Response of the Myocardium to Hypertrophic Conditions in the Adult Population

Conditions studied

Left Ventricular Hypertrophy, Hypertension, Myocardial Fibrosis

About this study

Hypertension and aortic stenosis are the two leading conditions that cause thickening of the heart muscles (left ventricular hypertrophy). Left ventricular hypertrophy is initially adaptive to maintain optimal heart function. Ultimately, heart failure occurs as a result of progressive muscle cell death and scarring (myocardial fibrosis). Dedicated techniques using cardiovascular magnetic resonance imaging (MRI) and novel high-sensitivity cardiac troponin blood assays are potential markers to detect myocardial fibrosis. Although hypertension-related heart disease is very common in Singapore, the significance of myocardial fibrosis is not well understood. In this study, the significance of myocardial fibrosis in 2000 patients with hypertension would be investigated. This will be the largest study using state-of-the-art MRI to examine the importance of myocardial fibrosis in hypertensive heart disease. 1000 participants, with at least 1 year follow-up, will be invited for a repeat assessment.

Interventions

• Other: Cardiovascular Magnetic Resonance — For the evaluation of left ventricular volumes, function and mass. This is also for the assessment of myocardial fibrosis based on delayed enhancement imaging technique.
• Other: Echocardiogram — For the assessment of diastolic and systolic function as well as valvular and cardiac function. Ventricular-arterial coupling will also be performed.
• Other: Electrocardiogram — To examine specific function of the heart.
• Device: Ambulatory Blood Pressure Monitoring — A 24-hour test.
• Other: Retinal Photography (Optional) — The test studies the structure and function of the eye vessels. It involves using eye drops to dilate the pupils, allowing the retinal photographer to have a better view of the back of the eye.

Primary outcomes

• First occurrence of cardiovascular event (10 years)