通过四维血流心脏磁共振成像的动能和血流动力学力揭示的非梗阻性肥厚型心肌病中的血流低效情况。
Flow inefficiencies in non-obstructive HCM revealed by kinetic energy and hemodynamic forces on 4D-flow CMR.
作者信息
Pola K, Ashkir Z, Myerson S, Arheden H, Watkins H, Neubauer S, Arvidsson P M, Raman B
机构信息
University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Lund University, Skåne University Hospital Lund, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden.
出版信息
Eur Heart J Imaging Methods Pract. 2024 Jul 16;2(3):qyae074. doi: 10.1093/ehjimp/qyae074. eCollection 2024 Jul.
AIMS
Patients with non-obstructive hypertrophic cardiomyopathy (HCM) exhibit myocardial changes which may cause flow inefficiencies not detectable on echocardiogram. We investigated whether left ventricular (LV) kinetic energy (KE) and hemodynamic forces (HDF) on 4D-flow cardiovascular magnetic resonance (CMR) can provide more sensitive measures of flow in non-obstructive HCM.
METHODS AND RESULTS
Ninety participants (70 with non-obstructive HCM and 20 healthy controls) underwent 4D-flow CMR. Patients were categorized as phenotype positive (P+) based on maximum wall thickness (MWT) ≥ 15 mm or ≥13 mm for familial HCM, or pre-hypertrophic sarcomeric variant carriers (P-). LV KE and HDF were computed from 4D-flow CMR. Stroke work was computed using a previously validated non-invasive method. P+ and P- patients and controls had comparable diastolic velocities and LV outflow gradients on echocardiography, LV ejection fraction, and stroke volume on CMR. P+ patients had greater stroke work than P- patients, higher systolic KE compared with controls (5.8 vs. 4.1 mJ, = 0.0009), and higher late diastolic KE relative to P- patients and controls (2.6 vs. 1.4 vs. 1.9 mJ, < 0.0001, respectively). MWT was associated with systolic KE ( = 0.5, < 0.0001) and diastolic KE ( = 0.4, = 0.005), which also correlated with stroke work. Systolic HDF ratio was increased in P+ patients compared with controls (1.0 vs. 0.8, = 0.03) and correlated with MWT ( = 0.3, = 0.004). Diastolic HDF was similar between groups. Sarcomeric variant status was not associated with KE or HDF.
CONCLUSION
Despite normal flow velocities on echocardiography, patients with non-obstructive HCM exhibited greater stroke work, systolic KE and HDF ratio, and late diastolic KE relative to controls. 4D-flow CMR provides more sensitive measures of haemodynamic inefficiencies in HCM, holding promise for clinical trials of novel therapies and clinical surveillance of non-obstructive HCM.
目的
非梗阻性肥厚型心肌病（HCM）患者存在心肌改变，这可能导致超声心动图无法检测到的血流效率低下。我们研究了四维血流心血管磁共振成像（CMR）上的左心室（LV）动能（KE）和血流动力学力（HDF）是否能为非梗阻性HCM的血流提供更敏感的测量指标。
方法和结果
90名参与者（70名非梗阻性HCM患者和20名健康对照者）接受了四维血流CMR检查。根据最大壁厚（MWT）≥15 mm（家族性HCM为≥13 mm）或肥厚前肌节变异携带者（P-）将患者分类为表型阳性（P+）。从四维血流CMR计算左心室KE和HDF。使用先前验证的非侵入性方法计算每搏功。P+和P-患者以及对照者在超声心动图上的舒张期速度和左心室流出道梯度、CMR上的左心室射血分数和每搏量相当。P+患者的每搏功高于P-患者，与对照者相比收缩期KE更高（5.8对4.1 mJ，P = 0.0009），相对于P-患者和对照者，舒张期末期KE更高（2.6对1.4对1.9 mJ，P分别<0.0001）。MWT与收缩期KE（P = 0.5，P < 0.0001）和舒张期KE（P = 0.4，P = 0.005）相关，这也与每搏功相关。与对照者相比，P+患者的收缩期HDF比率增加（1.0对0.8，P = 0.03），并与MWT相关（P = 0.3，P = 0.004）。各组之间的舒张期HDF相似。肌节变异状态与KE或HDF无关。
结论
尽管超声心动图上血流速度正常，但与对照者相比，非梗阻性HCM患者表现出更高的每搏功、收缩期KE和HDF比率以及舒张期末期KE。四维血流CMR为HCM中的血流动力学效率低下提供了更敏感的测量指标，有望用于新疗法的临床试验和非梗阻性HCM的临床监测。
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