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Prognostic Value of Left Ventricular Kinetic Energy for Predicting Major Adverse Events in Hypertrophic

Mengyao Hu1, Xiaodan Zhao2, Ru-San Tan3

  • 1Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Jiangxi, China; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.

JACC. Asia
|April 8, 2026
PubMed

Insights

Reduced left ventricular global kinetic energy (KEiEDV) in hypertrophic cardiomyopathy (HCM) patients predicts major adverse cardiac events (MACE). This 4D flow cardiac magnetic resonance (CMR) metric offers valuable prognostic information for risk stratification.

Area of Science:

  • Cardiovascular Imaging
  • Cardiac Physiology
  • Biomedical Engineering

Background:

  • Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular (LV) hypertrophy, which significantly impacts blood flow hemodynamics.
  • Altered LV hemodynamics in HCM can contribute to adverse clinical outcomes.

Purpose of the Study:

  • To investigate the predictive capability of 4-dimensional (4D) flow cardiac magnetic resonance (CMR) parameters for major adverse cardiac events (MACE) in patients with HCM.
  • To assess whether specific 4D flow CMR-derived metrics can identify HCM patients at higher risk for MACE.

Main Methods:

  • Retrospective analysis of 165 adult HCM patients and 115 healthy controls from the INITIATE registry.
  • All subjects underwent cine and 4D flow CMR.
  • LV ejection fraction, maximal left atrial volume, LV flow components, and LV global kinetic energy indexed to end-diastolic volume (KEiEDV) were calculated.

Main Results:

  • HCM patients exhibited reduced LV global KEiEDV compared to controls, with even lower values observed in those experiencing MACE.
  • LV global KEiEDV provided incremental predictive value for MACE beyond traditional cine imaging and late gadolinium enhancement.
  • A threshold of KEiEDV ≤ 6.37 μJ/mL independently predicted MACE (HR: 4.12) and remained significant after multivariable adjustment.

Conclusions:

  • 4D flow-derived LV global KEiEDV is significantly reduced in HCM patients who experience MACE.
  • This metric offers incremental prognostic value for clinical risk stratification in HCM.
  • 4D flow CMR parameters hold potential for improving risk assessment in hypertrophic cardiomyopathy.
Abstract

Keywords:
4D flow CMRflow componenthypertrophic cardiomyopathykinetic energysurvival analysis

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