Quantitative Analysis of Left Ventricular Flow Dynamics in Latent Obstructive Hypertrophic Cardiomyopathy Using Vector Flow Mapping

Cardiology ◽  
2020 ◽  
Vol 145 (4) ◽  
pp. 227-235
Author(s):  
Xiaoli Zhu ◽  
Lei Xu ◽  
Lei Zuo ◽  
Jing Wang ◽  
Bo Wang ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Characteristic Curve ◽  
Left Ventricular ◽  
Flow Mapping ◽  
Relaxation Phase ◽  
Vector Flow Mapping ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Blood Flow Patterns ◽  
Ejection Phase ◽  
Diastolic Functions

Objectives: This study aimed to assess left ventricular (LV) energy loss (EL), circulation and vortex area using vector flow mapping (VFM) in patients with latent obstructive hyper­trophic cardiomyopathy (LOHCM) and nonobstructive hypertrophic cardiomyopathy (NOHCM). Methods: Fourteen LOHCM patients, 10 NOHCM patients, and 11 healthy individuals were evaluated by transthoracic echocardiography. An offline VFM workstation was used to analyze the LV blood flow patterns and fluid dynamics. The hemodynamic parameters, EL, circulation, and vortex area in 7 cardiac phases were calculated and analyzed. Results: Compared with controls and NOHCM patients, EL was significantly higher in ­LOHCM patients during the rapid ejection phase, slow ejection (SE) phase, and isovolumetric relaxation phase (p < 0.05). LOHCM patients also showed increased circulation during SE compared to the other two groups (p < 0.05). The ability to discriminate between NOHCM and LOHCM was assessed by the area under the receiver-operating characteristic curve (AUC), and EL during SE was found to have the largest AUC (0.964); the best cutoff value was 6.34 J/m3/s, with a sensitivity of 100% and specificity of 80%. Conclusions: The VFM technique can detect abnormal changes of LV EL and vortex characteristics in hypertrophic cardiomyopathy patients. Compared with controls and NOHCM patients, the LOHCM patients have worse systolic and diastolic functions.

INTRA-LEFT VENTRICULAR FLOW DISTRIBUTIONS IN DIASTOLIC AND SYSTOLIC PHASES, BASED ON ECHO VELOCITY FLOW MAPPING OF NORMAL SUBJECTS AND HEART FAILURE PATIENTS, TO CHARACTERIZE LEFT VENTRICULAR PERFORMANCE OUTCOMES OF HEART FAILURE

2012 ◽  
Vol 12 (05) ◽  
pp. 1240029 ◽  
Author(s):  
THU-THAO LE ◽  
RU-SAN TAN ◽  
FEIQIONG HUANG ◽  
LIANG ZHONG ◽  
SRIDHAR IDAPALAPATI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Velocity Vector ◽  
Normal Subjects ◽  
Performance Outcomes ◽  
Left Ventricular ◽  
Inflow Rate ◽  
Flow Mapping ◽  
Velocity Flow ◽  
Outflow Rate ◽  
Blood Flow Patterns

Heart failure (HF), one of the most common diseases in the world, causes left ventricular dysfunction (LV) and high mortality. HF patients are stratified into two groups based on their LV ejection fraction (EF) — HF with normal EF (HFNEF) and with reduced EF (HFREF). EF is a commonly used measure of LV contractile performance. Despite preserved EF, a complex mixture of systolic and diastolic dysfunction and variable degrees of LV remodelling underlying HFNEF poses challenges to diagnose and provide pharmacological treatment for HFNEF. In recent years, the velocity flow mapping (VFM) technique has been developed to generate flow velocity vector fields by post-processing color Doppler echocardiographic (echo) images. We aim to obtain the intra-LV blood flow patterns for patients with HFNEF, HFREF, and normal subjects, in order to characterize the LV performance outcomes of normal subjects and HF patients. Two subjects from each group of HFNEF, HFREF, and normal underwent echo scans. Velocity vector distributions throughout the cardiac cycle were then analysed using the VFM technique. In each subject, the outflow rate during systole, inflow rate during diastole, as well as wall stress-based pressure-normalized contractility index, dσ*/dt max , were computed and compared among the groups. This study demonstrated the use of VFM to visualize LV blood flow patterns in HF patients and normal subjects. Different patterns of flow distributions were observed in these subjects. In HFREF patients, dσ*/dt max , the peak outflow rate and peak inflow rate during early filling were markedly reduced. In HFNEF patients, peak outflow rates were increased compared to those of normal subjects.

