Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study


Background: Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. Methods and Results: Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P < 0.001) and MR (16.8 ± 3.6 versus 21.6% ± 3.0%, P < 0.005). 3D MR MWCS was lower at the base versus apex (P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions ( P < 0.001), contributing to the higher mean global MWCS by MR than echo. MR longitudinal strain was severely depressed in LVH patients (11.0 ± 3.3 versus 16.5% ± 2.5%, P < 0.001) and apical twist was increased (17.5 ± 4.3 versus 13.7 ± 3.7, P < 0.05). Importantly, both circumferential and longitudinal shortening correlated with LV relative wall thickness (R > 0.60, P = 0.001 for both). Conclusions: In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.

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Biederman, R. , Young, A. , Doyle, M. , Devereux, R. , Kortright, E. , Perry, G. , Bella, J. , Oparil, S. , Calhoun, D. , Pohost, G. and Dell’Italia, L. (2015) Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study. Journal of Biomedical Science and Engineering, 8, 213-225. doi: 10.4236/jbise.2015.83021.

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The authors declare no conflicts of interest.


[1] Koren, M.J., Devereux, R.B., Casale, P.N., Savage, D.D. and Laragh, J.H. (1991) Relation of Left Ventricular Mass and Geometry to Morbidity and Mortality in Uncomplicated Essential Hypertension. Annals of Internal Medicine, 114, 345-352.
[2] de Simone, G., Devereux, R.B., Koren, M.J., Mensah, G.A., Casale, P.N. and Laragh, J.H. (1996) Midwall Left Ventricular Mechanics. An Independent Predictor of Cardiovascular Risk in Arterial Hypertension. Circulation, 93, 259-265.
[3] Levy, D., Garrison, R.J., Savage, D.D., Kannel, W.B. and Castelli, W.P. (1990) Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study. The New England Journal of Medicine, 322, 1561-1566.
[4] Aurigemma, G.P., Silver, K.H., Priest, M.A. and Gaasch, W.H. (1995) Geometric Changes Allow Normal Ejection Fraction Despite Depressed Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy. Journal of the American College of Cardiology, 26, 195-202.
[5] de Simone, G., Devereux, R.B., Roman, M.J., Ganau, A., Saba, P.S., Alderman, M.H., Laragh, J.H., et al. (1994) Assessment of Left Ventricular Function by the Midwall Fractional Shortening/End-Systolic Stress Relation in Human Hypertension. Journal of the American College of Cardiology, 23, 1441-1451.
[6] Shimizu, G., Zile, M.R., Blaustein, A.S. and Gaasch, W.H. (1985) Left Ventricular Chamber Filling and Midwall Fiber Lengthening in Patients with Left Ventricular Hypertrophy: Overestimation of Fiber Velocities by Conventional Midwall Measurements. Circulation, 71, 266-272.
[7] Shimizu, G., Hirota, Y., Kita, Y., Kawamura, K., Saito, T. and Gaasch, W.H. (1991) Left Ventricular Midwall Mechanics in Systemic Arterial Hypertension. Myocardial Function Is Depressed in Pressure-Overload Hypertrophy. Circulation, 83, 1676-1684.
[8] Bing, O.H., Matsushita, S., Fanburg, B.L. and Levine, H.J. (1971) Mechanical Properties of Rat Cardiac Muscle during Experimental Hypertrophy. Circulation Research, 28, 234-245.
[9] Jacob, R., Vogt, M. and Rupp, H. (1986) Pathophysiologic Mechanisms in Cardiac Insufficiency Induced by Chronic Pressure Overload—An Attempt to Analyze Specific Factors in Animal Experiment. Basic Research in Cardiology, 81, 203-216.
[10] Spann Jr., J.F., Buccino, R.A., Sonnenblick, E.H. and Braunwald, E. (1967) Contractile State of Cardiac Muscle Obtained from Cats with Experimentally Produced Ventricular Hypertrophy and Heart Failure. Circulation Research, 21, 341-354.
[11] Heng, M.K., Janz, R.F. and Jobin, J. (1985) Estimation of Regional Stress in the Left Ventricular Septum and Free Wall: An Echocardiographic Study Suggesting a Mechanism for Asymmetric Septal Hypertrophy. American Heart Journal, 110, 84-90.
[12] Lew, W.Y. and LeWinter, M.M. (1986) Regional Comparisons of Midwall Segments and Area Shortening in the Canine Left Ventricle. Circulation Research, 58, 678-691.
[13] Axel, L. and Dougherty, L. (1989) MR Imaging of Motion with Spatial Modulation of Magnetization. Radiology, 171, 841-845.
[14] Young, A.A., Imai, H., Chang, C.N. and Axel, L. (1994) Two-Dimensional Left Ventricular Deformation during Systole Using Magnetic Resonance Imaging with Spatial Modulation of Magnetization. Circulation, 89, 740-752.
[15] Clark, N.R., Reichek, N., Bergey, P., Hoffman, E.A., Brownson, D., Palmon, L. and Axel, L. (1991) Circumferential Myocardial Shortening in the Normal Human Left Ventricle. Assessment by Magnetic Resonance Imaging Using Spatial Modulation of Magnetization. Circulation, 84, 67-74.
