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Asynchronous filling in ischemic heart disease and hypertrophic cardiomyopathy
Insights
Asynchronous filling is common in hypertrophic cardiomyopathy (HCM) and ischemic heart disease (IHD). This study quantifies regional asynchronous emptying and filling using a novel multigated blood-pool technique.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Hypertrophic cardiomyopathy (HCM) and ischemic heart disease (IHD) can cause significant cardiac dysfunction.
- Assessing regional and global cardiac emptying and filling dynamics is crucial for understanding disease progression and guiding treatment.
Purpose of the Study:
- To evaluate regional and global left-ventricular emptying and filling patterns in patients with HCM and IHD.
- To quantify asynchronous cardiac motion using Fourier series analysis of multigated blood-pool data.
- To correlate asynchronous filling indices with global diastolic function parameters.
Main Methods:
- Multigated blood-pool imaging was performed on 16 HCM patients, 43 IHD patients, and 14 controls.
- Regional and global left-ventricular volume curves were analyzed using Fourier series decomposition (second- and third-order harmonics).
- Standard deviations of time to end-systole, peak ejection, and peak filling were calculated as indices of asynchronous motion.
Main Results:
- Patients with IHD and HCM exhibited significantly higher time to peak filling standard deviation (TPF-SD) compared to time to end-systole (TES-SD) and time to peak ejection (TPE-SD).
- In HCM patients, phase delays were localized to specific regions, correlating with abnormal wall motion.
- TPF-SD showed inverse correlations with left-ventricular ejection fraction, peak filling rate, and the peak filling rate to peak ejection rate ratio, indicating a link between asynchronous filling and diastolic dysfunction.
Conclusions:
- Asynchronous filling is a prevalent finding in both IHD and HCM.
- The developed technique provides a quantitative method for assessing regional asynchronous emptying and filling in these cardiac conditions.
- This quantitative assessment can aid in understanding the pathophysiology and clinical implications of diastolic disturbances in HCM and IHD.
Abstract:
A multigated blood-pool study was performed to assess regional and global emptying and filling in 16 patients with hypertrophic cardiomyopathy (HCM), 43 patients with ischemic heart disease (IHD), and 14 controls. The regional volume curve was fitted using second-order harmonics in the Fourier series, while the global left-ventricular volume curve was fitted using third-order harmonics. As asynchronous indices, the standard deviations (SD) in distribution histograms of time to end-systole (TES), time to peak ejection (TPE), and time to peak filling (TPF) were obtained in the left ventricle. In patients with IHD, the TPF-SD was higher (14.4 +/- 11.3 degrees) than the TES-SD (7.8 +/- 5.1 degrees) and TPE-SD (8.1 +/- 5.9 degrees), suggesting the presence of asynchronous filling. In patients with HCM, the TPF-SD was also higher (11.6 +/- 11.1 degrees) than the TES-SD (3.5 +/- 2.4 degrees) and TPE-SD (6.2 +/- 4.4 degrees). The phase delay was localized in the anteroseptal or apical region in all 5 HCM patients with abnormal wall motion, while it corresponded with the region of abnormal wall motion in the patients with IHD. The TPF-SD was inversely correlated with the left-ventricular ejection fraction (r = -0.46), peak filling rate (r = -0.50), and the ratio of peak filling rate to peak ejection rate (r = -0.52), suggesting that asynchronous filling is related to global diastolic disturbance. We conclude that asynchronous filling is often present in patients with IHD and HCM, and that our technique can be used to obtain a quantitative assessment of regional asynchronous emptying and filling in these diseases.