Regional Heterogeneity of LV Wall Thickness.

S egmental variation in left ventricular (LV) wall thickness is important in characterizing hypertrophic cardiomyopathy, post-infarction remodeling, and myocardial noncompaction. In each of these disorders, cardiac magnetic resonance (CMR) has greatly extended our understanding due to its ability to comprehensively assess LV structure, function, and myocardial composition over the entire LV chamber and myocardial volumes. In this issue of iJACC, de Marvao et al. (1) combine CMR with computational anatomy techniques to demonstrate that segmental wall thickness variation of lesser degree is also prevalent in normotensives, prehypertensives, and hypertensives. Though the patterns are similar in each category, the degree of variation and the relationship of wall thickness to systolic blood pressure (BP) vary. However, the general theme is that wall thickness and relativewall thickness tend to increase in parallel with BP in each subset with the greatest effects seen in the septum and anterior wall. The effect on relative wall thickness is greatest in mid-LV in normotensives and pre-hypertensives but shifts to basal segments of the septum and anterior wall in overt hypertensives.