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Published on: May 24, 2021
Quantitative Analysis of Left Ventricular Flow Dynamics in Latent Obstructive Hypertrophic Cardiomyopathy Using
Xiaoli Zhu1, Lei Xu1, Lei Zuo1
1Ultrasound Department of Xijing Hospital, Xijing Hypertrophic Cardiomyopathy Center, Fourth Military Medical University, Xi'an, China.
Insights
Latent obstructive hypertrophic cardiomyopathy (LOHCM) patients exhibit higher left ventricular (LV) energy loss (EL) and altered circulation compared to nonobstructive (NOHCM) patients and controls. Vector flow mapping (VFM) effectively identifies these hemodynamic changes.
Area of Science:
- Cardiology
- Medical Imaging
- Fluid Dynamics
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
- HCM can present with or without left ventricular outflow tract obstruction.
- Distinguishing between obstructive and nonobstructive forms is clinically important.
Purpose of the Study:
- To assess left ventricular (LV) energy loss (EL), circulation, and vortex area using vector flow mapping (VFM).
- To compare hemodynamic parameters between patients with latent obstructive HCM (LOHCM), nonobstructive HCM (NOHCM), and healthy controls.
- To evaluate the diagnostic capability of VFM parameters in differentiating LOHCM from NOHCM.
Main Methods:
- Transthoracic echocardiography was performed on 14 LOHCM patients, 10 NOHCM patients, and 11 controls.
- Offline VFM workstation analyzed LV blood flow patterns and fluid dynamics.
- Hemodynamic parameters, including EL, circulation, and vortex area, were calculated across 7 cardiac phases.
Main Results:
- LOHCM patients showed significantly higher LV EL during rapid ejection, slow ejection (SE), and isovolumetric relaxation phases compared to controls and NOHCM patients (p < 0.05).
- Increased circulation during SE was observed in LOHCM patients compared to the other groups (p < 0.05).
- LV EL during SE demonstrated high diagnostic accuracy (AUC=0.964) for differentiating LOHCM from NOHCM, with a cutoff of 6.34 J/m3/s (100% sensitivity, 80% specificity).
Conclusions:
- Vector flow mapping (VFM) can detect abnormal LV energy loss and vortex dynamics in HCM patients.
- LOHCM patients exhibit impaired systolic and diastolic function compared to controls and NOHCM patients.
- VFM parameters, particularly LV EL during SE, are valuable for distinguishing between LOHCM and NOHCM.
Objectives:
This study aimed to assess left ventricular (LV) energy loss (EL), circulation and vortex area using vector flow mapping (VFM) in patients with latent obstructive hyper-trophic cardiomyopathy (LOHCM) and nonobstructive hypertrophic cardiomyopathy (NOHCM).
Methods:
Fourteen LOHCM patients, 10 NOHCM patients, and 11 healthy individuals were evaluated by transthoracic echocardiography. An offline VFM workstation was used to analyze the LV blood flow patterns and fluid dynamics. The hemodynamic parameters, EL, circulation, and vortex area in 7 cardiac phases were calculated and analyzed.
Results:
Compared with controls and NOHCM patients, EL was significantly higher in -LOHCM patients during the rapid ejection phase, slow ejection (SE) phase, and isovolumetric relaxation phase (p < 0.05). LOHCM patients also showed increased circulation during SE compared to the other two groups (p < 0.05). The ability to discriminate between NOHCM and LOHCM was assessed by the area under the receiver-operating characteristic curve (AUC), and EL during SE was found to have the largest AUC (0.964); the best cutoff value was 6.34 J/m3/s, with a sensitivity of 100% and specificity of 80%.
Conclusions:
The VFM technique can detect abnormal changes of LV EL and vortex characteristics in hypertrophic cardiomyopathy patients. Compared with controls and NOHCM patients, the LOHCM patients have worse systolic and diastolic functions.
