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4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction

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Abstract

To noninvasively assess left atrial (LA) kinetic energy (KE) in hypertrophic cardiomyopathy (HCM) patients using 4D flow MRI and evaluate coupling associations with mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction. Twenty-nine retrospectively identified patients with HCM underwent 4D flow MRI. MRI-estimated peak LVOT pressure gradient (∆PMRI) was used to classify patients into non-obstructive and obstructive HCM. Time-resolved volumetric LA kinetic energy (KELA) was computed throughout systole. Average systolic (KELA-avg) and peak systolic (KELA-peak) KELA were compared between non-obstructive and obstructive HCM groups, and associations to MR severity and LVOT ∆PMRI were tested.The study included 15 patients with non-obstructive HCM (58.6 [45.9, 65.2] years, 7 females) and 14 patients with obstructive HCM (51.9 [47.6, 62.6] years, 6 females). Obstructive HCM patients demonstrated significantly elevated instantaneous KELA over all systolic time-points compared to non-obstructive HCM (P < 0.05). Obstructive HCM patients also demonstrated higher KELA-avg (14.8 [10.6, 20.4] J/m3 vs. 33.4 [23.9, 61.3] J/m3, P < 0.001) and KELA-peak (22.1 [15.9, 28.7] J/m3 vs. 57.2 [44.5, 121.4] J/m3, P < 0.001) than non-obstructive HCM. MR severity was significantly correlated with KELA-avg (rho = 0.81, P < 0.001) and KELA-peak (rho = 0.79, P < 0.001). LVOT ∆PMRI was strongly correlated with KELA metrics in obstructive HCM (KELA-avg: rho = 0.86, P < 0.001; KELA-peak: rho = 0.85, P < 0.001).In HCM patients, left atrial kinetic energy, by 4D flow MRI, is associated with MR severity and the degree of LVOT obstruction.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

The code that supports the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

ANG was supported by a medical student grant by the Radiological Society of North America (RSNA).

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Authors and Affiliations

  1. Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 N Michigan, Suite 1600, Chicago, IL, 60611, USA

    Aakash N. Gupta, Gilles Soulat, Ryan Avery, Bradley D. Allen, James Carr, Michael Markl & Mohammed S. M. Elbaz

  2. Department of Radiology, Mayo Clinic, Rochester, MN, 55902, USA

    Jeremy D. Collins

  3. Department of Medicine, Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA

    Lubna Choudhury & Robert O. Bonow

  4. Department of Biomedical Engineering, Northwestern University, McCormick School of Engineering, Evanston, IL, 60208, USA

    Michael Markl

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Contributions

ANG assisted with conception and design of project, image analysis, data analysis, manuscript preparation, and manuscript review and is the guarantor of study integrity. GS assisted with image analysis, data analysis and manuscript review. RA assisted with data analysis and manuscript review. BA assisted with image analysis, data analysis and manuscript review. JDC assisted with conception and design of project, image analysis, and manuscript review. LC assisted with data analysis and manuscript review. ROB assisted with data analysis and manuscript review. JC participated in image analysis and manuscript review. MM assisted with sequence design and implementation, conception and design of project, data collection, and manuscript review. MSME assisted with conception and design of project, data analysis, manuscript preparation, and manuscript review. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohammed S. M. Elbaz.

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Conflict of interest

ROB has served as Editor-in-Chief of JAMA Cardiology and editor of Braunwald’s Heart Disease for Elsevier. MM has received research support from Siemens Healthineers, research grants from Circle Cardiovascular Imaging and Cryolife Inc, and is a consultant for Circle Cardiovascular Imaging. None of the other authors report a conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Supplementary Information

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Left atrial kinetic energy maps in an example patient with obstructive HCM (mp4 408 KB)

4D flow MRI streamlines visualization of intracardiac blood flow in a patient with non-obstructive HCM (mp4 804 KB)

4D flow MRI streamlines visualization of intracardiac blood flow in a patient with obstructive HCM (mp4 898 KB)

APPENDIX 1

APPENDIX 1

Results of non-volume-normalized KELA association to MR severity and LVOT ∆PMRI

For completeness, here we present results when KELA values are not normalized to the segmented LA volume as expressed in units of Joules. Results using non-normalized KELA values demonstrate consistent associations with MR severity (Fig. 6) and LVOT ∆PMRI (Fig. 7) to those presented in the main text with volume-normalized KELA values.

Fig. 6
figure 6

Association between MR severity and a non-normalized KELA-avg and b non-normalized KELA-peak metrics

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Fig. 7
figure 7

Correlations between a non-normalized KELA-avg and b non-normalized KELA-peak metrics and severity of LVOT obstruction by LVOT ∆PMRI

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Gupta, A.N., Soulat, G., Avery, R. et al. 4D flow MRI left atrial kinetic energy in hypertrophic cardiomyopathy is associated with mitral regurgitation and left ventricular outflow tract obstruction. Int J Cardiovasc Imaging 37, 2755–2765 (2021). https://doi.org/10.1007/s10554-021-02167-6

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