Association between circulating ω-3 polyunsaturated fatty acid levels and left cardiac myocardial strain in hypertension: a CMR-FT study

Objective: To assess the association between circulating polyunsaturated fatty acids (PUFAs) and left cardiac myocardial strain in hypertensive patients using cardiac magnetic resonance feature tracking. Methods: This retrospective study included 364 patients with preserved left ventricular ejection fraction (179 hypertensive, 185 controls). Left atrial (LA) and left ventricular (LV) strain parameters were derived from CMR images using CVI42 software. Group comparisons were performed using independent t-tests, ANCOVA, Mann-Whitney U tests, or chi-square tests as appropriate. Univariate and multivariable linear regression were used to examine associations between ω-3 PUFA levels and myocardial strain parameters. Logistic regression and ROC curve analysis were conducted to evaluate predictive value. Inter-observer agreement was assessed using intraclass correlation coefficients. Results: < 0.05). ROC analysis showed DHA and DPA had moderate predictive value for LV dysfunction (AUC 0.613, 0.602), while DHA, EPA, and total ω-3 predicted LA dysfunction (AUC 0.612, 0.609, 0.629). Conclusion: Blood ω-3 PUFA levels in hypertensive patients are independently associated with impaired left cardiac myocardial strain and increased dysfunction risk, an effect observed only in the hypertensive group. Different ω-3 subtypes demonstrate predictive value for left cardiac dysfunction. LV dysfunction is primarily associated with DHA and DPA, while LA dysfunction with EPA and total ω-3. Female patients are more sensitive to this effect. Blind ω-3 supplementation should be avoided, and sex-specific management strategies considered.