening (C).
Figure 2
Figure 2
Scatter graphs for hypertensive patients and normotensive controls showing the relationship of midwall fractional shortening to mean end‐diastolic wall thickness (A), long‐axis shortening to mean end‐diastolic wall thickness (B), and radial strain to mean end‐diastolic wall thickness (C).
Figure 3
Figure 3
Scatter graphs for hypertensive patients and normotensive controls showing the relationship of end‐diastolic wall thickness (EDWT) to end‐systolic wall thickness (ESWT) (A), EDWT to absolute wall thickening (AWT) (B), EDWT to left ventricular ejection fraction (LVEF) (C), and AWT to LVEF (D).
See this image and copyright information in PMC

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