A novel and practical cardiovascular magnetic resonance method to quantify mitral annular excursion and recoil applied to hypertrophic cardiomyopathy

Journal of Cardiovascular Magnetic Resonance

Leon Axel³  Stuart D Katz²  Muhamed Saric²  Monvadi B Srichai¹  Robert Donnino³  Sharath Bhagavatula³  Sohae Chung³  Shahryar G Saba⁴ 

[1] Current affiliation: Medstar Heart Institute, Medstar Georgetown University Hospital, Washington DC 20007, USA;Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA;Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA;Current affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA

关键词: Hypertrophic cardiomyopathy;    Left ventricular function;    Mitral annular motion;    Cardiovascular magnetic resonance;   

Others  :  801216
DOI  :  10.1186/1532-429X-16-35

 received in 2013-11-29, accepted in 2014-05-02,  发布年份 2014

【 摘 要 】

Background

We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers.

Methods

We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac cycle. Based on AVJ displacement versus time, we calculated maximum AVJ displacement (MD) and velocity in early diastole (MVED), velocity in diastasis (VDS) and the composite index VDS/MVED.

Results

Patients with HCM showed significantly slower median lateral and septal AVJ recoil velocities during early diastole, but faster velocities in diastasis. We observed a 16-fold difference in VDS/MVED at the lateral AVJ [median 0.141, interquartile range (IQR) 0.073, 0.166 versus 0.009 IQR -0.006, 0.037, P < 0.001]. Patients with HCM also demonstrated significantly less mitral annular excursion at both the septal and lateral AVJ. Performed offline, AVJ motion analysis took approximately 10 minutes per subject.

Conclusions

Atrioventricular junction motion analysis provides a practical and novel CMR method to assess mitral annular motion. In this proof of concept study we found highly statistically significant differences in mitral annular excursion and recoil between HCM patients and healthy volunteers.

【 授权许可】

   
2014 Saba et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]Carlsson M, Ugander M, Mosen H, Buhre T, Arheden H: Atrioventricular plane displacement is the major contributor to left ventricular pumping in healthy adults, athletes, and patients with dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 2007, 292:H1452-9.
• [2]Hu K, Liu D, Herrmann S, Niemann M, Gaudron PD, Voelker W, Ertl G, Bijnens B, Weidemann F: Clinical implication of mitral annular plane systolic excursion for patients with cardiovascular disease. Eur Heart J Cardiovasc Imaging 2013, 14:205-12.
• [3]Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, Lam PK, Sanderson JE: Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol 2003, 41:820-6.
• [4]Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, Yu CM, Sanderson JE: Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy. J Hypertens 2005, 23:183-91.
• [5]Saba SGCS, Tseng S, Bhagavatula S, Donnino R, Srichai MB, Saric M, Katz S, Axel L: Cardiac MRI correlates of diastolic left ventricular function assessment by echocardiography. J Cardiovasc Magn Reson 2013, 15:E53. BioMed Central Full Text
• [6]Saba SG, Sachdev V, Hannoush H, Axel L, Arai AE: Quantification of mitral annular excursion from cine MRI and validated by Doppler echocardiography. J Cardiovasc Magn Reson 2014, 16:P20. BioMed Central Full Text
• [7]Nishimura RA, Holmes DR Jr: Clinical practice: hypertrophic obstructive cardiomyopathy. N Engl J Med 2004, 350:1320-7.
• [8]Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW, Quinones MA, Roberts R, Marian AJ: Tissue doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation 2001, 104:128-30.
• [9]Kramer CM, Reichek N, Ferrari VA, Theobald T, Dawson J, Axel L: Regional heterogeneity of function in hypertrophic cardiomyopathy. Circulation 1994, 90:186-94.
• [10]Pai VM: Phase contrast using multiecho steady-state free precession. Magn Reson Med 2007, 58:419-24.
• [11]Matos J, Kronzon I, Panagopoulos G, Perk G: Mitral annular plane systolic excursion as a surrogate for left ventricular ejection fraction. J Am Soc Echocardiogr 2012, 25:969-74.
• [12]Ganame J, Mertens L, Eidem BW, Claus P, D’Hooge J, Havemann LM, McMahon CJ, Elayda MA, Vaughn WK, Towbin JA, Ayres NA, Pignatelli RH: Regional myocardial deformation in children with hypertrophic cardiomyopathy: morphological and clinical correlations. Eur Heart J 2007, 28:2886-94.
• [13]Young AA, Kramer CM, Ferrari VA, Axel L, Reichek N: Three-dimensional left ventricular deformation in hypertrophic cardiomyopathy. Circulation 1994, 90:854-67.
• [14]Severino S, Caso P, Galderisi M, De Simone L, Petrocelli A, de Divitiis O, Mininni N: Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic cardiomyopathy. Am J Cardiol 1998, 82:1394-8.
• [15]Moon JC, Reed E, Sheppard MN, Elkington AG, Ho SY, Burke M, Petrou M, Pennell DJ: The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol 2004, 43:2260-4.
• [16]Crilley JG, Boehm EA, Blair E, Rajagopalan B, Blamire AM, Styles P, McKenna WJ, Ostman-Smith I, Clarke K, Watkins H: Hypertrophic cardiomyopathy due to sarcomeric gene mutations is characterized by impaired energy metabolism irrespective of the degree of hypertrophy. J Am Coll Cardiol 2003, 41:1776-82.
• [17]Frey N, Luedde M, Katus HA: Mechanisms of disease: hypertrophic cardiomyopathy. Nat Rev Cardiol 2012, 9:91-100.
• [18]Ha JW, Oh JK, Redfield MM, Ujino K, Seward JB, Tajik AJ: Triphasic mitral inflow velocity with middiastolic filling: clinical implications and associated echocardiographic findings. J Am Soc Echocardiogr 2004, 17:428-31.