Introduction

Hypertensive heart disease (HHD) is characterized by structural remodeling due to chronic hypertension, including myocardial hypertrophy, myocardial fibrosis, and changes in the left atrial structure, ultimately leading to heart failure. Quantitative evaluation of this structural remodeling holds crucial importance in clinical treatment asessment and prognosis prediction. The purpose of this study is to employ cardiac magnetic resonance feature tracking (CMR-FT) technology to investigate changes in left ventricular myocardial mechanics at different stages of heart failure in hypertensive patients.

Methods

A retrospective study was conducted on 99 hypertensive patients, including those without heart failure (n=25), those with heart failure and preserved ejection fraction (n=24), those with heart failure and mid-range ejection fraction (n=23) and those with heart failure and reduced ejection fraction (n=27). All participants underwent CMR examination, and left atrial and left ventricular myocardial strain and strain rate were independently measured by two physicians using standard 2CH and 4CH cine sequences. Impaired myocardial strain at different heart failure stages was compared, and correlations between left atrial strain and left ventricular strain parameters, as well as NT-proBNP, were analyzed. Receiver operating characteristic (ROC) curves were employed to assess the diagnostic efficiency of various parameters.

Results

Compared with the non-heart failure group，the heart failure group exhibited impaired left ventricular ejection fraction (LVEF), εs, εe, εa, SRs, SRe, SRa, GPCS, GPRS, and GPLS. Significantly, εs, εa, GPCS, GPRS, and GPLS in the HFrEF group differed from the HFpEF group (P<0.001), and in LVEF, εe, GPCS, GPRS, and GPLS in the HFmrEF group differed from the HFmrEF group (P<0.001). A moderate correlation was observed between εs and GPLS (r=-0.756, P<0.001), εa and GPLS (r=-0.705, P<0.001), and εa and GPCS (r=-0.706, P<0.001). Notably, GPCS and GPLS were found to be the best parameters for discriminating heart failure from non-heart failure group (GPCS, area under curve, AUC = 0.888; GPLS, AUC=0.889; both P < 0.001). They were also the optimal parameters for discriminating HFpEF from HFmrEF (GPCS, AUC = 0.914; GPLS, AUC= 0.757; both P < 0.05), HFpEF from HFrEF (GPCS, AUC = 0.986; GPLS, AUC= 0.963; both P < 0.001),and HFmrEF from HFrEF (GPCS, AUC = 0.820; GPLS, AUC= 0.757; both P < 0.05). The Bland-Altman analysis confirmed strong inter-physician agreement.

Conclusion

CMR-FT derived myocardial strain exhibits promising diagnostic potential for assessing different stages of heart failure in hypertensive heart disease. Importantly, GPCS and GPLS emerge as superior diagnostic indicators.

Acknowledgements

This work is supported by Central Hospital of Dalian University of Technology.

References

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