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Hypertrophic obstructive cardiomyopathy-left ventricular outflow tract shapes and their hemodynamic influences

T Mayr1,2, L Riazy1,2,3, R F Trauzeddel1,2,4

  • 1ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.

The International Journal of Cardiovascular Imaging
|September 20, 2024
PubMed

Insights

Cardiovascular magnetic resonance identified three distinct shapes of left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy patients. These anatomical variations significantly impact blood flow dynamics and may influence treatment strategies.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Fluid Dynamics

Background:

  • Hypertrophic cardiomyopathy (HCM) is a common genetic heart disorder.
  • Left ventricular outflow tract (LVOT) obstruction is a key phenotype in HCM.
  • LVOT obstruction's anatomical variations can affect hemodynamics and treatment decisions.

Purpose of the Study:

  • To identify distinct anatomical shapes of LVOT obstruction in HCM using cardiovascular magnetic resonance (CMR).
  • To assess the hemodynamic consequences of these identified LVOT obstruction shapes.

Main Methods:

  • In-vivo analysis: 3D LVOT reconstruction from 2D CMR slices in 125 HCM patients.
  • In-vitro analysis: 2D and 4D flow measurements on 3D printed phantoms based on in-vivo anatomy.
  • Patient cohort: 125 consecutive HCM patients (mean age 64.17 years, 42 female).

Main Results:

  • Three primary LVOT obstruction shapes identified: K-shape (28.8%), X-shape (51.2%), V-shape (10.4%), and a mixed shape (9.6%).
  • Each shape exhibited unique hemodynamic profiles and maximum velocities.
  • V-shape demonstrated the highest velocity (138.87 cm/s), followed by K-shape (137.11 cm/s) and X-shape (125.39 cm/s).

Conclusions:

  • This study is the first to identify and categorize distinct anatomical shapes of LVOT obstruction in HCM.
  • These identified shapes (K, X, V) appear to influence the hemodynamic characteristics of HCM.
  • Further research into these variants may refine therapeutic decision-making for HCM patients.

Keywords:
Cardiovascular magnetic resonanceHemodynamicsHypertrophic cardiomyopathyHypertrophic obstructive cardiomyopathyLeft ventricular outflow obstructionShape analysis

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