[16] Palmon, L.C., Reichek, N., Yeon, S.B., Clark, N.R., Brownson, D., Hoffman, E., et al. (1994) Intramural Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy with Normal Pump Function. Circulation, 89, 122-131.
[17] Biederman, R.W.W., Doyle, M., Young, A.A., Devereux, R.B., Kortright, E., Perry, G., et al. (2008) Marked Regional Left Ventricular Heterogeneity in Hypertensive Left Ventricular Hypertrophy Patients. A Losartan Intervention for Endpoint Reduction Hypertension (LIFE) Cardiovascular and Echocardiographic Substudy. Hypertension, 52, 279-286.
[18] Young, A.A., Kramer, C.M., Ferrari, V.A., Axel, L. and Reichek, N. (1994) Three-Dimensional Left Ventricular Deformation in Hypertrophic Cardiomyopathy. Circulation, 90, 854-867.
[19] Young, A.A., Axel, L., Dougherty, L., Bogen, D.K. and Parenteau, C.S. (1993) Validation of Tagging with MR Imaging to Estimate Material Deformation. Radiology, 188, 101-108.
[20] Dahlof, B., Devereux, R., de Faire, U., Fyhrquist, F., Hedner, T., Ibsen, H., et al., for the LIFE Study Group (1997) The Losartan Intervention for Endpoint Reduction (LIFE) Study in Hypertension. Rationale, Design and Methods. American Journal of Hypertension, 10, 705-713.
[21] Devereux, R.B., Bella, J.N., Boman, K., Gerdts, E., Nieminen, M.S., Rokkedal, J., et al. (2001) Echocardiographic Left Ventricular Geometry in Hypertensive Patients with Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study. Blood Press, 10, 74-82.
[22] Sahn, D.J., DeMaria, A., Kisslo, J. and Weyman, A. (1978) Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements. Circulation, 58, 1072-1083.
[23] Cerqueira, M.D., Weissman, N.J., Dilsizian, V., Jacobs, A.K., Kaul, S., Laskey, W.K., et al. (2002) Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart. Circulation, 105, 539-542.
[24] Doyle, M., Walsh, E.G., Foster, R.E. and Pohost, G.M. (1997) Common k-Space Acquisition: A Method to Improve Myocardial Grid-Tag Contrast. Magnetic Resonance in Medicine, 37, 754-763.
[25] Bailes, D.R., Gilderdale, D.J., Bydder, G.M., Collins, A.G. and Firmin, D.N. (1985) Respiratory Ordered Phase Encoding (ROPE): A Method for Reducing Respiratory Motion Artefacts in MR Imaging. Journal of Computer Assisted Tomography, 9, 835-838.
[26] Young, A.A., Cowan, B.R., Thrupp, S.F., Hedley, W.J. and Dell’Italia, L.J. (2000) Left Ventricular Mass and Volume: Fast Calculation with Guide-Point Modeling on MR Images. Radiology, 216, 597-602.
[27] Fung, Y.C. (1965) Foundations of Solid Mechanics. Prentice Hall, Inc., Englewood Cliffs.
[28] Biederman, R.W.W., Doyle, M., Yamrozik, J., Williams, R.B., Rathi, V.K., Vido, D., et al. (2005) Physiologic Compensation is Supranormal in Compensated Aortic Stenosis: Does It Return to Normal after Aortic Valve Replacement or Is It Blunted by Coexistent Coronary Artery Disease? Circulation, 112, I-429-I-436.
[29] Ahmed, M.I., Desai, R.V., Gaddam, K.K., Venkatesh, B.A., Agarwal, S., Inusah, S., et al. (2012) Relation of Torsion and Myocardial Strains to LV Ejection Fraction in Hypertension. JACC: Cardiovascular Imaging, 5, 273-281.
[30] Choi, E.Y., Rosen, B.D., Fernandes, V.R., Yan, R.T., Yoneyama, K., Donekal, S., et al. (2013) Prognostic Value of Myocardial Circumferential Strain for Incident Heart Failure and Cardiovascular Events in Asymptomatic Individuals: The Multi-Ethnic Study of Atherosclerosis. European Heart Journal, 34, 2354-2361.
[31] Slotwiner, D.J., Devereux, R.B., Schwartz, J.E., Pickering, T.G., de Simone, G., Ganau, A., et al. (1998) Relation of Age to Left Ventricular Function in Clinically Normal Adults. American Journal of Cardiology, 82, 621-626.
[32] Oxenham, H.C., Young, A.A., Cowan, B.R., Gentles, T.L., Occleshaw, C.J., Fonseca, C.G., et al. (2003) Age-Related Changes in Myocardial Relaxation Using Three-Dimensional Tagged Magnetic Resonance Imaging. Journal of Cardiovascular Magnetic Resonance, 5, 421-430.
[33] Augustine, D., Lewandowski, A.J., Lazdam, M., Rai, A., Francis, J., Myerson, S., et al. (2013) Global and Regional Left Ventricular Myocardial Deformation Measures by Magnetic Resonance Feature Tracking in Healthy Volunteers: Comparison with Tagging and Relevance of Gender. Journal of Cardiovascular Magnetic Resonance, 15, 8.
[34] Zhang, L., Gao, J., Xie, M., Yin, P., Liu, W., Li, Y., et al. (2013) Left Ventricular Three-Dimensional Global Systolic Strain by Real-Time Three-Dimensional Speckle-Tracking in Children: Feasibility, Reproducibility, Maturational Changes, and Normal Ranges. Journal of the American Society of Echocardiography, 26, 853-859.
[35] Bottini, P.B., Carr, A.A., Prisant, L.M., Flickinger, F.W., Allison, J.D. and Gottdiener, J.S. (1995) Magnetic Resonance Imaging Compared to Echocardiography to Assess Left Ventricular Mass in the Hypertensive Patient. American Journal of Hypertension, 8, 221-228

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