The Importance of Cardiac Magnetic Resonance in the Assessment Risk of Cardiac Arrhythmias in Patients with Arterial Hypertension

Abstract

Objectives: Arterial hypertension (AH) is one of the major risk factors for cardiovascular diseases. An association between untreated AH and arrhythmia is observed. Cardiac magnetic resonance (CMR) assesses myocardial fibrosis by detecting foci of late gadolinium enhancement (LGE). Clinical significance of LGE at the right ventricular insertion point (RVIP) is not fully established. This study aimed to assess the relationship between the presence of LGE at the RVIP determined by CMR and the incidence of arrhythmia in a group suffering from arterial hypertension. Methods: The study group consisted of 81 patients with AH (37 men and 44 women, age: 56.7 ± 7.1 years). All subjects underwent CMR and 24 h Holter ECG monitoring. Two subgroups were distinguished in the study group based on the criterion of the presence of LGE at the RVIP in CMR. The RVIP+ subgroup consisted of patients with LGE at the RVIP, while the RVIP- group consisted of patients without LGE at the RVIP. Results: The RVIP+ subgroup was characterized by higher maximum and minimum heart rates in 24 h Holter ECG recordings compared to the RVIP- subgroup (p < 0.05). The RVIP+ subgroup had a statistically significantly higher number of single premature supraventricular beats, supraventricular tachycardias, and single premature ventricular beats than the RVIP- subgroup (p < 0.05). Regression analysis documented that a longer duration of AH (counted from diagnosis) as well as the occurrence of LGE at the RVIP (assessed by CMR) are independent risk factors for arrhythmia (p < 0.05). Conclusions: Due to the possibility of detecting LGE at the RVIP, CMR may be a useful diagnostic method in estimating the risk of arrhythmias in the group of patients with AH.

Keywords: arrhythmias; arterial hypertension; cardiac magnetic resonance; right ventricular insertion point.

Figure 1

Late gadolinium enhancement (LGE) sequence images in cardiac magnetic resonance (CMR): (A) in a female patient with an LGE focus on the right ventricular insertion point (indicated by an orange arrow), (B) in a male patient with a subtle LGE focus on the right ventricular insertion point (indicated by an orange arrow), and (C) in a patient without LGE foci.

Figure 1

Late gadolinium enhancement (LGE) sequence images in cardiac magnetic resonance (CMR): (A) in a female patient with an LGE focus on the right ventricular insertion point (indicated by an orange arrow), (B) in a male patient with a subtle LGE focus on the right ventricular insertion point (indicated by an orange arrow), and (C) in a patient without LGE foci.