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Title: Novel index of maladaptive myocardial remodeling in hypertension
Authors: Goh V.J.
Le T.-T.
Bryant J.
Wong J.I.
Su B.
Lee C.-H.
Pua C.J.
Sim C.P.Y.
Ang B.
Aw T.C.
Cook S.A. 
Chin C.W.L. 
Keywords: Blood pressure
Heart diseases
Left ventricular
Magnetic resonance imaging
Natriuretic peptide
Issue Date: 2017
Publisher: Lippincott Williams and Wilkins
Citation: Goh V.J., Le T.-T., Bryant J., Wong J.I., Su B., Lee C.-H., Pua C.J., Sim C.P.Y., Ang B., Aw T.C., Cook S.A., Chin C.W.L. (2017). Novel index of maladaptive myocardial remodeling in hypertension. Circulation: Cardiovascular Imaging 10 (9) : e006840. ScholarBank@NUS Repository.
Abstract: Background: Hypertensive left ventricular hypertrophy (HTN-LVH) is a leading cause of heart failure. Conventional patterns of cardiac geometry do not adequately risk-stratify patients with HTN-LVH. Using cardiovascular magnetic resonance, we developed a novel Remodeling Index (RI) that was designed to detect an exaggerated hypertrophic response to hypertension and tested its potential to risk-stratify hypertensive patients. Methods and Results: The RI was derived using LaPlace's Law (3?end-diastolic volume/max wall thickness), and normal RI ranges were established in 180 healthy volunteers. The utility of the RI was examined in 256 asymptomatic hypertensive patients and 10 patients with heart failure with preserved ejection fraction. Hypertensive patients underwent multimodal cardiac assessment: contrast-enhanced cardiovascular magnetic resonance, echocardiograms, 24-hour blood pressure monitoring, and cardiac biomarkers (high-sensitivity cardiac troponins, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and galectin-3). Blood pressure accounted for only 20% of the variance observed in LV mass. Although there was no association between blood pressure and myocardial fibrosis, LV mass was independently associated with fibrosis. Compared with hypertensive patients without LVH (n=191; 74.6%) and those with HTN-LVH and normal RI (n=50; 19.5%), patients with HTN-LVH and low RI (HTN-LVH/low RI; n=15, 5.9%) had an amplified myocardial response: elevated indexed LV masses (83±24 g/m2), more fibrosis (73%), and higher biomarkers of myocardial injury and dysfunction (P<0.05 for all). RI was similar in HTNLVH/low RI and heart failure with preserved ejection fraction (4.1 [3.4-4.5] versus 3.7 [3.4-4.0], respectively; P=0.15). Conclusions: We suggest that RI provides an approach for stratifying hypertensive patients and is suitable for testing in other disease cohorts to assess its clinical utility. © 2017 American Heart Association, Inc.
Source Title: Circulation: Cardiovascular Imaging
ISSN: 19419651
DOI: 10.1161/CIRCIMAGING.117.006840
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