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

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

doi:10.1007/s10554-021-02167-6

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

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^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆P_MRI) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KE_LA) was computed throughout systole. Average systolic (KE_LA-avg) and peak systolic (KE_LA-peak) KE_LA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆P_MRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KE_LA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KE_LA-avg (14.8 [10.6, 20.4] J/m³ vs. 33.4 [23.9, 61.3] J/m³, P < 0.001) and KE_LA-peak (22.1 [15.9, 28.7] J/m³ vs. 57.2 [44.5, 121.4] J/m³, P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KE_LA-avg (rho = 0.81, P < 0.001) and KE_LA-peak (rho = 0.79, P < 0.001). LVOT ∆P_MRI was strongly correlated with KE_LA metrics in obstructive HCM (KE_LA-avg: rho = 0.86, P < 0.001; KE_LA-peak: rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction.

Original language	English (US)
Pages (from-to)	2755-2765
Number of pages	11
Journal	International Journal of Cardiovascular Imaging
Volume	37
Issue number	9
DOIs	https://doi.org/10.1007/s10554-021-02167-6
State	Published - Sep 2021

Funding

ROB has served as Editor-in-Chief of JAMA Cardiology and editor of Braunwald’s Heart Disease for Elsevier. MM has received research support from Siemens Healthineers, research grants from Circle Cardiovascular Imaging and Cryolife Inc, and is a consultant for Circle Cardiovascular Imaging. None of the other authors report a conflict of interest. ANG was supported by a medical student grant by the Radiological Society of North America (RSNA).

Keywords

4D flow MRI
Hypertrophic cardiomyopathy
Intracardiac energetics
Mitral regurgitation
left ventricular outflow tract obstruction

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

Access to Document

10.1007/s10554-021-02167-6

Cite this

Gupta, A. N., Soulat, G., Avery, R., Allen, B. D., Collins, J. D., Choudhury, L., Bonow, R. O., Carr, J., Markl, M., & Elbaz, M. S. M. (2021). 4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction. International Journal of Cardiovascular Imaging, 37(9), 2755-2765. https://doi.org/10.1007/s10554-021-02167-6

@article{42ca92a22104434dafe33b13fc693ba4,

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

abstract = "To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆PMRI) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KELA) was computed throughout systole. Average systolic (KELA-avg) and peak systolic (KELA-peak) KELA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆PMRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KELA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KELA-avg (14.8 [10.6, 20.4] J/m3 vs. 33.4 [23.9, 61.3] J/m3, P < 0.001) and KELA-peak (22.1 [15.9, 28.7] J/m3 vs. 57.2 [44.5, 121.4] J/m3, P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KELA-avg (rho = 0.81, P < 0.001) and KELA-peak (rho = 0.79, P < 0.001). LVOT ∆PMRI was strongly correlated with KELA metrics in obstructive HCM (KELA-avg: rho = 0.86, P < 0.001; KELA-peak: rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction.",

keywords = "4D flow MRI, Hypertrophic cardiomyopathy, Intracardiac energetics, Mitral regurgitation, left ventricular outflow tract obstruction",

author = "Gupta, \{Aakash N.\} and Gilles Soulat and Ryan Avery and Allen, \{Bradley D.\} and Collins, \{Jeremy D.\} and Lubna Choudhury and Bonow, \{Robert O.\} and James Carr and Michael Markl and Elbaz, \{Mohammed S.M.\}",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.",

year = "2021",

month = sep,

doi = "10.1007/s10554-021-02167-6",

language = "English (US)",

volume = "37",

pages = "2755--2765",

journal = "International Journal of Cardiovascular Imaging",

issn = "1569-5794",

publisher = "Springer Science and Business Media B.V.",

number = "9",

}

Gupta, AN, Soulat, G, Avery, R , Allen, BD , Collins, JD , Choudhury, L , Bonow, RO , Carr, J , Markl, M & Elbaz, MSM 2021, '4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction', International Journal of Cardiovascular Imaging, vol. 37, no. 9, pp. 2755-2765. https://doi.org/10.1007/s10554-021-02167-6

4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction. / Gupta, Aakash N.; Soulat, Gilles; Avery, Ryan et al.
In: International Journal of Cardiovascular Imaging, Vol. 37, No. 9, 09.2021, p. 2755-2765.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - 4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction

AU - Gupta, Aakash N.

AU - Soulat, Gilles

AU - Avery, Ryan

AU - Allen, Bradley D.

AU - Collins, Jeremy D.

AU - Choudhury, Lubna

AU - Bonow, Robert O.

AU - Carr, James

AU - Markl, Michael

AU - Elbaz, Mohammed S.M.

PY - 2021/9

Y1 - 2021/9

N2 - To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆PMRI) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KELA) was computed throughout systole. Average systolic (KELA-avg) and peak systolic (KELA-peak) KELA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆PMRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KELA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KELA-avg (14.8 [10.6, 20.4] J/m3 vs. 33.4 [23.9, 61.3] J/m3, P < 0.001) and KELA-peak (22.1 [15.9, 28.7] J/m3 vs. 57.2 [44.5, 121.4] J/m3, P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KELA-avg (rho = 0.81, P < 0.001) and KELA-peak (rho = 0.79, P < 0.001). LVOT ∆PMRI was strongly correlated with KELA metrics in obstructive HCM (KELA-avg: rho = 0.86, P < 0.001; KELA-peak: rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction.

AB - To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆PMRI) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KELA) was computed throughout systole. Average systolic (KELA-avg) and peak systolic (KELA-peak) KELA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆PMRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KELA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KELA-avg (14.8 [10.6, 20.4] J/m3 vs. 33.4 [23.9, 61.3] J/m3, P < 0.001) and KELA-peak (22.1 [15.9, 28.7] J/m3 vs. 57.2 [44.5, 121.4] J/m3, P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KELA-avg (rho = 0.81, P < 0.001) and KELA-peak (rho = 0.79, P < 0.001). LVOT ∆PMRI was strongly correlated with KELA metrics in obstructive HCM (KELA-avg: rho = 0.86, P < 0.001; KELA-peak: rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction.

KW - 4D flow MRI

KW - Hypertrophic cardiomyopathy

KW - Intracardiac energetics

KW - Mitral regurgitation

KW - left ventricular outflow tract obstruction

UR - http://www.scopus.com/inward/record.url?scp=85100205828&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85100205828&partnerID=8YFLogxK

U2 - 10.1007/s10554-021-02167-6

DO - 10.1007/s10554-021-02167-6

M3 - Article

C2 - 33523363

AN - SCOPUS:85100205828

SN - 1569-5794

VL - 37

SP - 2755

EP - 2765

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

IS - 9

ER -

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this