4D flow MRI and T1 -Mapping: Assessment of altered cardiac hemodynamics and extracellular volume fraction in hypertrophic cardiomyopathy

Pim van Ooij; Bradley D. Allen; Carla Contaldi; Julio Garcia; Jeremy Collins; James Carr; Lubna Choudhury; Robert O. Bonow; Alex J. Barker; Michael Markl

doi:10.1002/jmri.24962

4D flow MRI and T1 -Mapping: Assessment of altered cardiac hemodynamics and extracellular volume fraction in hypertrophic cardiomyopathy

Pim van Ooij
, Bradley D. Allen
, Carla Contaldi
, Julio Garcia
, Jeremy Collins
, James Carr
, Lubna Choudhury
, Robert O. Bonow
, Alex J. Barker
, Michael Markl

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Purpose: Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. Materials and Methods: Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 x 2.1-4.0 x 2.5-3.2 mm(3); venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15 degrees) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 15 years) and 10 age-matched healthy controls (45 14 years). In addition, pre- and postcontrast myocardial T-1-mapping (resolution = 2.3 x 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35 degrees) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss E-L as well as left ventricular ECV. Results: HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 +/- 16 mmHg vs. 9 +/- 2 mmHg) and energy loss E-L (3.8 +/- 2.5 mW vs. 1.5 +/- 0.7 mW, P <0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R-2 = 0.44, P <0.001) and energy loss E-L (R-2 = 0.46, P <0.001). Conclusions: The integration of 4D-flow and T-1-mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM

Original language	English
Pages (from-to)	107-114
Number of pages	8
Journal	Journal of magnetic resonance imaging
Volume	43
Issue number	1
DOIs	https://doi.org/10.1002/jmri.24962
Publication status	Published - 2016

Keywords

Adolescent
Adult
Aged
Blood Volume
Blood Volume Determination/methods
Cardiac-Gated Imaging Techniques/methods
Cardiomyopathy, Hypertrophic/diagnosis
Extracellular Fluid/metabolism
Female
Heart Ventricles/pathology
Humans
Image Interpretation, Computer-Assisted/methods
Imaging, Three-Dimensional/methods
Magnetic Resonance Angiography/methods
Magnetic Resonance Imaging, Cine/methods
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Stroke Volume
Young Adult

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@article{e0f1767e7bc0444a9128ad44aec5cf34,

title = "4D flow MRI and T1 -Mapping: Assessment of altered cardiac hemodynamics and extracellular volume fraction in hypertrophic cardiomyopathy",

abstract = "Purpose: Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. Materials and Methods: Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 x 2.1-4.0 x 2.5-3.2 mm(3); venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15 degrees) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 15 years) and 10 age-matched healthy controls (45 14 years). In addition, pre- and postcontrast myocardial T-1-mapping (resolution = 2.3 x 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35 degrees) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss E-L as well as left ventricular ECV. Results: HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 +/- 16 mmHg vs. 9 +/- 2 mmHg) and energy loss E-L (3.8 +/- 2.5 mW vs. 1.5 +/- 0.7 mW, P <0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R-2 = 0.44, P <0.001) and energy loss E-L (R-2 = 0.46, P <0.001). Conclusions: The integration of 4D-flow and T-1-mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM",

keywords = "Adolescent, Adult, Aged, Blood Volume, Blood Volume Determination/methods, Cardiac-Gated Imaging Techniques/methods, Cardiomyopathy, Hypertrophic/diagnosis, Extracellular Fluid/metabolism, Female, Heart Ventricles/pathology, Humans, Image Interpretation, Computer-Assisted/methods, Imaging, Three-Dimensional/methods, Magnetic Resonance Angiography/methods, Magnetic Resonance Imaging, Cine/methods, Male, Middle Aged, Reproducibility of Results, Sensitivity and Specificity, Stroke Volume, Young Adult",

author = "\{van Ooij\}, Pim and Allen, \{Bradley D.\} and Carla Contaldi and Julio Garcia and Jeremy Collins and James Carr and Lubna Choudhury and Bonow, \{Robert O.\} and Barker, \{Alex J.\} and Michael Markl",

note = "{\textcopyright} 2015 Wiley Periodicals, Inc.",

year = "2016",

doi = "10.1002/jmri.24962",

language = "English",

volume = "43",

pages = "107--114",

journal = "Journal of magnetic resonance imaging",

issn = "1053-1807",

publisher = "John Wiley and Sons Inc.",

number = "1",

}

TY - JOUR

T1 - 4D flow MRI and T1 -Mapping

T2 - Assessment of altered cardiac hemodynamics and extracellular volume fraction in hypertrophic cardiomyopathy

AU - van Ooij, Pim

AU - Allen, Bradley D.

