Hypertensive Heart Disease-The Imaging Perspective

Abstract

Hypertensive heart disease (HHD) develops in response to the chronic exposure of the left ventricle and left atrium to elevated systemic blood pressure. Left ventricular structural changes include hypertrophy and interstitial fibrosis that in turn lead to functional changes including diastolic dysfunction and impaired left atrial and LV mechanical function. Ultimately, these changes can lead to heart failure with a preserved (HFpEF) or reduced (HFrEF) ejection fraction. This review will outline the clinical evaluation of a patient with hypertension and/or suspected HHD, with a particular emphasis on the role and recent advances of multimodality imaging in both diagnosis and differential diagnosis.

Keywords: Fabry’s disease; PET; cardiac amyloidosis; cardiovascular magnetic resonance; computed tomography; echocardiography; hypertensive heart disease; hypertrophic cardiomyopathy; myocardial perfusion scintigraphy.

Figure 1

Commonly used classification of left ventricular geometry and typical geometry changes occurring in patients with uncontrolled hypertension/hypertensive heart disease. PWT denotes posterior wall thickness; LVIDd denotes Left Ventricular Inner Diastolic diameter; ECV denotes myocardial extracellular volume. Deteriorating function implies both parameters of systolic and diastolic function. Normal values for Left Ventricular Mass Index depend on gender and imaging modality used.

Figure 2

Tissue characterization with Late Gadolinium Enhancement (LGE) and Extracellular Volume (ECV) Map. Adapted with permission from [33].