Tadic Marijana, Cuspidi Cesare, Plein Sven, Milivojevic Isidora Grozdic, Wang Dao Wen, Grassi Guido, Mancia Giuseppe
Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia.
University of Milan-Bicocca, Milan, Italy.
Heart Fail Rev. 2021 Nov;26(6):1383-1390. doi: 10.1007/s10741-020-09943-x.
Arterial hypertension represents the most frequent cardiovascular risk factor that is associated with cardiac remodeling. Hypertensive heart disease was defined by the presence of left ventricular hypertrophy (LVH) and diastolic dysfunction, and it has been diagnosed by echocardiography in everyday clinical practice. Interstitial myocardial fibrosis is the underlying cause of hypertension-induced cardiac remodeling, and it could not be visualized with different echocardiographic methods. Cardiac magnetic resonance (CMR) and its methods such as late gadolinium enhancement, and T1 mapping provides qualitative and quantitative assessment of interstitial myocardial fibrosis in hypertensive patients. Furthermore, CMR can provide differentiation of LVH between hypertensive patients and cardiomyopathies (hypertrophic or Fabry disease). Timely diagnosis of cardiac impairment and early treatment is essential because regression of LVH could be achieved with adequate treatment. Diffuse cardiac fibrosis in hypertensive patients might be an underlying mechanism that explains the increased cardiovascular morbidity and mortality in this population. Future longitudinal investigations are necessary to determine causal relationship between diffuse fibrosis and cardiovascular outcome in these patients. The aim of this review is to summarize the current knowledge regarding CMR techniques and their potential usage in patients with hypertensive heart disease.
动脉高血压是与心脏重塑相关的最常见心血管危险因素。高血压性心脏病的定义为存在左心室肥厚（LVH）和舒张功能障碍，在日常临床实践中通过超声心动图进行诊断。心肌间质纤维化是高血压诱导的心脏重塑的根本原因，不同的超声心动图方法无法对其进行可视化。心脏磁共振成像（CMR）及其延迟钆增强、T1映射等方法可对高血压患者的心肌间质纤维化进行定性和定量评估。此外，CMR可以区分高血压患者和心肌病（肥厚型或法布里病）之间的LVH。及时诊断心脏损伤并尽早治疗至关重要，因为通过适当治疗可使LVH消退。高血压患者的弥漫性心脏纤维化可能是解释该人群心血管发病率和死亡率增加的潜在机制。未来需要进行纵向研究以确定这些患者中弥漫性纤维化与心血管结局之间的因果关系。本综述的目的是总结关于CMR技术及其在高血压性心脏病患者中的潜在应用的当前知识。
