Abstract Body: Objectives
To evaluate the ability of cardiac magnetic resonance (CMR) to distinguish hypertensive heart disease from hypertrophic cardiomyopathy (HCM) in patients with left ventricular hypertrophy (LVH), and to explore ethnic and sex-related differences in cardiac remodelling.
Methods
This cross-sectional study included 100 consecutive hypertensive patients from a tertiary hypertension clinic. All underwent 12-lead electrocardiography (ECG), echocardiography, and CMR. Nineteen were referred for further evaluation at the inherited cardiac conditions clinic. Based on CMR-derived end-diastolic wall thickness (EDWT), patients were classified as hypertensive (HTN, EDWT <15 mm), grey zone hypertensive (GZH, EDWT ≥15 mm), or HCM (confirmed on follow-up). ECG, echocardiography and CMR parameters were compared among groups. Subgroup analyses examined ethnic and sex differences in HTN and GZH patients.
Findings
Median age of the total cohort was 51.0 [45.8–58.0] years; 61% were male and 65% of Afro-Caribbean (AC) ethnicity. Among 19 patients referred for further evaluation, four were diagnosed with HCM, all of AC ethnicity; the remaining 15 were classified as GZH.
On ECG, T-wave inversion (TWI) prevalence was similar across groups. However, lateral TWI was more frequent in GZH and HCM vs HTN (GZH vs HTN p=0.001; HCM vs HTN p<0.001), and inferior TWI more common in HCM vs HTN (p=0.016). Diastolic parameters on echocardiography were also worse in GZH and HCM than HTN, with similar findings between GZH and HCM. On CMR, HCM patients had smaller LV volumes and higher LVEF than GZH (LV-EDV p=0.024; LV-EDV indexed p=0.019; LVEF p=0.012). LGE prevalence was similar in GZH and HCM, both significantly higher than HTN (GZH vs HTN p<0.001; HCM vs HTN p=0.029).
In ethnicity- and sex-stratified analysis (excluding confirmed HCM), AC males had greater maximal wall thickness (p=0.004) and right atrial area (p=0.040) than White males. No significant differences were observed between AC and White females, though LGE was more frequent in AC women (21.4% vs 0%).
Conclusion
Comprehensive cardiac imaging may help distinguish hypertensive remodelling from HCM, especially when considering parameters beyond simple wall thickness measurements. These distinctions have significant implications for clinical practice, particularly in ethnically diverse populations. Ethnic-specific considerations and comprehensive cardiac imaging are essential in the assessment of LVH in hypertension.