Talle Mohammed A, Doubell Anton F, Robbertse Pieter-Paul S, Lahri Sa'ad, Herbst Philip G
Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa.
Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri and University of Maiduguri Teaching Hospital, Maiduguri 600004, Nigeria.
J Cardiovasc Dev Dis. 2023 Aug 27;10(9):367. doi: 10.3390/jcdd10090367.
(1) Background: Altered cardiac morphology and function are associated with increased risks of adverse cardiac events in hypertension. Our study aimed to assess left ventricular (LV) morphology, geometry, and function using cardiovascular magnetic resonance (CMR) imaging in patients with hypertensive crisis. (2) Methods: Patients with hypertensive crisis underwent CMR imaging at 1.5 Tesla to assess cardiac volume, mass, function, and contrasted study. Left ventricular (LV) function and geometry were defined according to the guideline recommendations. Late gadolinium enhancement (LGE) was qualitatively assessed and classified into ischemic and nonischemic patterns. Predictors of LGE was determined using regression analysis. (3) Results: Eighty-two patients with hypertensive crisis (aged 48.5 ± 13.4 years, and 57% males) underwent CMR imaging. Of these patients, seventy-eight percent were hypertensive emergency and twenty-two percent were urgency. Diastolic blood pressure was higher under hypertensive emergency ( = 0.032). Seventy-nine percent (92% of emergency vs. 59% of urgency, respectively; = 0.003) had left ventricular hypertrophy (LVH). The most prevalent LV geometry was concentric hypertrophy (52%). Asymmetric LVH occurred in 13 (22%) of the participants after excluding ischemic LGE. Impaired systolic function occurred in 46% of patients, and predominantly involved hypertensive emergency. Nonischemic LGE occurred in 75% of contrasted studies (67.2% in emergency versus 44.4% in urgency, respectively; < 0.001). Creatinine and LV mass were independently associated with nonischemic LGE. (5) Conclusion: LVH, altered geometry, asymmetric LVH, impaired LV systolic function, and LGE are common under hypertensive crisis. LVH and LGE more commonly occurred under hypertensive emergency. Longitudinal studies are required to determine the prognostic implications of asymmetric LVH and LGE in hypertensive crisis.
(1) 背景：心脏形态和功能改变与高血压患者发生不良心脏事件的风险增加相关。我们的研究旨在使用心血管磁共振（CMR）成像评估高血压急症患者的左心室（LV）形态、几何形状和功能。(2) 方法：高血压急症患者接受1.5特斯拉的CMR成像，以评估心脏容积、质量、功能并进行对比研究。左心室（LV）功能和几何形状根据指南建议进行定义。延迟钆增强（LGE）进行定性评估并分为缺血性和非缺血性模式。使用回归分析确定LGE的预测因素。(3) 结果：82例高血压急症患者（年龄48.5±13.4岁，男性占57%）接受了CMR成像。在这些患者中，78%为高血压急症，22%为高血压亚急症。高血压急症时舒张压更高（P = 0.032）。79%（急症患者中分别为92%，亚急症患者中为59%；P = 0.003）有左心室肥厚（LVH）。最常见的LV几何形状为向心性肥厚（52%）。排除缺血性LGE后，13例（22%）参与者出现不对称LVH。46%的患者出现收缩功能受损，且主要累及高血压急症患者。75%的对比研究出现非缺血性LGE（急症患者中为67.2%，亚急症患者中为44.4%；P < 0.001）。肌酐和LV质量与非缺血性LGE独立相关。(5) 结论：高血压急症时LVH、几何形状改变、不对称LVH、LV收缩功能受损和LGE很常见。LVH和LGE在高血压急症时更常见。需要进行纵向研究以确定不对称LVH和LGE在高血压急症中的预后意义。
