H. Sakhi , G. Soulat , D. Craiem , U. Gencer , V. Stipechi , T. Puscas , A. Hagege , E. Mousseaux
{"title":"Characterization of impaired left ventricular mitral filling in HCM: A 4D-flow CMR study","authors":"H. Sakhi , G. Soulat , D. Craiem , U. Gencer , V. Stipechi , T. Puscas , A. Hagege , E. Mousseaux","doi":"10.1016/j.acvdsp.2023.04.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Diastolic dysfunction<span><span> is common and contributes to many clinical manifestations in hypertrophic cardiomyopathy (HCM). 4-dimensionnal (4D) flow </span>cardiac magnetic resonance (CMR) sequence can assess left ventricular mitral filling. The purpose of this study was to determine if the peak early filling rate normalized to the filling volume (PEFR/FV), estimated from 4D-flow sequence can accurately assess impaired left ventricular mitral filling and predict clinical outcomes.</span></p></div><div><h3>Method</h3><p><span>This monocentric study included 44 HCM patients from a prospective HCM register and 44 healthy volunteers, who all underwent CMR with 4D-Flow sequence. Median follow-up time of HCM cohort patients was 2.3 years (interquartile range: 1.7 to 3.3 years). The predefined primary endpoint was a composite criteria that included syncope, onset of atrial fibrillation, admission for congestive heart failure with administration of </span>diuretics, decision to perform septal reduction therapy due to persistent symptomatic obstruction, stroke, ventricular tachycardia or fibrillation and cardiac death.</p></div><div><h3>Results</h3><p>PEFR/FV was significantly lower in HCM cohort compared to healthy volunteers (<em>P</em> <!--><<!--> <!-->0.001). PFR/FV significantly correlated with BNP (<em>r</em> <!-->=<!--> <!-->−0.31, <em>P</em> <!--><<!--> <!-->0.001) and with E/E’ ratio (<em>r</em> <!-->=<!--> <!-->−0.56, p<!--> <!--><<!--> <span>0.001). PEFR/FV according to NYHA status in HCM cohort was statistically different (</span><em>P</em> <!-->=<!--> <!-->0.001). Primary endpoint occurred in 14 patients (32%). In univariate and bivariate adjusted cox-model analysis PEFR/FV<!--> <!--><<!--> <!-->2.61 s -1 was significantly associated with primary endpoint with Hazard Ratio ranging from [HR<!--> <!-->=<!--> <!-->9.46 (95% CI 2.61–45.17, <em>P</em> <!--><<!--> <!-->0.001) to 15.21 (95%CI 3.51–80.22, <em>P</em> <!--><<!--> <!-->0.001)] according to succesive bivariate models.</p></div><div><h3>Conclusion</h3><p>4D-Flow can accurately assess left ventricular mitral filling with a good predictive value of clinical outcomes in HCM patients. Relation of PEFR/FV calculated with 4D flow in HCM.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 251"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001568","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Diastolic dysfunction is common and contributes to many clinical manifestations in hypertrophic cardiomyopathy (HCM). 4-dimensionnal (4D) flow cardiac magnetic resonance (CMR) sequence can assess left ventricular mitral filling. The purpose of this study was to determine if the peak early filling rate normalized to the filling volume (PEFR/FV), estimated from 4D-flow sequence can accurately assess impaired left ventricular mitral filling and predict clinical outcomes.
Method
This monocentric study included 44 HCM patients from a prospective HCM register and 44 healthy volunteers, who all underwent CMR with 4D-Flow sequence. Median follow-up time of HCM cohort patients was 2.3 years (interquartile range: 1.7 to 3.3 years). The predefined primary endpoint was a composite criteria that included syncope, onset of atrial fibrillation, admission for congestive heart failure with administration of diuretics, decision to perform septal reduction therapy due to persistent symptomatic obstruction, stroke, ventricular tachycardia or fibrillation and cardiac death.
Results
PEFR/FV was significantly lower in HCM cohort compared to healthy volunteers (P < 0.001). PFR/FV significantly correlated with BNP (r = −0.31, P < 0.001) and with E/E’ ratio (r = −0.56, p < 0.001). PEFR/FV according to NYHA status in HCM cohort was statistically different (P = 0.001). Primary endpoint occurred in 14 patients (32%). In univariate and bivariate adjusted cox-model analysis PEFR/FV < 2.61 s -1 was significantly associated with primary endpoint with Hazard Ratio ranging from [HR = 9.46 (95% CI 2.61–45.17, P < 0.001) to 15.21 (95%CI 3.51–80.22, P < 0.001)] according to succesive bivariate models.
Conclusion
4D-Flow can accurately assess left ventricular mitral filling with a good predictive value of clinical outcomes in HCM patients. Relation of PEFR/FV calculated with 4D flow in HCM.
期刊介绍:
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.