Elsevier

American Heart Journal

Volume 151, Issue 1, January 2006, Pages 109-114
American Heart Journal

Clinical Investigation
Imaging and Diagnostic Testing
Regional diastolic dysfunction in individuals with left ventricular hypertrophy measured by tagged magnetic resonance imaging—The Multi-Ethnic Study of Atherosclerosis (MESA)

https://doi.org/10.1016/j.ahj.2005.02.018Get rights and content

Background

Impairment of global diastolic function is considered to be the mechanism of congestive heart failure in individuals with preserved systolic left ventricular (LV) function. Left ventricular hypertrophy (LVH) is known to be a risk factor for congestive heart failure with preserved systolic function, and this process may begin as a regional process. We investigated whether regional LV diastolic function measured by magnetic resonance tagging is altered in asymptomatic participants of the MESA with LVH and preserved systolic LV function.

Methods

Regional systolic and diastolic strain rates were calculated from strain data in 218 participants of the MESA study. Circumferential strain was calculated from the midwall layer of the septum, anterior, lateral, and inferior walls at mid-LV level. Global LV function measures were studied by magnetic resonance imaging in 4291 MESA participants. Left ventricular hypertrophy for men and women was defined from the MESA population using previously established Framingham criteria.

Results

Global systolic function was slightly less in the LVH (ejection fraction = 0.66 ± 0.10) versus the non-LVH group (ejection fraction = 0.69 ± 0.07, P < .001). Stepwise regression analyses showed a direct relationship between regional diastolic dysfunction and increasing LV mass. Regional systolic strain and strain rate measures from participants with LVH were not significantly different from those without LVH. However, regional diastolic strain rate was significantly reduced in participants with LVH (1.5 ± 1.1 s−1) compared with the non-LVH group (2.2 ± 1.1 s−1, P < .001) regardless of age or sex.

Conclusions

Left ventricular hypertrophy is associated with regional diastolic dysfunction in individuals without evidence of clinical cardiovascular disease and preserved systolic function. Magnetic resonance imaging tagging provides detailed quantification of regional diastolic function noninvasively.

Section snippets

Study population

Briefly, the purpose of the MESA study is to investigate the various mechanisms and risk factors underlying the development and progression of subclinical cardiovascular disease.17 Men and women, aged 45 to 85 years, from 4 different ethnic groups (white, African American, Hispanics, and Chinese), were enrolled from 6 communities. A major exclusion criterion is the presence of clinical cardiovascular disease. Six thousand eight hundred fourteen men and women have been enrolled in the study. Of

Left ventricular hypertrophy

Demographic and hemodynamic data from all participants with MRI studies are presented in Table I. Participants without history of hypertension, antihypertension medications, or current hypertension were 1082 men and 1144 women. The cohort's upper 95th percentile, that is, men with LVMI >107.8 g/m2 and women with LVMI >85.3 g/m2 were considered as having LVH. The cohort's lower 5th percentile for LVEF values was 57.3%.

Global LV function

Left ventricular hypertrophy was present in 9.8% individuals (n = 422) in the

Discussion

This report demonstrates for the first time myocardial relaxation impairment in asymptomatic individuals with LVH, in a large epidemiologic multicenter study. Moreover, we demonstrate that regional diastolic function is impaired despite normal systolic function in these individuals. Finally, this study proposes a novel index of LV diastolic performance that is based on direct measurements of myocardial relaxation using MRI tissue tagging.

Magnetic resonance imaging results presented in this

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    The authors have no conflicts of interest to disclose.

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