Prognostic value of left ventricular phenotypes in patients with hypertensive heart disease using cardiac magnetic resonance

The pathogenesis of hypertensive heart disease (HHD) involves increased left ventricular (LV) thickness and fibrosis, resulting in abnormal relaxation and contraction. Several studies have demonstrated an association between LV phenotypes assessed by echocardiography and prognosis in patients with HHD. However, no studies have investigated the prognosis using cardiac magnetic resonance (CMR).Propose: To evaluate the prognostic value of LV phenotypes in patients with HHD using CMR.This retrospective cohort study included consecutive patients with hypertension referred for clinical CMR at our Hospital, between 2011 and 2019. Patients with specific cardiomyopathies, congenital heart disease, or a history of cardiac surgery were excluded. LV phenotypes were classified into four groups—normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy—based on indexed LV mass and the LV mass-to-volume ratio. Patients were followed for major adverse cardiovascular events (MACE), including all-cause death, acute coronary syndrome, hospitalisation for heart failure, and stroke.Among 756 patients (70±10 years; 47, 340 had normal geometry, 143 had concentric remodelling, 148 had concentric hypertrophy, and 125 had eccentric hypertrophy. Over a median follow-up of 8.6 years (IQR: 5.0–10.5 years), a total of 153 MACE occurred. The annualised MACE rates were highest in patients with eccentric hypertrophy (5.8, followed by concentric hypertrophy (3.5, concentric remodelling (2.7, and normal geometry (1.5. Cox regression analyses showed that eccentric hypertrophy, concentric hypertrophy, and concentric remodelling were associated with an increased risk of MACE compared to normal geometry, with unadjusted HRs of 4.30 (95 2.73–6.77; p0.001), 2.62 (95 1.70–4.02; p0.001), and 2.01 (95 1.27–3.18; p=0.003), respectively. After adjusting for variables significantly associated with MACE in univariable analysis (age, blood pressure, coronary artery disease, heart failure, left ventricular ejection fraction, and late gadolinium enhancement), eccentric hypertrophy and concentric hypertrophy remained significantly associated with MACE, with adjusted HRs of 2.86 (95 1.55–5.26; p=0.001) and 2.54 (95 1.55–4.16; p0.001), respectively.In patients with hypertension, LV geometry assessed by CMR provides prognostic value, with eccentric and concentric hypertrophy being significantly associated with MACE. The clinical implications include an increased emphasis on the importance of assessing LV geometry using CMR. However, these findings warrant validation in larger or multicentre studies.