Abstract 4344: Biventricular Pacemaker Therapy Corrects Dyssynchrony in Non-Obstructive Hypertrophic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ibrar Ahmed ◽  
Khalid Abozguia ◽  
Ganesh Nallur-Shivu ◽  
Thanh T Phan ◽  
Abdul Maher ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Biventricular Pacing ◽  
Cardiac Resynchronisation Therapy ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Control Group ◽  
Pacemaker Therapy ◽  
Time To Peak ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Peak Longitudinal Strain

Background. Previous studies have reported dyssynchrony using Tissue Doppler in patients with hypertrophic cardiomyopathy (HCM). In this study we assessed dyssynchrony using speckle tracking echocardiography (STE) in patients with non-obstructive hypertrophic cardiomyopathy vs a healthy control group and in a subgroup of highly symptomatic patients evaluated the acute effects of biventricular pacing on STE and Tissue Doppler (TDI) derived measures of dyssynchrony. Methods. We studied 48 healthy controls (age 48 ±18yrs, 22 males, LVEF 63 ±5%, QRS 86 ±7ms) and 57 patients with HCM (age 54 ±11yrs, 38 males, LVEF 61 ±7%, QRS 110 ±36ms). A subgroup of 15 symptomatic patients with HCM (Peak VO2<60% predicted) underwent biventricular pacing (age 53 ±12yrs, 12 males, LVEF 61 ±7%, QRS 110 ±32ms). Echocardiography was performed with the pacemaker off (VVi30) and on (DDDR, AV delay 90ms, LV-RV delay 0 – 4ms). Using STE, the standard deviation (SD) in time to peak longitudinal strain (Tϵ-SD), the time to peak longitudinal systolic velocity (Ts) for each of 18 left ventricular segments and the SD of this timing (Ts-SD) was derived. Using TDI dyssynchrony was assessed from the SD of Ts for the basal six segments and the maximum difference in Ts between any two basal segments (Ts-peak[basal]). Results. Using STE, Tϵ-SD (54.99 ±33.61ms vs 24.55 ±21.18ms p<0.001), Ts-SD (71.06 ±32.32ms vs 46.17 ±21.50ms p<0.001) and Ts (155.74 ±23.14ms vs 123.71 ±11.25ms p<0.001) were greater in HCM than in controls. Using STE we demonstrated that biventricular pacing significantly reduced Tϵ-SD and Ts-SD to values similar to those observed in controls (Ts-SD p=0.13). Using TDI we demonstrated that biventricular pacing significantly reduced Ts, Ts-SD, and Ts-peak[basal]. See Table . (All values expressed as mean ±SD) Conclusion. Cardiac resynchronisation therapy significantly reduced dyssynchrony in symptomatic patients with non-obstructive HCM as demonstrated using STE and TDI. Table

Abstract 15137: Vector Flow Mapping is a Novel Useful Technique in Assessing Inertia Force of Late Systolic Aortic Flow and Left Ventricular Early Diastolic Function

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kazuaki Wakami ◽  
Kenta Hachiya ◽  
Syunsuke Murai ◽  
Tsuyoshi Ito ◽  
Hiroshi Fujita ◽  
...  
Keyword(s):  
Blood Flow ◽  
Time Constant ◽  
Color Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Inertia Force ◽  
Lv Function ◽  
Flow Mapping ◽  
Vector Flow Mapping ◽  
Late Systole

