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Left ventricular anatomy in obstructive hypertrophic cardiomyopathy: beyond basal septal hypertrophy

Uxio Hermida1, David Stojanovski1, Betty Raman2

  • 1School of Biomedical Engineering and Imaging Sciences, King's College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK.

European Heart Journal. Cardiovascular Imaging
|November 28, 2022
PubMed

Insights

Obstructive hypertrophic cardiomyopathy (oHCM) involves specific left ventricular (LV) shapes, including lengthening and apical dilatation. Understanding this LV anatomy can help redefine management strategies for LVOT obstruction.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Obstructive hypertrophic cardiomyopathy (oHCM) is defined by dynamic left ventricular outflow tract (LVOT) obstruction.
  • The precise role of left ventricular (LV) shape in oHCM pathophysiology remains unclear.
  • This study investigates the specific LV end-diastolic morphology associated with oHCM.

Purpose of the Study:

  • To identify the characteristic LV end-diastolic morphology in patients with oHCM.
  • To quantify LV shape variations using a statistical shape model.
  • To explore the relationship between LV morphology, LVOT obstruction, and genotype.

Main Methods:

  • Analysis of cardiovascular magnetic resonance images from 2398 HCM patients.
  • Construction of 3D LV models and application of principal component analysis.
  • Development of linear discriminant axes to quantify LV morphology (Z-scores).

Main Results:

  • oHCM is characterized by basal septal hypertrophy, LV lengthening, apical dilatation, and LVOT inward remodeling.
  • Distinct LV morphological differences were observed between obstructive cases at rest and during stress.
  • Genotype-negative cases exhibited a trend towards more obstructive phenotypes.

Conclusions:

  • The LV anatomy in oHCM involves a complex remodeling pattern beyond basal septal hypertrophy.
  • Variations in LV morphology at rest versus stress suggest diverse mechanisms for LVOT obstruction.
  • Quantifiable Z-scores for LV anatomy may aid in redefining oHCM management strategies.
Abstract

Keywords:
cardiac atlasclinical biomarkercomputational anatomymachine learningshape analysisventricular remodelling

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