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STATE-OF-THE-ART PAPER

The Hypertensive Heart

An Integrated Understanding Informed by Imaging

Departments of Internal Medicine and Biomedical Informatics, The Ohio State University, Columbus, Ohio

Manuscript received April 7, 2009; revised manuscript received June 16, 2009, accepted July 20, 2009.

^_* Reprint requests and correspondence: Dr. Subha V. Raman, The Ohio State University, Internal Medicine, 473 West 12th Avenue, Suite 200, Columbus, Ohio 43210 (Email: raman.1{at}osu.edu).

Clinical sequelae of hypertension include heart failure, arrhythmias, and ischemic events, especially myocardial infarction and stroke. Recognizing the hypertensive heart has diagnostic as well as prognostic implications. Current imaging techniques offer noninvasive approaches to detecting myocardial fibrosis, ischemia, hypertrophy, and disordered metabolism that form the substrate for hypertensive heart disease. In addition, recognition of aortopathy and atrial myopathy as contributors to myocardial disease warrant incorporation of aortic and atrial functional measurements into a comprehensive understanding of the hypertensive heart.

Key Words: hypertension • left ventricular hypertrophy • diastolic heart failure • imaging • hypertensive heart disease • pathophysiology

Abbreviations and Acronyms   CMR = cardiac magnetic resonance   HHD = hypertensive heart disease   LGE = late gadolinium enhancement   LV = left ventricle/ventricular   31P-MRS = phosphorus magnetic resonance spectroscopy

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