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Left ventricular extracellular volume fraction and atrioventricular interaction in hypertension

  • Cardiac
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Abstract

Objectives

Left atrial enlargement (LAE) predicts cardiovascular morbidity and mortality. Impaired LA function also confers poor prognosis. This study aimed to determine whether left ventricular (LV) interstitial fibrosis is associated with LAE and LA impairment in systemic hypertension.

Methods

Following informed written consent, a prospective observational study of 86 hypertensive patients (49 ± 15 years, 53% male, office SBP 168 ± 30 mmHg, office DBP 97 ± 4 mmHg) and 20 normotensive controls (48 ± 13 years, 55% male, office SBP 130 ± 13 mmHg, office DBP 80 ± 11 mmHg) at 1.5-T cardiovascular magnetic resonance was conducted. Extracellular volume fraction (ECV) was calculated by T1-mapping. LA volume (LAV) was measured with biplane area-length method. LA reservoir, conduit and pump function were calculated with the phasic volumetric method.

Results

Indexed LAV correlated with indexed LV mass (R = 0.376, p < 0.0001) and ECV (R = 0.359, p = 0.001). However, ECV was the strongest significant predictor of LAE in multivariate regression analysis (odds ratio [95th confidence interval] 1.24 [1.04–1.48], p = 0.017). Indexed myocardial interstitial volume was associated with significant reductions in LA reservoir (R = -0.437, p < 0.0001) and conduit (R = -0.316, p = 0.003) but not pump (R = -0.167, p = 0.125) function. Multiple linear regression, correcting for age, gender, BMI, BP and diabetes, showed an independent decrease of 3.5% LA total emptying fraction for each 10 ml/m2 increase in myocardial interstitial volume (standard β coefficient -3.54, p = 0.002).

Conclusions

LV extracellular expansion is associated with LAE and impaired LA reservoir and conduit function. Future studies should identify if targeting diffuse LV fibrosis is beneficial in reverse remodelling of LA structural and functional pathological abnormalities in hypertension.

Key Points

• Left atrial enlargement (LAE) and impairment are markers of adverse prognosis in systemic hypertension but their pathophysiology is poorly understood.

• Left ventricular extracellular volume fraction was the strongest independent multivariate predictor of LAE and was associated with impaired left atrial reservoir and conduit function.

• LV interstitial expansion may play a central role in the pathophysiology of adverse atrioventricular interaction in systemic hypertension.

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Abbreviations

ANOVA:

Analysis of ariance

BMI:

Body mass index

CMR:

Cardiovascular magnetic resonance

DBP:

Diastolic blood pressure

ECV:

Extracellular volume fraction

EDV:

End-diastolic volume

ESC:

European Society of Cardiology

ESV:

End-systolic volume

LA:

Left atrial

LAE:

Left atrial enlargement

LAV:

Left atrial volume

LAVmax :

Maximal left atrial volume

LAVmin :

Minimal left atrial volume

LAVpre-A :

Left atrial volume just prior to left atrial contraction

LV:

Left ventricular

LVH:

Left ventricular hypertrophy

LVM:

Left ventricular mass

ROI:

Region of interest

SBP:

Systolic blood pressure

SSFP:

Steady state free precession

SV:

Stroke volume

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Acknowledgements

This work was supported by the Bristol National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit at the Bristol Heart Institute. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or Department of Health.

We thank Christopher Lawton, Superintendent Radiographer, and the Bristol Heart Institute CMR radiographers for their expertise in performing the CMRs. JCLR: Clinical Society of Bath Postgraduate Research Bursary 2014 and Royal College of Radiologists Kodak Research Scholarship 2014. ECH and JFRP are funded by the British Heart Foundation.

Funding

This study has received funding by The Royal College of Radiologists Kodak Research Scholarship 2014.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Magnetic Resonance, Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, BS2 8HW, Bristol, UK

    Jonathan C. L. Rodrigues, Tamas Erdei, Amardeep Ghosh Dastidar & Gergley Szantho

  2. School of Physiology, Pharmacology & Neuroscience, Faculty of Biomedical Science, University of Bristol, Bristol, UK

    Jonathan C. L. Rodrigues, Emma C. Hart & Julian F. R. Paton

  3. Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, BA1 3NG, Bath, UK

    Jonathan C. L. Rodrigues

  4. BHI CardioNomics Research Group, Clinical Research and Imaging Centre-Bristol, University of Bristol, Bristol, UK

    Amy E. Burchell, Laura E. K. Ratcliffe, Emma C. Hart, Angus K. Nightingale & Julian F. R. Paton

  5. Department of Radiology, Bristol Royal Infirmary, University Bristol NHS Foundation Trust, Bristol, UK

    Nathan E. Manghat & Mark C. K. Hamilton

Authors
  1. Jonathan C. L. Rodrigues
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  2. Tamas Erdei
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Corresponding author

Correspondence to Jonathan C. L. Rodrigues.

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Guarantor

The scientific guarantor of this publication is Dr Mark Hamilton.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

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Rodrigues, J.C.L., Erdei, T., Dastidar, A.G. et al. Left ventricular extracellular volume fraction and atrioventricular interaction in hypertension. Eur Radiol 29, 1574–1585 (2019). https://doi.org/10.1007/s00330-018-5700-z

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  • DOI: https://doi.org/10.1007/s00330-018-5700-z

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