Basal septal curvature as a transformative imaging-based biomarker in hypertensive and metabolic heart diseases

Abstract Background Basal septal hypertrophy (BSH) is characterized by thickening of the basal interventricular septum and serves as an early imaging biomarker of left ventricular remodeling in hypertensive heart disease. BSH affects approximately 1.5% of the general population, with prevalence increasing to 20% among hypertensive patients. Current diagnostic methods, including wall thickness measurement and visual assessment, suffer from poor reproducibility and subjective interpretation. Basal Septal Curvature (BSC), a systematic computational approach measuring curvature along the left ventricular septal wall, has been developed to provide objective, reproducible quantification of the characteristic sigmoidal septum morphology. Objective To analyse the pathophysiological correlations and clinical significance of BSC as a diagnostic measure for BSH using a large-scale population-based imaging cohort. Methods We analysed approximately 40,000 cases (3D subdivison surface mesh data) from a large-scale population-based imaging cohort using 3D modeling to extract endocardial curvature values along the left ventricular septum. Average curvature metrics were calculated and correlated with structural and functional cardiac parameters. Survival regression models incorporating curvature values and clinical covariates were constructed to validate BSC against cardiovascular outcomes. Results Left ventricular remodeling demonstrated the strongest correlation with curvature metrics (r = 0.37), establishing a clear link between BSH and hypertensive heart disease. Significant correlations were observed between curvature measurements and age (r = .34), septal wall thickness (r = .24), mean arterial pressure (r = 0.22), and cardiac age acceleration (r = .19). Survival analysis revealed that average curvature metrics produced significant hazard ratios for incident hypertension in females (p = .0002) and major adverse cardiovascular events (MACE) in males (p = .02). The curvature-based approach successfully distinguished patients with hypertrophic cardiomyopathy through characteristic curvature patterns. Conclusions BSC provides a robust, quantitative biomarker for early detection and monitoring of BSH in hypertensive cardiac remodeling. The method's ability to predict incident hypertension and cardiovascular events, combined with its objective measurement approach, supports its clinical utility as a strong alternative to traditional visual or thickness-based assessments for BSH diagnosis and risk stratification.