Background: We previously reported that the inertia force (IF) of blood flowing out of left ventricle (LV) during late-systole produces greater LV elastic recoil force and brings faster LV relaxation. Vector flow mapping (VFM TM , Hitachi-Aloka) enables us to see blood flow velocity vectors that are generated from conventional color Doppler imaging data at any phase of cardiac cycle without angle dependency. Using VFM, kinetic energy (KE) of ejecting blood flow during systole at the LV outflow tract (LVOT) can be obtained. Thus, we investigated whether the KE obtained at the LVOT during late systole (KE-ls) had any relations with the IF and invasively obtained LV function parameters. Method: Study subjects were 33 patients who underwent diagnostic cardiac catheterization and echocardiographic examination on the same day. Color Doppler images were acquired in the apical 3-chamber view. The frame rate ranged was from 40 to 51 frames per minute. Data analyses were performed offline using the commercially available software (DAS-RS1 TM, Hitachi-Aloka). A data sampling area was set at the level just below the aortic valve in the LVOT. The KE-ls was computed as the sum of KE values computed in frame by frame basis during late-systole; late-systole was defined as the latter one-third of ejecting time. LV pressure wave was obtained using a catheter-tipped micromanometer, and then, the first derivative of LV pressure (dP/dt) and a time constant τ of LV pressure decay during isovolumic relaxation were calculated. From LV pressure-dP/dt relationships (phase loop), the IF was determined. Results: A significant positive correlation was observed between the KE-ls and the IF (r=0.79, p<0.0001). The log transformed KE-ls had significant correlations with both peak negative dP/dt (r=0.53, p<0.01) and the time constant τ (r=-0.67, p<0.0001). Conclusion: VFM is a new useful technique to see blood flow in the LV chamber. Noninvasively obtained KE-ls using VFM, which may be a noninvasive surrogate for the IF, has significant correlations with the parameters of LV relaxation.

scholarly journals Alcohol septal ablation in hypertrophic cardiomyopathy

2018 ◽  
Vol 2018 (3) ◽  
Author(s):  
Juan José Santos Mateo ◽  
Juan R Gimeno
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Interventricular Septum ◽  
Ventricular Outflow Tract ◽  
Clinical Results ◽  
Left Ventricular ◽  
Alcohol Septal Ablation ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow ◽  
Surgical Myectomy

Alcohol septal ablation (ASA) has become an alternative to surgical myectomy in obstructive hypertrophic cardiomyopathy since it was first introduced in 1994 by Sigwart. The procedure alleviates symptoms by producing a limited infarction of the upper interventricular septum, resulting in a decrease in left ventricular outflow tract (LVOT) gradient. The technique has been improved over time and the results are comparable with those of myectomy. Initial concerns about long-term outcomes have been largely resolved. In this review, we discuss indications, technical aspects, clinical results and patient selection to ASA.

scholarly journals Assessment of myocardial function in obstructive hypertrophic cardiomyopathy cats with and without response to medical treatment by carvedilol

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Ryohei Suzuki ◽  
Yohei Mochizuki ◽  
Yunosuke Yuchi ◽  
Yuyo Yasumura ◽  
Takahiro Saito ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Treatment Response ◽  
Myocardial Function ◽  
Left Ventricular Outflow Tract ◽  
Beta Blockers ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow

Abstract Background Inconsistency of treatment response in cats with obstructive hypertrophic cardiomyopathy is well recognized. We hypothesized that the difference in response to beta-blockers may be caused by myocardial functional abnormalities. This study was designed to compare myocardial function in cats with obstructive hypertrophic cardiomyopathy with and without response to beta-blockers. Twenty-one, client-owned, hypertrophic cardiomyopathy cats treated with carvedilol were analyzed. After carvedilol treatment, cats with decreased left ventricular outflow tract velocity were categorized as responders (n = 10); those exhibiting no response (no decrease in the left ventricular outflow tract velocity) were categorized as non-responders (n = 11). The cats were examined using layer-specific assessment of the myocardial function (whole, endocardial, and epicardial layers) longitudinally and circumferentially by two-dimensional speckle-tracking echocardiography, before and after carvedilol treatment. Results The non-responder cats had a significantly higher age, end-diastolic left ventricular posterior-wall thickness, peak velocity of left ventricular outflow tract, and dose of carvedilol than the responders (p = 0.04, p < 0.01, p < 0.01, and p < 0.01, respectively). The circumferential strain in the epicardial layer was lower and circumferential endocardial to epicardial strain ratio was higher in non-responders than responders (p < 0.001 and p = 0.006). According to the multivariate analysis, circumferential strain in the epicardial layer was the only independent correlate of treatment response with carvedilol. Conclusions Myocardial function, assessed by two-dimensional speckle-tracking echocardiography, differed in cats with hypertrophic cardiomyopathy with and without response to beta-blockers. The determination of layer-specific myocardial function may facilitate detailed pathophysiologic assessment and treatment response in cats with hypertrophic cardiomyopathy.

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