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Feasibility study of cardiac magnetic resonance four-dimensional flow imaging in evaluating left ventricular diastolic function in patients with hypertrophic cardiomyopathy
LIU Yuhao  LI Wei  LIANG Wenying  OUYANG Lina  SUN Xiao  WANG Yifan  ZHU Li 

Cite this article as: Liu YH, Li W, Liang WY, et al. Feasibility study of cardiac magnetic resonance four-dimensional flow imaging in evaluating left ventricular diastolic function in patients with hypertrophic cardiomyopathy[J]. Chin J Magn Reson Imaging, 2022, 13(10): 127-131. DOI:10.12015/issn.1674-8034.2022.10.019.

[Abstract] Objective Cardiac magnetic resonance four-dimensional flow (CMR 4D Flow) was used to measure left ventricular blood flow in patients with hypertrophic cardiomyopathy (HCM) with impaired diastolic function relaxation and to explore the feasibility of using left ventricular hemodynamic characteristics to evaluate diastolic function.Materials and Methods A total of 45 HCM patients and 31 healthy controls were retrospectively collected. All subjects in both groups underwent a 3.0 T magnetic resonance steady-state free entry sequence and CMR 4D Flow sequence scan. The CVI42 post-processing software was used to measure the basic functional parameters of the left ventricle and the average blood flow velocity (cm/s) at the mitral valve level in the early (left ventricular aspiration) and late (left active atrial contraction) levels of the left ventricular inflow and outflow tract in the two groups. The independent samples t-test or Mann-Whitney U test were used to compare the clinical data and imaging parameters of the two groups; and Spearman correlation analysis was performed on the average blood flow velocity in early diastole, left ventricular myocardial mass, and peak diastolic thickness of the left ventricular wall.Results The left ventricular mass (LVmass) and the global peak wall thickness (GPWT) in the HCM group were significantly higher than those in the healthy control group [LVmass: (163.70±52.18) vs. (87.27±21.01), unit: g; GPWT: (19.64±3.85) vs. (9.99±2.00), unit: mm; HCM group vs. healthy control group, P<0.001]; for the average diastolic blood flow velocity at the level of the mitral valve, the average blood flow velocity in the early diastole of the HCM group was lower than that of the healthy control group [29.70 (17.90) vs. 50.50 (16.90), unit: cm/s; HCM group vs. healthy control group, P<0.001]; the mean blood flow velocity in late diastole between HCM patients and the control group was not statistically different; the E/A value of the HCM group was significantly lower than that of the healthy control group [(1.26±0.70) vs. (1.80±0.85), HCM group vs. healthy control group, P=0.003].Conclusions The use of CMR 4D Flow can visualize the blood flow in the left ventricle, accurately distinguish the intraventricular blood flow trajectory of the heart in the early and late diastole. In addition, the decrease of mean flow velocity in the early diastolic stage of mitral valve level (E peak) and E/A value is helpful for quantitative evaluation of left ventricular diastolic dysfunction in patients with hypertrophic cardiomyopathy, and provides a reference for patients to formulate individualized treatment plans.
[Keywords] hypertrophic cardiomyopathy;diastolic function;four-dimensional blood flow;left ventricle;cardiac magnetic resonance;magnetic resonance imaging

LIU Yuhao1, 2   LI Wei1   LIANG Wenying2   OUYANG Lina2   SUN Xiao3   WANG Yifan3   ZHU Li3*  

1 Department of Radiology, Baoji Central Hospital, Baoji 721000, China

2 Ningxia Medical University, Yinchuan 750000, China

3 Department of Radiology, General Hospital of Ningxia Medical University, Yichuan 750000, China

Zhu L, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS National Key Research and Development Program (No. 2022YFC2010000);National Natural Science Foundation of China (No. 82160333); Natural Science Foundation of Ningxia (No. 2020AAC03420).
Received  2022-05-24
Accepted  2022-10-09
DOI: 10.12015/issn.1674-8034.2022.10.019
Cite this article as: Liu YH, Li W, Liang WY, et al. Feasibility study of cardiac magnetic resonance four-dimensional flow imaging in evaluating left ventricular diastolic function in patients with hypertrophic cardiomyopathy[J]. Chin J Magn Reson Imaging, 2022, 13(10): 127-131. DOI:10.12015/issn.1674-8034.2022.10.019.

Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. J Am Coll Cardiol, 2020, 76(25): 3022-3055. DOI: 10.1016/j.jacc.2020.08.044.
Norrish G, Kaski JP. The Risk of Sudden Death in Children with Hypertrophic Cardiomyopathy[J]. Heart Fail Clin, 2022, 18(1): 9-18. DOI: 10.1016/j.hfc.2021.07.012.
Geske JB, Ommen SR, Gersh BJ. Hypertrophic Cardiomyopathy: Clinical Update[J]. JACC Heart Fail, 2018, 6: 364-375. DOI: 10.1016/j.jchf.2018.02.010.
Ong KC, Geske JB, Hebl VB, et al. Pulmonary hypertension is associated with worse survival in hypertrophic cardiomyopathy[J]. Eur Heart J Cardiovasc Imaging, 2016, 17: 604-610. DOI: 10.1093/ehjci/jew024.
Heart Failure Group of Cardiology Branch of Chinese Medical Association, Heart Failure Professional Committee of Chinese Medical Doctor Association, Editorial Committee of Chinese Journal of Cardiovascular Diseases. Chinese Heart Failure Diagnosis and Treatment Guidelines 2018[J]. Chinese Journal of Cardiology, 2018, 46(10): 760-789. DOI: 10.3760/cma.j.issn.0253-3758.2018.10.004.
Hu J, Yang SL. Research status of ultrasonography in evaluating cardiac diastolic function[J]. Journal of Molecular Imaging, 2020, 43(4): 4. DOI: 10.12122/j.issn.1674-4500.2020.04.08.
China Regional Committee of the International Society for Cardiovascular Magnetic Resonance, Cardiovascular Magnetic Resonance Branch of China International Exchange Promotion Association for Medical and Health Care. Chinese Expert Consensus on the Standardization of Cardiovascular Magnetic Resonance Imaging[J]. Chin J Med Imaging Technol, 2019, 35(2): 9. DOI: 10.13929/j.1003-3289.201810056.
Azarine A, Garçon P, Stansal A, et al. Four-dimensional Flow MRI: Principles and Cardiovascular Applications[J]. Radiographics, 2019, 39: 632-648. DOI: 10.1148/rg.2019180091.
Demirkiran A, Ooij PV, Westenberg J, et al. Clinical intra-cardiac 4D Flow CMR: acquisition, analysis, and clinical applications[J]. Eur Heart J Cardiovasc Imaging, 2022, 23(2): 154-165. DOI: 10.1093/EHJCI/JEAB112.
Pruijssen JT, Allen BD, Barker AJ ,et al. Hypertrophic Cardiomyopathy Is Associated with Altered Left Ventricular 3D Blood Flow Dynamics[J/OL]. Radiol Cardiothorac Imaging, 2020, 2 [2022-05-23]. DOI: 10.1148/ryct.2020190038.
Suwa K, Akita K, Iguchi K, et al. Hemodynamic change in patients with hypertrophic obstructive cardiomyopathy before and after alcohol septal ablation using 4D Flow magnetic resonance imaging: a retrospective observational study[J/OL]. BMC Cardiovasc Disord, 2021, 21 [2022-05-23]. DOI: 10.1186/s12872-021-02003-8.
Maisch B, Mahrholdt H. The 2014 ESC guidelines on the diagnosis and management of hypertrophic cardiomyopathy: what is new?[J]. Herz, 2014, 39(8): 919-930. DOI: 10.1007/s00059-014-4177-z.
Echocardiography Group of Chinese Medical Association of Ultrasound Medicine, Professional Committee of Echocardiography of Cardiovascular Branch of Chinese Medical Doctor Association. Guidelines for Clinical Application of Echocardiography to Assess Cardiac Systolic and Diastolic Function[J]. Chinese Journal of Ultrasonography, 2020, 29(6): 461-477. DOI: 10.3760/cma.j.cn131148-20200227-00115.
