The Additive Value of Cardiovascular Magnetic Resonance Imaging in Hypertensive Heart Disease
Cardiovascular magnetic resonance (CMR) can provide a wealth of diagnostic information in the assessment of hypertensive heart disease (HHD) that is complementary to echocardiography. CMR assessment of left ventricular wall thickness, volumes and function
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Sebastian Onciul, Peter Swoboda, and Sven Plein
12.1 C ardiovascular Magnetic Resonance for the Assessment of Hypertensive Heart Disease Non-invasive imaging plays an important role in the management of the patient with arterial hypertension specifically in the identification of asymptomatic end-organ damage and complications of hypertension, screening for causes of secondary hypertension and risk stratification. The most commonly detected cardiac sequela of hypertension is left ventricular hypertrophy, often first detected on routine electrocardiogram (ECG). Echocardiography is recommended as the first-line imaging modality for the further assessment of suspected hypertensive heart disease (HHD) due to its widespread availability, safety and relatively low cost. Conventional echocardiography is able to quantify the degree of left ventricular hypertrophy (LVH), to assess the left ventricular (LV) systolic and diastolic function and to identify any coexistent valvular pathology. However, in a significant proportion of patients, the quality of imaging is limited by poor acoustic windows. Pharmacological stress echocardiography may aid in the non-invasive diagnosis of ischaemic heart disease, while exercise echocardiography is recommended for the evaluation of patients with heart failure with preserved ejection fraction (HfpEF). Cardiovascular magnetic resonance (CMR) is an increasingly available imaging modality with several unique properties. CMR offers high-quality functional and morphological information as well as tissue characterization independently of the body habitus, without exposing the patient to ionizing radiation (Table 12.1). In patients with HHD, CMR can offer precise information regarding LV wall thickness, S. Onciul (*) University of Medicine and Pharmacy Carol Davila, Bucharest, Romania P. Swoboda · S. Plein Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK e-mail: [email protected]; [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_12
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Table 12.1 Echocardiography versus cardiovascular magnetic resonance for the assessment of hypertensive heart disease LV wall thickness measurement LV volumes and systolic function Detection of myocardial fibrosis Assessment of diastolic function Differentiation among LV hypertrophy phenotypes Coexistent valvulopathies Ischaemia detection Detection of secondary causes of hypertension Dependency on body habitus Availability
Echocardiography ++ ++ − +++ +
CMR +++ +++ +++ ++ +++a
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CMR cardiovascular magnetic resonance, LV left ventricle a CMR may help distinguishing among hypertrophic cardiomyopathy, athlete’s heart, cardiac amyloidosis, Anderson-Fabry disease and hypertensive heart disease b With stress ec
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