PURPOSE: Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. MATERIALS AND METHODS: Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 × 2.1-4.0 × 2.5-3.2 mm(3) ; venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15°) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 ± 15 years) and 10 age-matched healthy controls (45 ± 14 years). In addition, pre- and postcontrast myocardial T1 -mapping (resolution = 2.3 × 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35°) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss EL ' as well as left ventricular ECV. RESULTS: HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 ± 16 mmHg vs. 9 ± 2 mmHg) and energy loss EL ' (3.8 ± 2.5 mW vs. 1.5 ± 0.7 mW, P < 0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R(2) = 0.44, P < 0.001) and energy loss EL ' (R(2) = 0.46, P < 0.001). CONCLUSIONS: The integration of 4D-flow and T1 -mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM.
PURPOSE:Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. MATERIALS AND METHODS: Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 × 2.1-4.0 × 2.5-3.2 mm(3) ; venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15°) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 ± 15 years) and 10 age-matched healthy controls (45 ± 14 years). In addition, pre- and postcontrast myocardial T1 -mapping (resolution = 2.3 × 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35°) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss EL ' as well as left ventricular ECV. RESULTS: HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 ± 16 mmHg vs. 9 ± 2 mmHg) and energy loss EL ' (3.8 ± 2.5 mW vs. 1.5 ± 0.7 mW, P < 0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R(2) = 0.44, P < 0.001) and energy loss EL ' (R(2) = 0.46, P < 0.001). CONCLUSIONS: The integration of 4D-flow and T1 -mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM.
Authors: Helmut Baumgartner; Judy Hung; Javier Bermejo; John B Chambers; Arturo Evangelista; Brian P Griffin; Bernard Iung; Catherine M Otto; Patricia A Pellikka; Miguel Quiñones Journal: J Am Soc Echocardiogr Date: 2009-01 Impact factor: 5.251
Authors: Alex J Barker; Pim van Ooij; Krishna Bandi; Julio Garcia; Mazen Albaghdadi; Patrick McCarthy; Robert O Bonow; James Carr; Jeremy Collins; S Chris Malaisrie; Michael Markl Journal: Magn Reson Med Date: 2013-10-02 Impact factor: 4.668
Authors: James C Moon; Daniel R Messroghli; Peter Kellman; Stefan K Piechnik; Matthew D Robson; Martin Ugander; Peter D Gatehouse; Andrew E Arai; Matthias G Friedrich; Stefan Neubauer; Jeanette Schulz-Menger; Erik B Schelbert Journal: J Cardiovasc Magn Reson Date: 2013-10-14 Impact factor: 5.364
Authors: Wessel P Brouwer; Emma N Baars; Tjeerd Germans; Karin de Boer; Aernout M Beek; Jolanda van der Velden; Albert C van Rossum; Mark B M Hofman Journal: J Cardiovasc Magn Reson Date: 2014-04-25 Impact factor: 5.364
Authors: Otavio R Coelho-Filho; Ravi V Shah; Richard Mitchell; Tomas G Neilan; Heitor Moreno; Bridget Simonson; Raymond Kwong; Anthony Rosenzweig; Saumya Das; Michael Jerosch-Herold Journal: Circulation Date: 2013-08-02 Impact factor: 29.690
Authors: Christopher A Miller; Josephine H Naish; Paul Bishop; Glyn Coutts; David Clark; Sha Zhao; Simon G Ray; Nizar Yonan; Simon G Williams; Andrew S Flett; James C Moon; Andreas Greiser; Geoffrey J M Parker; Matthias Schmitt Journal: Circ Cardiovasc Imaging Date: 2013-04-03 Impact factor: 7.792
Authors: Sacha Bull; Steven K White; Stefan K Piechnik; Andrew S Flett; Vanessa M Ferreira; Margaret Loudon; Jane M Francis; Theodoros D Karamitsos; Bernard D Prendergast; Matthew D Robson; Stefan Neubauer; James C Moon; Saul G Myerson Journal: Heart Date: 2013-01-24 Impact factor: 5.994
Authors: Aakash N Gupta; Gilles Soulat; Ryan Avery; Bradley D Allen; Jeremy D Collins; Lubna Choudhury; Robert O Bonow; James Carr; Michael Markl; Mohammed S M Elbaz Journal: Int J Cardiovasc Imaging Date: 2021-02-01 Impact factor: 2.357
Authors: Judith T Pruijssen; Bradley D Allen; Alex J Barker; Robert O Bonow; Lubna Choudhury; James C Carr; Michael Markl; Pim van Ooij Journal: Radiol Cardiothorac Imaging Date: 2020-02-27
Authors: Saul Crandon; Mohammed S M Elbaz; Jos J M Westenberg; Rob J van der Geest; Sven Plein; Pankaj Garg Journal: Int J Cardiol Date: 2017-09-28 Impact factor: 4.164