Advanced imaging tools for evaluating cardiac morphological and functional impairment in hypertensive disease

Abstract

Arterial hypertension represents a systemic burden, and it is responsible of various morphological, functional and tissue modifications affecting the heart and the cardiovascular system. Advanced imaging techniques, such as speckle tracking and three-dimensional echocardiography, cardiac magnetic resonance, computed tomography and PET-computed tomography, are able to identify cardiovascular injury at different stages of arterial hypertension, from subclinical alterations and overt organ damage to possible complications related to pressure overload, thus giving a precious contribution for guiding timely and appropriate management and therapy, in order to improve diagnostic accuracy and prevent disease progression. The present review focuses on the peculiarity of different advanced imaging tools to provide information about different and multiple morphological and functional aspects involved in hypertensive cardiovascular injury. This evaluation emphasizes the usefulness of the emerging multiimaging approach for a comprehensive overview of arterial hypertension induced cardiovascular damage.

FIGURE 1

Example showing alterations provided by different advanced imaging tools at early stage, consolidated stage of arterial hypertension and complications. At early stages: (a) 2D GLS and regional strain impairment with predominant involvement of basal and middle longitudinal strain, (b) Myocardial work components alteration in hypertensive patients, (c) LV concentric geometry with increased LVM/EDV ratio detectable at 3D-echocardiography. At consolidated stage: (d) LVH evaluated by MRI, E) LGE nonischemic intramyocardial pattern (white arrow) of the basal anterior septum (left: basal short axis view, right: three-chamber view) in a hypertensive patient with LVH, (f) contrast-enhanced CT showing LA dilation. Complications: (g) Aneurism of the ascending aorta detected by contrast-CT, (h) Aortic valve calcification and stenosis by CT, (i) ¹⁸F-NaF PET-CT showing uptake within both the descending left coronary artery and the aortic valve. ¹⁸F-NaF, fluorine-18-sodium fluoride; 2D, two-dimensional; 3D, three-dimensional; CT, computed tomography; EDV, end-diastolic volume; GLS, global longitudinal strain; LA, left atrial; LV, left ventricular; LVH, left ventricular hypertrophy; LVM, left ventricular mass; PET-CT, PET-computed tomography.

FIGURE 2

Schema depicting the advanced imaging tools useful in the cardiac and vascular damage induced by arterial hypertension; some evaluations are common to one or more techniques while each method owns its peculiarities. ¹⁸F-FDG, fluorine-18-fluorodeoxyglycose; ¹⁸F-NaF, fluorine-18-sodium fluoride; 2D, two-dimensional; 3D, three-dimensional; CAD, coronary artery disease; CT, computed tomography; ECV, extracellular volume fraction; EDV, end-diastolic volume; GLS, global longitudinal strain; LA, left atrial; LGE, late gadolinium enhancement; LV, left ventricular; LVH, left ventricular hypertrophy; LVM, left ventricular mass; PET-CT, PET-computed tomography.