Novel insights into diminished cardiac reserve in non-obstructive hypertrophic cardiomyopathy from four-dimensional flow cardiac magnetic resonance component analysis

Author:

Ashkir Z1ORCID,Johnson S1,Lewandowski A J2ORCID,Hess A3ORCID,Wicks E14,Mahmod M1ORCID,Myerson S1ORCID,Ebbers T56ORCID,Watkins H7ORCID,Neubauer S1ORCID,Carlhäll C J568ORCID,Raman B1ORCID

Affiliation:

1. Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital , Headington, Oxford OX3 9 DU , UK

2. Oxford Cardiovascular Clinical Research Facility (CCRF), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital , Headington, Oxford OX3 9 DU , UK

3. Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (NDCN), University of Oxford, John Radcliffe Hospital , Headington, Oxford OX3 9 DU , UK

4. Inherited Cardiovascular Conditions (ICC) Service, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Level 6, West Wing, John Radcliffe Hospital , Headington, Oxford OX3 9 DU , UK

5. Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University , SE-581 83 Linköping , Sweden

6. Center for Medical Image Science and Visualization (CMIV), Linköping University , SE-581 83 Linköping , Sweden

7. Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital , Headington, Oxford OX3 9 DU , UK

8. Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University , SE-581 83 Linköping , Sweden

Abstract

Abstract Aims Hypertrophic cardiomyopathy (HCM) is characterized by hypercontractility and diastolic dysfunction, which alter blood flow haemodynamics and are linked with increased risk of adverse clinical events. Four-dimensional flow cardiac magnetic resonance (4D-flow CMR) enables comprehensive characterization of ventricular blood flow patterns. We characterized flow component changes in non-obstructive HCM and assessed their relationship with phenotypic severity and sudden cardiac death (SCD) risk. Methods and results Fifty-one participants (37 non-obstructive HCM and 14 matched controls) underwent 4D-flow CMR. Left-ventricular (LV) end-diastolic volume was separated into four components: direct flow (blood transiting the ventricle within one cycle), retained inflow (blood entering the ventricle and retained for one cycle), delayed ejection flow (retained ventricular blood ejected during systole), and residual volume (ventricular blood retained for >two cycles). Flow component distribution and component end-diastolic kinetic energy/mL were estimated. HCM patients demonstrated greater direct flow proportions compared with controls (47.9 ± 9% vs. 39.4 ± 6%, P = 0.002), with reduction in other components. Direct flow proportions correlated with LV mass index (r = 0.40, P = 0.004), end-diastolic volume index (r = −0.40, P = 0.017), and SCD risk (r = 0.34, P = 0.039). In contrast to controls, in HCM, stroke volume decreased with increasing direct flow proportions, indicating diminished volumetric reserve. There was no difference in component end-diastolic kinetic energy/mL. Conclusion Non-obstructive HCM possesses a distinctive flow component distribution pattern characterised by greater direct flow proportions, and direct flow-stroke volume uncoupling indicative of diminished cardiac reserve. The correlation of direct flow proportion with phenotypic severity and SCD risk highlight its potential as a novel and sensitive haemodynamic measure of cardiovascular risk in HCM.

Funder

Clinical Research Training Fellowship

British Heart Foundation

NIHR Oxford Biomedical Research Centre

Intermediate Clinical Transitional Research Fellowship

British Heart Foundation Oxford Centre of Research Excellence

Swedish Research Council

Swedish Heart and Lung Foundation

ALF Grant Region Ostergotland

Oxford British Heart Foundation Centre of Research Excellence

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine

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