Prognostic Value of Left Ventricular Kinetic Energy for Predicting Major Adverse Events in Hypertrophic Cardiomyopathy

Figures

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  Figure 1. Flowchart of Patient Inclusion Initially, 227 hypertrophic cardiomyopathy (HCM) patients with 4-dimensional (4D) flow were identified, and after applying exclusion criteria, 165 patients were included in the final analysis. We used 115 normal control subjects with similar age and sex distribution from another registry. CAG = coronary angiography; CCTA = coronary computed tomography angiography; CMR = cardiac magnetic resonance; INITIATE = Integrated Computation Modeling of Right Heart Mechanics and Blood Flow Dynamics in Congenital Heart Disease; MI = myocardial infarction.

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  Figure 2. Examples of 4D Flow CMR-derived Parameters (First row) Velocity overlaid on 3-chamber view at peak systole (color denoted the flow velocity: 0 cm/s [blue] to 80 cm/s [red]); (second row): left ventricular (LV) flow components; (third row) pie plot; and (fourth row) LV–kinetic energy normalized to left ventricular end-diastolic volume (KEiEDV) curve in a healthy (left), and HCM patient (right). Upward arrow denoted increase in the parameter, and downward arrow denoted decrease in the parameter. EDV = end-diastolic volume; KE = kinetic energy; LVEDV = left ventricular end-diastolic volume; other abbreviations as in Figure 1.

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  Figure 3. Box-and-Whisker Plot of LV Global KEiEDV Comparisons of LV global KEiEDV between healthy and HCM (black and pink colors) and HCM without composite events and with composite events (orange and brown colors). P values are from non-parametric Mann-Whitney U test. Abbreviations as in Figures 1 and 2.

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  Figure 4. Incremental Value of LV Global KEiEDV Nested binary regression analysis was performed to investigate the incremental value of LV global KEiEDV in predicting HCM with composite events, either as a (A) dichotomous or (B) continuous variable. The base model included age, NYHA functional class and family history of sudden cardiac death. LAV = left atrial volume; LGE = late gadolinium enhancement; LVEF = left ventricular ejection fraction; other abbreviations as in Figures 1 and 2.

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  Figure 5. Kaplan-Meier Curves for Composite Events Stratified by LV Global KEiEDV Survival analysis found that LV global KEiEDV >6.37 μJ/mL had better survival than those ≤6.37 μJ/mL (log-rank P < 0.0001). Abbreviations as in Figure 2.

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  Central Illustration. Prognostic and Incremental Value of Left Ventricular Kinetic Energy in Predicting Major Adverse Cardiac Events (A) This study included 165 hypertrophic cardiomyopathy (HCM) patients and 115 healthy control subjects with similar age and sex. All participants underwent cine and 4-dimensional (4D) flow cardiac magnetic resonance (CMR), HCM patients also underwent late gadolinium enhancement (LGE) imaging. (B,)left) Representative 4D flow velocity map superimposed on a 3-chamber view at peak systole (color denoted the flow velocity: 0 cm/s [blue] to 80 cm/s [red]); (middle) corresponding particle tracing at the same time frame; (right) corresponding left ventricular (LV) kinetic energy normalized to left ventricular end-diastolic volume (KEiEDV) curve with key parameters indicated. (C) Nested binary analysis demonstrated the incremental prognostic value of LV global KEiEDV over a base model (age, NYHA functional class, and family history of SCD), as well as over maximal left atrial volume (LAV), left ventricular ejection fraction (LVEF), and LV LGE extent, for predicting composite events in HCM. (D) Kaplan-Meier survival analysis found that LV global KEiEDV >6.37 μJ/mL had better…