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Geometric predictors of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a 3D
Yunsun Song1, Dong Hyun Yang1, Bríain Ó Hartaigh2
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, Korea.
Insights
Cardiac CT identified key geometric predictors for left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) patients. A spiral pattern of LV hypertrophy, longer anterior mitral leaflet length, and increased distance from the lateral papillary muscle base to the LV apex predict LVOTO.
Area of Science:
- Cardiovascular Imaging
- Cardiac Morphology
- Hypertrophic Cardiomyopathy Research
Background:
- Left ventricular outflow tract obstruction (LVOTO) is a significant complication in hypertrophic cardiomyopathy (HCM).
- Accurate prediction of LVOTO is crucial for patient management and risk stratification.
- Geometric factors within the left ventricle may contribute to the development of LVOTO in HCM.
Purpose of the Study:
- To identify geometric predictors of LVOTO in patients with HCM using cardiac computed tomography (CT).
- To establish quantitative imaging markers for LVOTO risk assessment in HCM.
Main Methods:
- Retrospective analysis of 141 HCM patients who underwent cardiac CT.
- Three-dimensional CT evaluation of left ventricular (LV) hypertrophy patterns, papillary muscle (PM) and mitral valve morphology, and aorto-mitral angle.
- Multivariable logistic regression and sensitivity analyses to determine independent predictors of LVOTO.
Main Results:
- LVOTO was identified in 28.4% of the study cohort.
- Patients with LVOTO showed a higher prevalence of a spiral LV hypertrophy pattern (51% vs. 16%), longer anterior mitral leaflet (AML) length (18.0 vs. 15.6 mm), and greater distance from the lateral PM base to the LV apex (26.4 vs. 22.0 mm) compared to those without LVOTO.
- Spiral LV hypertrophy pattern, AML length, and the lateral PM base-to-LV apex distance were confirmed as independent predictors of LVOTO.
Conclusions:
- A spiral pattern of LV hypertrophy, increased AML length, and a longer lateral PM base-to-LV apex distance are significant independent predictors of LVOTO in HCM patients.
- Cardiac CT-derived geometric measurements can aid in identifying HCM patients at higher risk for developing LVOTO.
Aims:
To establish geometric predictors of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) patients by use of cardiac computed tomography (CT).
Methods And Results:
A total of 141 consecutive patients with HCM who underwent cardiac CT comprised the analytic sample. The degree, pattern, and extent of left ventricular (LV) hypertrophy were evaluated using 3D CT. Abnormality of papillary muscle (PM), mitral valve, and aorto-mitral angle were evaluated quantitatively. Multivariable logistic regression analysis and sensitivity analysis were performed to reliably identify predictors of LVOTO. LVOTO was present among 40 (28.4%) patients. Those with LVOTO displayed a higher prevalence for having a spiral pattern of LV hypertrophy (e.g. 51 vs. 16%, P < 0.001), a longer anterior mitral leaflet (AML) length (e.g. 18.0 vs. 15.6 mm, P = 0.007), and a longer distance from lateral PM base to LV apex (e.g. 26.4 vs. 22.0 mm, P < 0.001), as compared with the non-LVOTO group. Multivariable logistic regression revealed all three variables [i.e. spiral pattern (95% confidence interval (CI), 3.75, 1.59-8.84); AML length (95% CI, 1.20, 1.03-1.40); the distance between lateral PM base and LV apex (95% CI, 1.09, 1.01-1.19)] retained significance after adjustment for numerous covariates.
Conclusion:
Spiral pattern of LV hypertrophy, the length of AML, and the distance between lateral PM base and LV apex were independent predictors of LVOTO in patients with HCM.