AU - Contaldi, Carla

AU - Garcia, Julio

AU - Collins, Jeremy

AU - Carr, James

AU - Choudhury, Lubna

AU - Bonow, Robert O.

AU - Barker, Alex J.

AU - Markl, Michael

PY - 2016

Y1 - 2016

N2 - Purpose: Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. Materials and Methods: Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 x 2.1-4.0 x 2.5-3.2 mm(3); venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15 degrees) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 15 years) and 10 age-matched healthy controls (45 14 years). In addition, pre- and postcontrast myocardial T-1-mapping (resolution = 2.3 x 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35 degrees) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss E-L as well as left ventricular ECV. Results: HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 +/- 16 mmHg vs. 9 +/- 2 mmHg) and energy loss E-L (3.8 +/- 2.5 mW vs. 1.5 +/- 0.7 mW, P <0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R-2 = 0.44, P <0.001) and energy loss E-L (R-2 = 0.46, P <0.001). Conclusions: The integration of 4D-flow and T-1-mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM

AB - Purpose: Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract (LVOT) and myocardial tissue abnormalities such as fibrosis. The aim of this study was to quantify changes in LVOT 3D hemodynamics and myocardial extracellular volume fraction (ECV, measure of fibrosis) and to investigate relationships between elevated flow metrics and left ventricular (LV) tissue abnormalities. Materials and Methods: Cardiac magnetic resonance imaging (MRI) including 4D flow (field strength = 1.5T, resolution = 2.1-4.0 x 2.1-4.0 x 2.5-3.2 mm(3); venc = 150-250 cm/s; TE/TR/FA = 2.2-2.5msec/4.6-4.9msec/15 degrees) for the in vivo assessment of 3D blood flow velocities with full coverage of the LVOT was applied in 35 patients with HCM (54 15 years) and 10 age-matched healthy controls (45 14 years). In addition, pre- and postcontrast myocardial T-1-mapping (resolution = 2.3 x 1.8 mm, slice thickness = 8 mm, TE/TR-FA = 1.0-1.1msec/2.0-2.2msec/35 degrees) of the LV (basal, mid-ventricular, apical short axis) was performed in a subgroup of 23 HCM patients. Analysis included the segmentation of the LVOT and quantification of peak systolic LVOT pressure gradients and rate of viscous energy loss E-L as well as left ventricular ECV. Results: HCM patients demonstrated significantly elevated peak systolic LVOT pressure gradients (21 +/- 16 mmHg vs. 9 +/- 2 mmHg) and energy loss E-L (3.8 +/- 2.5 mW vs. 1.5 +/- 0.7 mW, P <0.005) compared to controls. There was a significant relationship between increased LV fibrosis (ECV) with both elevated pressure gradients (R-2 = 0.44, P <0.001) and energy loss E-L (R-2 = 0.46, P <0.001). Conclusions: The integration of 4D-flow and T-1-mapping-MRI allowed for the evaluation of tissue and flow abnormalities in HCM patients. Our findings suggest a mechanistic link between abnormal LVOT flow, increased LV loading, and adverse myocardial remodeling in HCM

KW - Adolescent

KW - Adult

KW - Aged

KW - Blood Volume

KW - Blood Volume Determination/methods

KW - Cardiac-Gated Imaging Techniques/methods

KW - Cardiomyopathy, Hypertrophic/diagnosis

KW - Extracellular Fluid/metabolism

KW - Female

KW - Heart Ventricles/pathology

KW - Humans

KW - Image Interpretation, Computer-Assisted/methods

KW - Imaging, Three-Dimensional/methods

KW - Magnetic Resonance Angiography/methods

KW - Magnetic Resonance Imaging, Cine/methods

KW - Male

KW - Middle Aged

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Stroke Volume

KW - Young Adult

U2 - 10.1002/jmri.24962

DO - 10.1002/jmri.24962

M3 - Article

C2 - 26227419

SN - 1053-1807

VL - 43

SP - 107

EP - 114

JO - Journal of magnetic resonance imaging

JF - Journal of magnetic resonance imaging

IS - 1

ER -

4D flow MRI and T1 -Mapping: Assessment of altered cardiac hemodynamics and extracellular volume fraction in hypertrophic cardiomyopathy

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Keywords

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