Characterization of impaired left ventricular mitral filling in HCM: A 4D-flow CMR study

H. Sakhi , G. Soulat , D. Craiem , U. Gencer , V. Stipechi , T. Puscas , A. Hagege , E. Mousseaux
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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.

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HCM左心室二尖瓣充盈受损的特征:4d血流CMR研究
舒张功能障碍是肥厚性心肌病(HCM)常见的临床表现之一。四维血流心脏磁共振(CMR)序列可评估左心室二尖瓣充盈。本研究的目的是确定从4d血流序列估计的峰值早期充盈率与充盈体积(PEFR/FV)是否可以准确评估左心室二尖瓣充盈受损并预测临床结果。方法本单中心研究纳入了44例HCM患者和44名健康志愿者,均采用4D-Flow序列进行CMR。HCM队列患者的中位随访时间为2.3年(四分位数范围:1.7 ~ 3.3年)。预先确定的主要终点是一个复合标准,包括晕厥、房颤发作、充血性心力衰竭入院并给予利尿剂、由于持续症状性梗阻、中风、室性心动过速或房颤以及心源性死亡而决定进行间隔缩小治疗。结果HCM组spefr /FV显著低于健康组(P <0.001)。PFR/FV与BNP显著相关(r = - 0.31, P <0.001), E/E比值(r = - 0.56, p <0.001)。HCM队列中NYHA状态的PEFR/FV差异有统计学意义(P = 0.001)。主要终点发生在14例患者(32%)。在单因素和双因素校正cox模型分析中,PEFR/FV <2.61 s -1与主要终点显著相关,风险比范围为[HR = 9.46] (95% CI 2.61 - 45.17, P <0.001)至15.21 (95%CI 3.51-80.22, P <0.001)]根据连续双变量模型。结论4d - flow能准确评估HCM患者左心室二尖瓣充盈情况,对HCM患者临床预后有较好的预测价值。HCM四维流动计算PEFR/FV的关系。
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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
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发文量
508
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.
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