Suzuki M, Kotooka N, Sakuma M, et al. Validity and Reliability of Three-chamber-View Three-directional Encoded Phase-contrast Magnetic Resonance Velocity-Vector Mapping for Transmitral Velocity Measurements: Comparison with Doppler Echocardiography and Intra- and Inter-observer Variability[J]. Magn Reson Med Sci, 2017, 16(2): 152-158. DOI: 10.2463/
Cerqueira M, Weissman N, Dilsizian V, et al. Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart A Statement for Healthcare Professionals From the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association[J]. Circulation, 2002, 105(4): 539-542. DOI: 10.1161/hc0402.102975.
Cui H, Schaff HV, Lentz Carvalho J, et al. Myocardial histopathology in patients with obstructive hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 2021, 77(17): 2159-2170. DOI: 10.1016/j.jacc.2021.03.008.
Song L, Zou YB, Wang DW, et al. Guidelines for the diagnosis and treatment of hypertrophic cardiomyopathy in Chinese adults[J]. Chinese Journal of Cardiology, 2017, 45(12): 1015-1032. DOI: 10.3760/cma.j.issn.0253-3758.2017.12.005.
Silvia C, Katia M, Davies RH, et al. Hypertrophic cardiomyopathy: insights from extracellular volume mapping[J/OL]. Eur J Prev Cardiol, 2022, 28(18) [2022-05-23]. DOI: 10.1093/EURJPC/ZWAA083.
She J, Zhao S, Chen Y, et al. Detecting Regional Fibrosis in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac Magnetic Resonance[J]. Acad Radiol, 2022, 4: 1-9. DOI: 10.1016/j.acra.2022.03.022.
Liu YH, Li W, Ouyang LN, et al. Preliminary study of left ventricular function in patients with hypertrophic cardiomyopathy with preserved ejection fraction by cardiac magnetic resonance tissue feature tracking technology[J]. Chin J Magn Reson Imaging, 2022, 13(1): 31-36. DOI: 10.12015/issn.1674-8034.2022.01.007.
Zhuang B, Sirajuddin A, Zhao S, et al. The role of 4D Flow MRI for clinical applications in cardiovascular disease: current status and future perspectives[J]. Quant Imaging Med Surg, 2021, 11(9): 4193-4210. DOI: 10.21037/qims-20-1234.
Kramer CM, Barkhausen J, Bucciarelli-Ducci C, et al. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update[J]. J Cardiovasc Magn Reson, 2020, 22(1): 1-18. DOI: 10.1186/s12968-020-00607-1.
Aquaro GD, Pizzino F, Terrizzi A, et al. Diastolic dysfunction evaluated by cardiac magnetic resonance: the value of the combined assessment of atrial and ventricular function[J]. Eur Radiol, 2019, 29(3): 1555-1564. DOI: 10.1007/s00330-018-5571-3.
Cao Y. Left ventricular diastolic dysfunction assessment[J]. Advances in Cardiovascular Diseases, 2017, 38(6): 5. DOI: 10.16806/j.cnki.issn.1004-3934.2017.06.016.
Deng Q, Yue WJ, Sun JY. Cardiac magnetic resonance assessment of left ventricular diastolic function and its research progress[J]. Chin J Magn Reson Imaging, 2021, 12(7): 110-113. DOI: 10.12015/issn.1674-8034.2021.07.026.
Young KM, Rodeheffer RJ, Chen HH, et al. Left ventricular diastolic dysfunction, including an impaired myocardial relaxation pattern, predicts long-term cardiovascular and non-cardiovascular mortality in the community[J]. Eur Heart J-Card Img, 2022, 23: 289-295. DOI: 10.1093/ehjci/jeab289.265.

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