Impact of adiposity on myocardial strain profiles in patients with hypertension: insights from cardiac magnetic resonance imaging

Obesity and hypertension frequently coexist and collectively increase the risk of cardiovascular disease. Subclinical myocardial dysfunction may develop in patients with both obesity and hypertension, even with preserved left ventricular ejection fraction (LVEF). This study aimed to investigate the association between obesity and myocardial strain in patients with hypertension using cardiac magnetic resonance (CMR). This cross-sectional study included 154 patients with primary hypertension who underwent CMR using 3.0T scanners with steady-state free precession sequences. Myocardial strain (radial, circumferential, and longitudinal) and strain rates were assessed using CMR tissue tracking. Multivariable linear regression evaluated associations between BMI and strain parameters after adjusting for confounding factors. A total of 154 patients with primary hypertension (mean age: 45.09 ± 12.42 years; 41 females, 26.6%) were included. Patients were stratified into groups of individuals with normal weight, individuals categorized as overweight, and individuals living with obesity. Despite comparable LVEF across groups (60.66% vs. 60.45% vs. 58.27%, p = 0.339), the obesity group showed lower absolute magnitudes of PDSR in the radial [−1.58 vs. −1.53 vs. −1.17 1/s, p = 0.001], circumferential [0.92 vs. 0.93 vs. 0.74 1/s, p < 0.001], and longitudinal [0.68 vs. 0.62 vs. 0.53 1/s, p = 0.002] directions. BMI was independently associated with radial ( β = 0.042, p = 0.033) and longitudinal ( β = −0.012, p = 0.023) diastolic strain rates. In patients with primary hypertension, higher BMI was associated with abnormalities in selected CMR-derived strain-rate parameters despite preserved LVEF.