Measurement of Turbulent Kinetic Energy in Hypertrophic Cardiomyopathy Using Triple-velocity Encoding 4D Flow MR Imaging

Figures

• 

  Fig. 1. The relationship between TKEpeak and visual scaling as vortex (a), helical (b), and general flow (c) in patients with HCM. #One-way ANOVA and ##Mann-Whitney U-test. HCM, hypertrophic cardiomyopathy; TKEpeak, peak turbulent kinetic energy.

• 

  Fig. 2. The correlation between TKE and morphological and functional factors, such as pressure gradient (a), a short diameter of the valve orifice (b), and systolic anterior motion (c) in patients with HCM. #Pearson’s test and ##Mann-Whitney U-test. HCM, hypertrophic cardiomyopathy; TKE, turbulent kinetic energy.

• 

  Fig. 3. The correlation of left ventricular mass with TKEpeak (a) and the pressure gradient at left ventricular outflow tract based on simplified Bernoulli’s equation (b) in all patients with HCM. The patients with NYHA 1 and NYHA ≥ 2 are shown as circles and rhombuses, respectively. Only the patients with NYHA 1 were plotted in c and d. NYHA, New York Heart Association; TKEpeak, peak turbulent kinetic energy.

• 

  Fig. 4. Imaging studies of a 68-year-old male with NYHA 2. 3D pathline view shows that eccentric blood flow (white arrow in a, early systole) causes abnormal vortex flow and reversal flow at the lesser curvature of the ascending aorta through the late systolic to diastolic phase (black arrows in b and c, late systole and diastole). In this patient, the TKEpeak around left ventricular outflow tract was highly elevated (19.71 mJ, arrows in d) despite the relatively low peak systolic velocity (162.2 cm/s). The irregular shape of LVOT with systolic anterior movement (white arrowheads in e, balanced steady-state free precession MRI) caused the diffuse elevation of TKE at the aorta. The high TKEpeak value may be associated with the symptoms. LVOT, left ventricular outflow tract; NYHA, New York Heart Association; TKEpeak, peak turbulent kinetic energy.

• 

  Fig. 5. Imaging studies of a 77-year-old male with NYHA 1. 3D pathline view shows a similar flow pattern with Fig. 4, the eccentric blood flow (white arrow in a, early systole) and abnormal vortex flow at the lesser curvature of the ascending aorta through the late systolic to diastolic phase (black arrows in b and c, late systole and diastole). In this patient, the TKEpeak around left ventricular outflow tract was only slightly elevated (8.82 mJ, arrows in d) despite the high peak systolic velocity (233.8 cm/s). The shape of the left ventricular outflow tract was maintained without systolic anterior movement (white arrowheads in e, balanced steady-state free precession MRI). NYHA, New York Heart Association; TKEpeak, peak turbulent kinetic energy.