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Review
. 2019 Jan 14;21(1):3.
doi: 10.1007/s11906-019-0910-6.

Recent Advances in Imaging of Hypertensive Heart Disease

Christopher L Schumann  1 , Nicholas R Jaeger  2 , Christopher M Kramer  3   4
Affiliations
Review

Recent Advances in Imaging of Hypertensive Heart Disease

Christopher L Schumann et al. Curr Hypertens Rep. .

Abstract

Purpose of review: To review recent advances in the imaging of hypertensive heart disease (HHD) with an emphasis on developments in the imaging of diffuse myocardial fibrosis using cardiac magnetic resonance (CMR).

Recent findings: HHD results from long-standing hypertension and is characterized by the development of left ventricular hypertrophy and diffuse interstitial fibrosis. Diffuse fibrosis traditionally required endomyocardial biopsy to diagnose, but recent developments using T1 mapping in CMR allow for noninvasive assessment. Studies using T1 mapping have shown an increase in extracellular volume fraction (ECV) in patients with HHD compared to normal controls, suggesting ECV can be used as a noninvasive marker for fibrosis in HHD. In addition to T1 mapping, other recent advances in HHD imaging include improvements in three-dimensional echocardiography, allowing for accurate real-time volumetric measurements, and the use of speckle tracking echocardiography to detect subclinical systolic dysfunction. Measurement of ECV using T1 mapping in CMR can be used as a noninvasive marker of diffuse myocardial fibrosis in HHD. While further studies are needed to validate this approach with larger patient cohorts, ECV can potentially be used to both monitor disease progression and assess therapeutic interventions in HHD.

Keywords: Cardiac magnetic resonance; Hypertensive heart disease; Speckle tracking echocardiography; T1 mapping; Three-dimensional echocardiography.

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Figures

Figure 1:
Figure 1:
CMR images of (A) Four chamber SSFP showing severe concentric LVH. (B) Basal short axis SSFP showing severe concentric LVH. (C) Two chamber view depicting anterior midwall LGE (arrow) in patient with HHD. (D) SSFP basal short axis image. (E) Pre-contrast T1 map in black & white. (F) T1 color map
See this image and copyright information in PMC

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