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. 2017 Apr 1;18(4):441-450.
doi: 10.1093/ehjci/jew117.

ECG strain pattern in hypertension is associated with myocardial cellular expansion and diffuse interstitial fibrosis: a multi-parametric cardiac magnetic resonance study

Jonathan C L Rodrigues  1   2 , Antonio Matteo Amadu  1   3 , Amardeep Ghosh Dastidar  1   4 , Bethannie McIntyre  5 , Gergley V Szantho  1   6 , Stephen Lyen  1   7 , Cattleya Godsave  8 , Laura E K Ratcliffe  9 , Amy E Burchell  9 , Emma C Hart  2   9 , Mark C K Hamilton  1   7 , Angus K Nightingale  1   4   9 , Julian F R Paton  2   9 , Nathan E Manghat  1   7 , Chiara Bucciarelli-Ducci  1   4   10
Affiliations

ECG strain pattern in hypertension is associated with myocardial cellular expansion and diffuse interstitial fibrosis: a multi-parametric cardiac magnetic resonance study

Jonathan C L Rodrigues et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: In hypertension, the presence of left ventricular (LV) strain pattern on 12-lead electrocardiogram (ECG) carries adverse cardiovascular prognosis. The underlying mechanisms are poorly understood. We investigated whether hypertensive ECG strain is associated with myocardial interstitial fibrosis and impaired myocardial strain, assessed by multi-parametric cardiac magnetic resonance (CMR).

Methods and results: A total of 100 hypertensive patients [50 ± 14 years, male: 58%, office systolic blood pressure (SBP): 170 ± 30 mmHg, office diastolic blood pressure (DBP): 97 ± 14 mmHg) underwent ECG and 1.5T CMR and were compared with 25 normotensive controls (46 ± 14 years, 60% male, SBP: 124 ± 8 mmHg, DBP: 76 ± 7 mmHg). Native T1 and extracellular volume fraction (ECV) were calculated with the modified look-locker inversion-recovery sequence. Myocardial strain values were estimated with voxel-tracking software. ECG strain (n = 20) was associated with significantly higher indexed LV mass (LVM) (119 ± 32 vs. 80 ± 17 g/m2, P < 0.05) and ECV (30 ± 4 vs. 27 ± 3%, P < 0.05) compared with hypertensive subjects without ECG strain (n = 80). ECG strain subjects had significantly impaired circumferential strain compared with hypertensive subjects without ECG strain and controls (-15.2 ± 4.7 vs. -17.0 ± 3.3 vs. -17.3 ± 2.4%, P < 0.05, respectively). In subgroup analysis, comparing ECG strain subjects to hypertensive subjects with elevated LVM but no ECG strain, a significantly higher ECV (30 ± 4 vs. 28 ± 3%, P < 0.05) was still observed. Indexed LVM was the only variable independently associated with ECG strain in multivariate logistic regression analysis [odds ratio (95th confidence interval): 1.07 (1.02-1.12), P < 0.05).

Conclusion: In hypertension, ECG strain is a marker of advanced LVH associated with increased interstitial fibrosis and associated with significant myocardial circumferential strain impairment.

Keywords: ECG; fibrosis; hypertension; hypertrophy; myocardial strain; remodelling.

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Figures

Figure 1
Figure 1
A flow chart describing the reasons for exclusion and final hypertensive sample size (n = 100). * Images degraded by implantable loop recorder.
Figure 2
Figure 2
Representative example of a hypertensive subject with ECG strain. (A) Evidence of ECG strain. (B) SSFP short-axis cine image at end-diastole. Indexed LVM = 153 g/m2. (C) LGE image showing no replacement fibrosis. (D) Native T1 map. Mean T1 relaxation time of myocardium = 1081 ms and of blood pool = 1595 ms. (E) Post-contrast T1 map. Mean T1 relaxation time of myocardium = 433 ms and of blood pool = 319 ms. ECV = 32%.
Figure 3
Figure 3
Representative example of a hypertensive subject with LVH but no ECG strain. (A) No evidence of ECG strain. (B) SSFP short-axis cine image at end-diastole. Indexed LVM = 92 g/m2. (C) LGE image showing no replacement fibrosis. (D) Native T1 map. Mean T1 relaxation time of myocardium = 1033 ms and of blood pool = 1653 ms. (E) Post-contrast T1 map. Mean T1 relaxation time of myocardium = 520 ms and of blood pool = 368 ms. ECV = 27%.
Figure 4
Figure 4
Graphs of (A) mean circumferential strain of the mid-myocardium, (B) mean global longitudinal strain, and (C) mean radial strain of the mid-myocardium over the cardiac cycle for normotensive control and hypertensive (ECG strain and no ECG strain) cohorts.
See this image and copyright information in PMC

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