4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction

Gupta, Aakash; Soulat, Gilles; Avery, Ryan; Allen, Bradley D.; Collins, Jeremy D.; Choudhury, Lubna; Bonow, Robert O.; Carr, James C.; Markl, Michael; Elbaz, Mohammed

doi:10.1007/s10554-021-02167-6

Cited by 5 publications

(7 citation statements)

References 34 publications

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“…Additionally, 11 studies (61%) compared patients with underlying cardiac disease and MVR to healthy volunteers for internal validity assessments. Across studies, underlying cardiac diseases such as mitral valve prolapse (MVP) [ 16 ], atrial fibrillation (AF) [ 17 ], and HCM [ 18 ] were included.…”

Section: Resultsmentioning

confidence: 99%

“…Across studies, underlying cardiac diseases such as mitral valve prolapse (MVP) [ 16 ], atrial fibrillation (AF) [ 17 ], and HCM [ 18 ] were included.…”

Section: Resultsmentioning

confidence: 99%

“…All studies administrated contrast agents before the 4D-flow acquisition, without specification of the exact timing, and used ECG triggering and respiratory gating. For flow analysis, retrospective valve tracking using post-processing software such as MASS (n = 6) (Leiden University Medical Center, The Netherlands) [ 9 – 11 , 17 , 20 , 21 ] and cvi42 (n = 2) (Circle Cardiovascular Imaging, Calgary, Canada) [ 8 , 18 ] was common. All studies visually assessed the quality of images and performed pre-processing for de-noising and anti-aliasing.…”

Section: Resultsmentioning

confidence: 99%

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Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Safarkhanlo

Jung

Bernhard

et al. 2023

Int J Cardiovasc Imaging

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Cardiac magnetic resonance (CMR) four-dimensional (4D) flow is a novel method for flow quantification potentially helpful in management of mitral valve regurgitation (MVR). In this systematic review, we aimed to depict the clinical role of intraventricular 4D-flow in MVR. The reproducibility, technical aspects, and comparison against conventional techniques were evaluated. Published studies on SCOPUS, MEDLINE, and EMBASE were included using search terms on 4D-flow CMR in MVR. Out of 420 screened articles, 18 studies fulfilled our inclusion criteria. All studies (n = 18, 100%) assessed MVR using 4D-flow intraventricular annular inflow (4D-flowAIM) method, which calculates the regurgitation by subtracting the aortic forward flow from the mitral forward flow. Thereof, 4D-flow jet quantification (4D-flowjet) was assessed in 5 (28%), standard 2D phase-contrast (2D-PC) flow imaging in 8 (44%) and the volumetric method (the deviation of left ventricle stroke volume and right ventricular stroke volume) in 2 (11%) studies. Inter-method correlations among the 4 MVR quantification methods were heterogeneous across studies, ranging from moderate to excellent correlations. Two studies compared 4D-flowAIM to echocardiography with moderate correlation. In 12 (63%) studies the reproducibility of 4D-flow techniques in quantifying MVR was studied. Thereof, 9 (75%) studies investigated the reproducibility of the 4D-flowAIM method and the majority (n = 7, 78%) reported good to excellent intra- and inter-reader reproducibility. Intraventricular 4D-flowAIM provides high reproducibility with heterogeneous correlations to conventional quantification methods. Due to the absence of a gold standard and unknown accuracies, future longitudinal outcome studies are needed to assess the clinical value of 4D-flow in the clinical setting of MVR.

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Section: Resultsmentioning

confidence: 99%

“…Across studies, underlying cardiac diseases such as mitral valve prolapse (MVP) [ 16 ], atrial fibrillation (AF) [ 17 ], and HCM [ 18 ] were included.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Safarkhanlo

Jung

Bernhard

et al. 2023

Int J Cardiovasc Imaging

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“…There are four major studies from the Northwestern group that reported on 4D flow MRI evaluation in HCM. 15,24,29,30 The first paper performed a visual assessment of blood flow TKE Measurement of HOCM by 4D Flow MRI pattern on the ascending aorta in HCM. 24 It showed that the prevalence of flow derangement is higher in HOCM than in HNCM, and is associated with increasing LVOT-PG and the presence of SAM.…”

Section: D Flow Mri In Hcmmentioning

confidence: 99%

“…30 The fourth paper mainly focused on left atrial flow dynamics which is out of focus in the current study. 29 Clinical study utilizing TKE…”

Section: D Flow Mri In Hcmmentioning

confidence: 99%

Measurement of Turbulent Kinetic Energy in Hypertrophic Cardiomyopathy Using Triple-velocity Encoding 4D Flow MR Imaging

