Assessment of Diastolic Function in Hypertrophic Cardiomyopathy by Computed Tomography–Derived Analysis of Left Ventricular Filling

Ghersin, Itai; Ghersin, Eduard; Abadi, Sobhi; Therrien, Jennifer E. Runco; Tanawuttiwat, Tanyanan; Aronson, Doron; Lessick, Jonathan

doi:10.1097/rct.0000000000000533

Cited by 5 publications

(5 citation statements)

References 16 publications

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“… 14 , 15 In the present study, we used cardiac computed tomography angiography (CTCA) to acquire complete and simultaneous LA and LV volumetric data to characterize the 3 components of LV diastolic filling. 16 We show that LA conduit function plays a key role in maintaining LV filling in advanced LVDD and strongly correlates with the development of pulmonary hypertension.…”

mentioning

confidence: 67%

Section: Methodsmentioning

confidence: 99%

“…19,20 LA expansion index, representing the relative LA volume changes during the reservoir phase, was calculated as follows: LA expansion indexI=(LAV max −LAV min )/LAV min . 15,16,18,[21][22][23] Based on these calculations, LV filling was divided into 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume, defined as the volume of blood that passes through the LA that cannot be accounted for by early or booster-pump function: LV SV−(LA max volume-LA min volume). 2 These components of the LA function were expressed in terms of LV filling as a percent contribution to LV SV.…”

Section: Asmentioning

confidence: 99%

“…17,18 In the AS group, manual editing was used to enhance the accuracy of the measurements. 16 For each patient, calculated time-volume curves were used to identify LV end-diastolic volume, LV end-systolic volume, LA maximum end-systolic volume, LA pre-A volume and LA minimum end-diastolic volume, and LV mass at end-diastole. LV ejection fraction was calculated as follows: LV ejection fraction=100×(LV end-diastolic volume−LV end-systolic volume)/LV end-diastolic volume.…”

Section: Clinical Perspectivementioning

confidence: 99%

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Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

Aronson,

Sliman,

Abadi

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity of diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction. METHODS: We performed volumetric and flow analyses of LA function across the spectrum of LV diastolic dysfunction, derived from a set of consecutive patients undergoing multiphasic cardiac computed tomography scanning (n=489). From LA and LV time-volume curves, we calculated 3 volumetric components: (1) early passive emptying volume; (2) late active (booster) volume; and (3) conduit volume. Results were prospectively validated on a group of patients with severe aortic stenosis (n=110). RESULTS: The early passive filling progressively decreased with worsening diastolic function ( P <0.001). The atrial booster contribution to stroke volume modestly increases with impaired relaxation ( P =0.021) and declines with more advanced diastolic function ( P <0.001), thus failing to compensate for the reduction in early filling. The conduit volume increased progressively ( P <0.001), accounting for 75% of stroke volume (interquartile range, 63–81%) with a restrictive filling pattern, compensating for the reduction in both early and booster functions. Similar results were obtained in patients with severe aortic stenosis. The pulmonary artery systolic pressure increased in a near-linear fashion when the conduit contribution to stroke volume increased above 60%. Maximal conduit flow rate strongly correlated with mitral E-wave velocity (r=0.71; P <0.0001), indicating that the increase in mitral E wave in diastolic dysfunction represents the increased conduit flow. CONCLUSIONS: An increase in conduit volume contribution to stroke volume represents a compensatory mechanism to maintain LV filling in advanced diastolic dysfunction. The increase in conduit volume despite increasing LV diastolic pressures is accomplished by an increase in pulmonary venous pressure.

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confidence: 67%

Section: Methodsmentioning

confidence: 99%

Section: Asmentioning

confidence: 99%

Section: Clinical Perspectivementioning

confidence: 99%

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Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

Aronson,

Sliman,

Abadi

et al. 2024

Circ: Cardiovascular Imaging

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“…It has been already shown that cardiac CT (CCT) may provide varying parameters for the assessment of diastolic dyfunction. [ 3 , 87 , 88 ] Similar to echocardiography, CCT has been applied to measure early and late diastolic filling rates for the assessment of diastolic function. However, LV filling rates are not recommended as the only indices of diastolic function due to their dependence on LV relaxation and LV filling pressure.…”

Section: Cardiac Computed Tomography In Hfpefmentioning

confidence: 99%

Imaging in Heart Failure with Preserved Ejection Fraction: A Multimodality Imaging Point of View

2023

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Heart failure with preserved ejection fraction (HFpEF) is an important global health problem. Despite increased prevalence due to improved diagnostic options, limited improvement has been achieved in cardiac outcomes. HFpEF is an extremely complex syndrome and multimodality imaging is important for diagnosis, identifying its different phenotypes and determining prognosis. Evaluation of left ventricular filling pressures using echocardiographic diastolic function parameters is the first step of imaging in clinical practice. The role of echocardiography is becoming more popular and with the recent developments in deformation imaging, cardiac MRI is extremely important as it can provide tissue characterisation, identify fibrosis and optimal volume measurements of cardiac chambers. Nuclear imaging methods can also be used in the diagnosis of specific diseases, such as cardiac amyloidosis.

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Left atrial function by cardiac computed tomography is a predictor of heart failure and cardiovascular death

Lessick

Mutlak

et al. 2021

Eur Radiol

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Assessment of Diastolic Function in Hypertrophic Cardiomyopathy by Computed Tomography–Derived Analysis of Left Ventricular Filling

Abstract: This study suggests that simultaneous depiction of computed tomography-derived LV and LA volume changes can characterize diastolic dysfunction in HCM.

Cited by 5 publications

References 16 publications

Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction

Imaging in Heart Failure with Preserved Ejection Fraction: A Multimodality Imaging Point of View

Left atrial function by cardiac computed tomography is a predictor of heart failure and cardiovascular death

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