The Impact of Hypertension on Left Ventricular Function and Remodeling in Non-Ischemic Dilated Cardiomyopathy Patients: A 3.0 T MRI Study

Background Hypertension (HTN) is highly prevalent in non-ischemic dilated cardiomyopathy (NIDCM) patients, but little is known about its impact on left ventricular (LV) function and remodeling. Purpose To evaluate the effect of hypertension on LV function and remodeling in NIDCM patients. Study Type Retrospective. Population Two-hundred and twelve NIDCM (HTN-) patients, 91 NIDCM (HTN+) patients, and 74 normal controls. Field Strength/Sequence 3.0 T/bSSFP and phase-sensitive inversion recovery sequence. Assessment The LV geometry, myocardial strain, remodeling index (calculated as LVM/LVEDV), and LGE were measured and compared between groups. Determinants of LV strain and remodeling in NIDCM were investigated. Statistical Tests Student's t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis test, univariable and multivariable linear regression. A P value Compared with normal controls, NIDCM patients had significantly higher LVEDV and significantly impaired LV strains, including LV global peak strain (PS) and peak systolic and diastolic strain rates in the radial, circumferential, and longitudinal directions. The NIDCM (HTN+) group had significantly decreased LV global longitudinal PS and peak diastolic strain rate (PDSR), and significantly increased LV mass index and remodeling index compared to the NIDCM (HTN-) group, despite there being no significant difference in ejection fraction (P = 0.241). The prevalence of LV LGE was significantly higher in the NIDCM (HTN+) group than in the NIDCM (HTN-) group. In multivariable regression models adjusted for potential confounders, hypertension was independently associated with LV global longitudinal PS and PDSR. Male sex, resting heart rate, and log(NT-proBNP) level were independent determinants of LV strains. Moreover, male sex, systolic and diastolic blood pressure, and presence of LGE were independent determinants of LV remodeling index. Data Conclusion These findings suggest that coexistence of hypertension may further exacerbate the reduction in LV global strain and the aggravation of LV remodeling in NIDCM patients. Level of Evidence 3 Technical Efficacy Stage 3

Automated summary

Hypertension has a detrimental impact on left ventricular function and remodeling in non-ischemic dilated cardiomyopathy patients. Hypertension is independently associated with LV strain and remodeling, while male sex, heart rate, blood pressure, and presence of myocardial infarction are independent determinants of LV strain and remodeling.