Cardiac Magnetic Resonance in Hypertensive Heart Disease: Time for a New Chapter

Abstract

Hypertension is one of the most important cardiovascular risk factors, associated with significant morbidity and mortality. Chronic high blood pressure leads to various structural and functional changes in the myocardium. Different sophisticated imaging methods are developed to properly estimate the severity of the disease and to prevent possible complications. Cardiac magnetic resonance can provide a comprehensive assessment of patients with hypertensive heart disease, including accurate and reproducible measurement of left and right ventricle volumes and function, tissue characterization, and scar quantification. It is important in the proper evaluation of different left ventricle hypertrophy patterns to estimate the presence and severity of myocardial fibrosis, as well as to give more information about the benefits of different therapeutic modalities. Hypertensive heart disease often manifests as a subclinical condition, giving exceptional value to cardiac magnetic resonance as an imaging modality capable to detect subtle changes. In this article, we are giving a comprehensive review of all the possibilities of cardiac magnetic resonance in patients with hypertensive heart disease.

Keywords: cardiac magnetic resonance; hypertension; hypertensive heart disease; left ventricle hypertrophy; myocardial fibrosis.

Figure 1

Asymmetric hypertrophic cardiomyopathy–with apical hypertrophy, as marked by arrows (A,B) versus left ventricular hypertrophy in hypertensive heart disease, concentric type, with predominant hypertrophy of the septum (marked by red arrow) (C,D) cine sequences.

Figure 2

Different cardiac magnetic resonance characteristics in patients with: (A,B)—hypertensive heart disease (left ventricular hypertrophy with subtle focal LGE marked by red arrow); (C,D)—hypertrophic cardiomyopathy (characteristic septal LGE marked by red arrow), cine and PSIR LGE sequences.

Figure 3

The utility of cardiac magnetic resonance in different stages of hypertensive hearts disease.

Figure 4

Cine sequences, LGE patterns, and native T1 mapping in patients with hypertensive heart disease, hypertrophic cardiomyopathy, and amyloidosis (A1): short-axis cine sequences with hypertrophic septum in a patient with hypertensive heart disease (HHD); (A2): subtle focal LGE phenomenon in a patient with HHD (marked by red arrow); (A3): T1 mapping showing diffuse borderline values of native T1 time in a patient with HHD; (B1): Hypertrophic cardiomyopathy with predominant septal hypertrophy (marked by red arrow); (B2): Septal LGE phenomenon in a patient with hypertrophic cardiomyopathy (marked by red arrow); (B3): T1 mapping in a patient with HCM revealing prolonged native T1 time (especially in the septum, which is important discriminator between HHD and HCM); (C1): cine sequences in short-axis revealing left ventricular hypertrophy in a patient with amyloidosis; (C2): diffuse subendocardial LGE phenomenon in a patient with amyloidosis (marked by red arrow); (C3): T1 mapping showing prolonged native T1 time in the subendocardium.