et al. 2024

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The turbulent kinetic energy (TKE) estimation based on 4D flow MRI has been currently developed and can be used to estimate the pressure gradient. The objective of this study was to validate the clinical value of 4D flow-based TKE measurement in patients with hypertrophic cardiomyopathy (HCM).Methods: From April 2018 to March 2019, we recruited 28 patients with HCM. Based on echocardiography, they were divided into obstructed HCM (HOCM) and non-obstructed HCM (HNCM). Triplevelocity encoding 4D flow MRI was performed. The volume-of-interest from the left ventricle to the aortic arch was drawn semi-automatically. We defined peak turbulent kinetic energy (TKE peak ) as the highest TKE phase in all cardiac phases.Results: TKE peak was significantly higher in HOCM than in HNCM (14.83 ± 3.91 vs. 7.11 ± 3.60 mJ, P < 0.001). TKE peak was significantly higher in patients with systolic anterior movement (SAM) than in those without SAM (15.60 ± 3.96 vs. 7.44 ± 3.29 mJ, P < 0.001). Left ventricular (LV) mass increased proportionally with TKE peak (P = 0.012, r = 0.466). When only the asymptomatic patients were extracted, a stronger correlation was observed (P = 0.001, r = 0.842).Conclusion: TKE measurement based on 4D flow MRI can detect the flow alteration induced by systolic flow jet and LV outflow tract geometry, such as SAM in patients with HOCM. The elevated TKE is correlated with increasing LV mass. This indicates that increasing cardiac load, by pressure loss due to turbulence, induces progression of LV hypertrophy, which leads to a worse prognosis.

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Evaluation of Left Ventricular Flow Kinetic Energy by Four‐Dimensional Blood Flow MRI in Nondialysis Chronic Kidney Disease Patients

Zhang,

Tang,

Xiong

et al. 2024

Magnetic Resonance Imaging

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BackgroundChronic kidney disease (CKD) is associated with increased, and early cardiovascular disease risk. Changes in hemodynamics within the left ventricle (LV) respond to cardiac remodeling. The LV hemodynamics in nondialysis CKD patients are not clearly understood.PurposeTo use four‐dimensional blood flow MRI (4D flow MRI) to explore changes in LV kinetic energy (KE) and the relationship between LV KE and LV remodeling in CKD patients.Study TypeRetrospective.Population98 predialysis CKD patients (Stage 3: n = 21, stage 4: n = 21, and stage 5: n = 56) and 16 age‐ and sex‐matched healthy controls.Field Strength/Sequence3.0 T/balanced steady‐state free precession (SSFP) cine sequence, 4D flow MRI with a fast field echo sequence, T1 mapping with a modified Look–Locker SSFP sequence, and T2 mapping with a gradient recalled and spin echo sequence.AssessmentDemographic characteristics (age, sex, height, weight, blood pressure, heart rate, aortic regurgitation, and mitral regurgitation) and laboratory data (eGFR, Creatinine, hemoglobin, ferritin, transferrin saturation, potassium, and carbon dioxide bonding capacity) were extracted from patient records. Myocardial T1, T2, LV ejection fraction, end diastolic volume (EDV), end systolic volume, LV flow components (direct flow, delayed ejection, retained inflow, and residual volume) and KE parameters (peak systolic, systolic, diastolic, peak E‐wave, peak A‐wave, E/A ratio, and global) were assessed. The KE parameters were normalized to EDV (KEiEDV). Parameters were compared between disease stage in CKD patients, and between CKD patients and healthy controls.Statistical TestsDifferences in clinical and imaging parameters between groups were compared using one‐way ANOVA, Kruskal Walls and Mann–Whitney U tests, chi‐square test, and Fisher's exact test. Pearson or Spearman's correlation coefficients and multiple linear regression analysis were used to compare the correlation between LV KE and other clinical and functional parameters. A P‐value of <0.05 was considered significant.ResultsCompared with healthy controls, peak systolic (24.76 ± 5.40 μJ/mL vs. 31.86 ± 13.18 μJ/mL), systolic (11.62 ± 2.29 μJ/mL vs. 15.27 ± 5.10 μJ/mL), diastolic (7.95 ± 1.92 μJ/mL vs. 13.33 ± 5.15 μJ/mL), peak A‐wave (15.95 ± 4.86 μJ/mL vs. 31.98 ± 14.51 μJ/mL), and global KEiEDV (9.40 ± 1.64 μJ/mL vs. 14.02 ± 4.14 μJ/mL) were significantly increased and the KEiEDV E/A ratio (1.16 ± 0.67 vs. 0.69 ± 0.53) was significantly decreased in CKD patients. As the CKD stage progressed, both diastolic KEiEDV (10.45 ± 4.30 μJ/mL vs. 12.28 ± 4.85 μJ/mL vs. 14.80 ± 5.06 μJ/mL) and peak E‐wave KEiEDV (15.30 ± 7.06 μJ/mL vs. 14.69 ± 8.20 μJ/mL vs. 19.33 ± 8.29 μJ/mL) increased significantly. In multiple regression analysis, global KEiEDV (β* = 0.505; β* = 0.328), and proportion of direct flow (β* = −0.376; β* = −0.410) demonstrated an independent association with T1 and T2 times.Data Conclusion4D flow MRI‐derived LV KE parameters show altered LV adaptations in CKD patients and correlate independently with T1 and T2 mapping that may represent myocardial fibrosis and edema.Level of Evidence4.Technical EfficacyStage 3.

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4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction

Cited by 5 publications

References 34 publications

Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Measurement of Turbulent Kinetic Energy in Hypertrophic Cardiomyopathy Using Triple-velocity Encoding 4D Flow MR Imaging

Evaluation of Left Ventricular Flow Kinetic Energy by Four‐Dimensional Blood Flow MRI in Nondialysis Chronic Kidney Disease Patients

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