Prevalence of Septal and Extra-septal Bulging in Resistant Hypertension Determined through Cardiac Magnetic Resonance Imaging and Comparison with Different Echocardiography-Based Diagnostic Criteria

PURPOSE. Few studies have analyzed focal myocardial bulging in resistant hypertension. This study investigated the prevalence and distribution of focal myocardial bulging in patients with resistant hypertension through geometric analyses. MATERIALS AND METHODS. Using two standard deviations above the mean wall thickness as the cutoff value and based on a 16-segment left ventricle model, geometric analyses were performed on 1,008 myocardial segments obtained from 63 patients with newly diagnosed resistant hypertension. The results were compared with different existing echocardiography-based diagnostic criteria. RESULTS. The results indicated that focal myocardial bulging was prevalent in 60.3% (38/63) of the patients. Of them, 34 patients (89.5%) exhibited focal bulging of the septal segments; 4 patients (10.5%) presented with extra-septal bulging segments. The prevalence of bulging was the highest (16/63, 25.4%) for the basal anteroseptal wall (Segment 2), followed by the middle inferoseptal wall (Segment 9) (15/63, 23.8%). Existing echocardiography-based diagnostic criteria are heterogeneous and do not include criteria for the entire left ventricle. CONCLUSION. Septal or extra-septal focal myocardial bulging is frequently observed on magnetic resonance images in patients with newly diagnosed resistant hypertension. Novel echocardiographic criteria are necessary for identifying bulging in hypertensive heart disease.