P.059 Segmental Left Ventricular Function Estimated by Strain Echocardiography in Relation to Arterial Stiffness in Hypertensives. MRI Findings in Respect to Myocardial Fibrosis — Preliminary Report

Abstract

Background

Left Ventricular (LV) diastolic function has been reported to be related with the presence of increased arterial stiffness in hypertension. Myocardial fibrosis is one of the main causes of diastolic dysfunction (DD).

Aim

To investigate the role of arterial stiffness in segmental LV systolic function and the presence of fibrosis with Delayed Enhancement (DE) MRI in hypertension.

Methods

We studied 20 consecutive hypertensive patients with mean age 51.6±6.1 years and normal EF 66.3±4.1%, with no history of coronary artery disease. All subjects had MRI with (DE) and 2D and colour doppler myocardial imaging of basal and mid LV segments (12) in the longitudinal axis. Mean longitudinal strain (S) and strain rate (SR) were averaged from each of the 12 segments assessed. Pulse wave velocity (PWV) carotid-femoral was measured.

Diastolic dysfunction was diagnosed based on published criteria regarding DT, IVRT, E/A and TDIEa.

Results

The mean duration of hypertension was 10.4±5.7 yrs. Diastolic dysfunction was evident in 16 out of the 20 patients. PWV was increased in patients with diastolic dysfunction (12.6±2.3 vs. 10.6±1.4 m/s) compared to those without DD. Septal basal and mid segment had the lowest systolic strain (basal: 15±2.7%, mid: 19.5±3.1%) and strain rate value (basal: 1.1±0.2/s, mid: 1.4±0.3/s) in comparison to the other segments. PWV was correlated with septal mid SR (r = –0.60, P < 0.05) and septal basal and mid S (r = –0.67, P < 0.05 and r = –0.69, P < 0.05). PWV was also correlated with mean S and SR (r = –0.58, P < 0.05 and r = –0.49, P < 0.05) and PP (r = 0.47, P < 0.05).MRI with DE detected 2 patients (10%) having replacement fibrosis, but did not detect interstitial or perivascular fibrosis.

Conclusion

Septal wall is the region mainly affected by the presence of hypertension in comparison to other segments. Arterial stiffness is related to global and regional longitudinal systolic function. MRI can exclude replacement but not subtle interstitial or perivascular fibrosis in hypertensive patients.