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Oxygenation-sensitive cardiovascular magnetic resonance in Hypertensive Heart Disease with LVMH and Non-LVMH：Insight from altered mechanics and cardiac BOLD imaging
Binghua Chen1, Rui Wu1, Dong-Aolei An1, Ruo-Yang Shi1, Qiu-Ying Yao1, Qing Lu1, Jiani Hu2, Meng Jiang3, Weibo Chen4, James Deen2, Ankush Chandra2, Jian-Rong Xu1, and Lian-Ming Wu1

1Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, 2Wayne State University, Detroit, MI, United States, 3Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, 4Philips Healthcare, Shanghai, China

Synopsis

According to our study findings, BOLD MRI detected greater deoxygenated hemoglobin in HTN LVMH(measured by T2* BOLD MRI)compared with HTN non-LVMH and control groups. Lower T2* BOLD MRI values were associated with higher ECV values and correlated with reductions in circumferential and longitudinal strain, strain rate and displacement. Higher LVMI was associated with an increase in ECV and nativeT1, and a decrease inT2* BOLD MRI values. To our knowledge, this is the first study to assess the influence of myocardial oxygenation on cardiac function in hypertensive patients by applying combined T2* BOLD MRI, T1mapping and strain analysis. Assessing myocardial capillary oxygenation by BOLD MRI relies on the measurement of BOLD MRI relaxation time through endogenous contrast of deoxygenated hemoglobin. Myocardial microvascular oxygenation could reflect a balance or imbalance between oxygen supply and demand.

Abstract

Objectives: Non-invasive assessment of myocardial oxygenation by T2* Blood Oxygen Level Dependent (BOLD) imaging in hypertensive patients with left ventricular myocardial hypertrophy (HTN LVMH) and hypertensive patients without LVMH (HTN non-LVMH) and its correlation with myocardial mechanics assessed by strain analysis. Methods: A total of 64 HTN patients and normotensive participants were recruited for this study . HTN patients were separated into two separate groups based on left ventricular mass index(LVMI). Using a 3.0 Tesla scanner, dedicated T1 mapping, BOLD MRI (T2*), and strain analysis were performed. All the images were analyzed by blinded observers and comparative statistics were conducted. Results: T2* BOLD values were significantly lower in the HTN LVMH group verses the controls (23.78±3.09 vs. 30.77±2.71, p<0.001) and HTN non-LVMH group (23.78±3.09 vs. 28.64±4.23, p<0.001). T2* BOLD values of the HTN non-LVMH patients were slightly lower than that of the controls (28.64±4.23, 30.77±2.71, p=0.04). Left ventricular peak global longitudinal and circumferential strain were reduced in all HTN LVMH patients compared to the HTN non-LVMH patients and the normotensive controls. The extracellular volume (ECV) and BOLD MRI values were also correlated with the three-dimensional global circumferential strain parameters (spearman rho = 0.6, p < 0.05 and Spearman rho=-0.43, p < 0.05).ECV and BOLD MRI correlated with longitudinal strain (spearman rho=0.64, p<0.05 and Spearman rho=-0.49, p<0.05). Patients with lowerT2* BOLD values had significant decreases in longitudinal and circumferential strain, strain rate, or displacement. Conclusions：By using T2* BOLD cardiac MRI and strain analysis, we showed that HTN LVMH patients have both impaired myocardial mechanics and reduced myocardial oxygenation compared to HTN non-LVMH and normotensive groups. T2* BOLD cardiac MRI could provide a feasible parameter for detecting myocardial microvascular oxygen concentrations in patients with HTN.

Acknowledgements

Supported by National Natural Science Foundation of China (Youth Program No.81401403), Shanghai Municipal Commission of Health and Family Planning excellent young talent program（No. 2017YQ031) and Shanghai Jiao Tong University Medical engineering cross fund （YG2014MS48).

References

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Figures

Fig. 1. Box plot shows the distribution of Native T1 mapping (A) , ECV (B) and T2* BOLD MRI values(C) in three groups. Boxes represent the 25th to 75th percentiles, and horizontal lines within the boxes represent the median values.

Fig. 2 Bland-Altman plots of interobserver native T1, ECV and T2* BOLD MRI. Bland-Altman plots for the measurement of native T1 (A), ECV (B), T2* BOLD MRI (C) showing good interobserver agreement.

Fig. 3(A-L) These figures display typical examples of normotensive, HTN LVMH and HTN non-LVMH groups. (A-C) A 70-year-old normotensive female shows highest T2star BOLD values in the cardiac interventricular septum compared with a 66-year-old HTN non-LVMH male, and a 55-year-old HTN LVMH male whose values was lowest which meaned greatest deoxygenated hemoglobin. (D-F,J-L) The T1 mapping and ECV values of HTN LVMH patient were higher than other two groups. (G-I) All of the LGE images didn't show focal hyperintensity.

Fig. 4(A-D): (A) Spearman correlation shows a positive association (Spearman rho = 0.71, p < 0.05) between T1mapping and LVMI. (B) Spearman correlation shows a positive association (Spearman rho = 0.72, p < 0.05) between ECV and LVMI. (C) Spearman correlation displays a negative association (Spearman rho = -0.52, p < 0.05) between T2* BOLD MRI and LVMI. (D) Spearman correlation displays a negative association (Spearman rho = -0.54, p < 0.05) between ECV and T2* BOLD MRI.

Fig. 5(A-D): shows the correlation between ECV or T2* BOLD MRI and strain. (A) Spearman correlation shows a positive association (Spearman rho = 0.6, p < 0.05) between ECV and peak circumferential strain. (B) Spearman correlation shows a positive association (Spearman rho = 0.64, p < 0.05) between ECV and peak longitudinal strain. (C) Spearman correlation displays a negative association (Spearman rho = -0.43, p < 0.05) between T2* BOLD MRI and peak circumferential strain. (D) Spearman correlation displays a negative association (Spearman rho = -0.49, p < 0.05) between peak longitudinal strain and T2* BOLD MRI.

Fig.5(E-F): (E)、(F) Spearman correlation displays a negative correlation between T2* BOLD MRI and peak systolic circumferential strain rate (Spearman rho = -0. 28, p=0.03)、T2* BOLD MRI and peak systolic longitudinal strain rate (Spearman rho = -0. 47, p=0.00).

Fig.5(G-H): Spearman correlation displays a positive correlation between T2* BOLD MRI and peak diastolic circumferential strain rate (Spearman rho =0.28 ,p=0.025)、T2* BOLD MRI and peak diastolic longitudinal strain rate systolic longitudinal(Spearman rho =0.38 ,p =0.002).

Fig. 5(I-J): Spearman correlation displays a negative correlation between T2* BOLD MRI and peak circumferential displacement (Spearman rho =-0.38,p =0.002), and a positive correlation between T2* BOLD MRI and peak longitudinal displacement (Spearman rho =0.38 ,p =0.002).

Proc. Intl. Soc. Mag. Reson. Med. 26 (2018)
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