Myocardial cell damage in human hypertension

OBJECTIVES The goal of this study was to investigate the presence of myocar dial cell damage in patients with systemic hypertension and its relationshi p with left ventricular hypertrophy (LVH). BACKGROUND Although initially compensatory, LVH adversely affects myocellul ar integrity and contributes to congestive heart failure in hypertensive pa tients. Noninvasive detection of myocardial damage can be of value. METHODS We performed imaging studies with In-111-labeled monoclonal antimyo sin antibodies to identify myocardial damage in 39 patients with systemic h ypertension and variable degrees of LVH. Three groups were considered: 16 a symptomatic patients with normal echocardiographic left ventricular mass (L VM) (group I); 14 asymptomatic patients with LVH (group II) and 9 patients with symptomatic hypertensive heart disease and advanced LVH (group III). T he severity of myocardial damage was represented as heart-to-lung (target-t o-background) antibody uptake ratio (normal: <1.55). RESULTS Mean LVM index was 105 +/- 14 g/m(2) in group I, 124 +/- 24 in grou p II and 174 +/- 29 in group III. Heart-to-lung ratios of antimyosin uptake were: 1.45 +/- 0.14 in group I, 4 of the 16 (25%) patients showing an abno rmal scan; 1.50 +/- 0.07 in group II with abnormal scans in 2 of the 14 (16 %) patients and 1.77 +/- 0.16 (p < 0.001) in group III, all 9 patients pres enting with abnormal antimyosin scans. On multivariate regression analysis LVM index was the main variable that independently correlated with the degr ee of myocardial uptake of antimyosin (r = 0.815; p = 0.001). CONCLUSIONS This study provides the first in vivo evidence of myocyte damag e in patients with hypertension. The severity of myocardial damage can be r elated to the magnitude of LVH. (C) 2000 by the American College of Cardiol ogy.