CMR-Flow

1349521 - Impaired left ventricular mitral filling by 4D Flow CMR is related to the prognosis of hypertrophic cardiomyopathy

Friday, January 27, 2023

12:20 PM – 1:20 PM

Location: Pacific Jewel

Presenting Author(s)

HS

Hichem Sakhi, MD

Junior Doctor
Assistance Publique – Hôpitaux de Paris
Paris, Ile-de-France, France

Primary Author(s)

HS

Hichem Sakhi, MD

Junior Doctor
Assistance Publique – Hôpitaux de Paris
Paris, Ile-de-France, France

Co-Author(s)

GS

Gilles Soulat, MD, PhD

Associate Professor
Assistance Publique – Hôpitaux de Paris, Ile-de-France, France
DC

Damian Craiem, PhD

Professor
Favaloro and National Technologic Universities, Argentina
UG

Umit Gencer, MSc

Engineer
Assistance Publique – Hôpitaux de Paris, Ile-de-France, France
VS

Valentina Stipechi, PhD

Engineer
Favaloro and National Technologic Universities, Argentina
TP

Tania Puscas, MD

Consultant Cardiologist
Assistance Publique – Hôpitaux de Paris, France
AH

Albert Hagege, MD, PhD

Professor
Assistance Publique – Hôpitaux de Paris, France
Elie Mousseaux, MD, PhD

Professor
Assistance Publique – Hôpitaux de Paris
Paris, Ile-de-France, France

Background: Diastolic dysfunction in hypertrophic cardiomyopathy (HCM) contributes strongly to clinical manifestations and prognosis. 4D phase contrast (4D-flow) cardiac magnetic resonance (CMR) is now an alternative to evaluate left ventricular (LV) filling. The purpose of this study was to determine if the peak early filling rate normalized to the filling volume (PEFR/FV) estimated from 4D-flow may assess impaired LV filling and predict clinical outcomes in HCM.

Methods: CMR with 4D-Flow and late gadolinium enhancement (LGE) and echocardiography were performed in 88 subjects, 44 with HCM issued from a prospective HCM register and 44 matched healthy volunteers. In HCM patients, a composite primary endpoint was assessed at follow-up (FU) including unexplained syncope, new-onset AF, hospitalization for congestive heart failure , ischemic stroke, sustained ventricular arrhythmia, septal reduction therapy and cardiac death.

Results: PEFR/FV was significantly lower in HCM patients compared to healthy volunteers (3.35 ±0.99 vs 4.42 ±1.68, p< 0.001), correlated with BNP level (r=-0.31, p< 0.001) and with E/E’, the pulsed Doppler early transmitral inflow velocity to the Doppler tissue imaging annulus velocity ratio (r=-0.54, p< 0.001). At a median FU of 2.3 years (IQR 1.7-3.3 years), the primary endpoint occurred in 14 patients (32%). In univariate and bivariate adjusted cox-model analysis, PEFR/FV≤2.61 s^-1 was significantly associated with primary endpoint with Hazard Ratio ranging from 9.46 [95%CI 2.61-45.17], (p< 0.001) to 15.21 [95%CI 3.51-80.22], (p< 0.001) independantly of age, BNP level, presence of LGE and E/E' according to successive bivariate models.

Conclusion:

In HCM, LV mitral filling by 4D-Flow CMR is impaired, correlates with Doppler and biological indices of diastolic dysfunction and predicts clinical outcomes .