Vector flow mapping in obstructive hypertrophic cardiomyopathy to assess the relationship of early systolic left ventricular flow and the mitral valve

Richard Ro, Dan Halpern, David Sahn, Peter Homel, Milla Arabadjian, Charles Lopresto, Mark V. Sherrid

Research output: Contribution to journalArticle

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Abstract

Background The hydrodynamic cause of systolic anterior motion of the mitral valve (SAM) is unresolved.

Objectives This study hypothesized that echocardiographic vector flow mapping, a new echocardiographic technique, would provide insights into the cause of early SAM in obstructive hypertrophic cardiomyopathy (HCM).

Methods We analyzed the spatial relationship of left ventricular (LV) flow and the mitral valve leaflets (MVL) on 3-chamber vector flow mapping frames, and performed mitral valve measurements on 2-dimensional frames in patients with obstructive and nonobstructive HCM and in normal patients.

Results We compared 82 patients (22 obstructive HCM, 23 nonobstructive HCM, and 37 normal) by measuring 164 LV pre- and post-SAM velocity vector flow maps, 82 maximum isovolumic vortices, and 328 2-dimensional frames. We observed color flow and velocity vector flow posterior to the MVL impacting them in the early systolic frames of 95% of obstructive HCM, 22% of nonobstructive HCM, and 11% of normal patients (p <0.001). In both pre- and post-SAM frames, we measured a high angle of attack >60° of local vector flow onto the posterior surface of the leaflets whether the flow was ejection (59%) or the early systolic isovolumic vortex (41%). Ricochet of vector flow, rebounding off the leaflet into the cul-de-sac, was noted in 82% of the obstructed HCM, 9% of nonobstructive HCM, and none (0%) of the control patients (p <0.001). Flow velocities in the LV outflow tract on the pre-SAM frame 1 and 2 mm from the tip of the anterior leaflet were low: 39 and 43 cm/s, respectively.

Conclusions Early systolic flow impacts the posterior surfaces of protruding MVL initiating SAM in obstructive HCM.

Original languageEnglish (US)
Pages (from-to)1984-1995
Number of pages12
JournalJournal of the American College of Cardiology
Volume64
Issue number19
DOIs
StatePublished - Nov 11 2014

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Hypertrophic Cardiomyopathy
Mitral Valve
Hydrodynamics
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Keywords

  • echocardiography
  • hypertrophic cardiomyopathy
  • hypertrophic obstructive cardiomyopathy
  • LVOT obstruction
  • vector flow map

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Vector flow mapping in obstructive hypertrophic cardiomyopathy to assess the relationship of early systolic left ventricular flow and the mitral valve. / Ro, Richard; Halpern, Dan; Sahn, David; Homel, Peter; Arabadjian, Milla; Lopresto, Charles; Sherrid, Mark V.

In: Journal of the American College of Cardiology, Vol. 64, No. 19, 11.11.2014, p. 1984-1995.

Research output: Contribution to journalArticle

Ro, Richard ; Halpern, Dan ; Sahn, David ; Homel, Peter ; Arabadjian, Milla ; Lopresto, Charles ; Sherrid, Mark V. / Vector flow mapping in obstructive hypertrophic cardiomyopathy to assess the relationship of early systolic left ventricular flow and the mitral valve. In: Journal of the American College of Cardiology. 2014 ; Vol. 64, No. 19. pp. 1984-1995.
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abstract = "Background The hydrodynamic cause of systolic anterior motion of the mitral valve (SAM) is unresolved.Objectives This study hypothesized that echocardiographic vector flow mapping, a new echocardiographic technique, would provide insights into the cause of early SAM in obstructive hypertrophic cardiomyopathy (HCM).Methods We analyzed the spatial relationship of left ventricular (LV) flow and the mitral valve leaflets (MVL) on 3-chamber vector flow mapping frames, and performed mitral valve measurements on 2-dimensional frames in patients with obstructive and nonobstructive HCM and in normal patients.Results We compared 82 patients (22 obstructive HCM, 23 nonobstructive HCM, and 37 normal) by measuring 164 LV pre- and post-SAM velocity vector flow maps, 82 maximum isovolumic vortices, and 328 2-dimensional frames. We observed color flow and velocity vector flow posterior to the MVL impacting them in the early systolic frames of 95{\%} of obstructive HCM, 22{\%} of nonobstructive HCM, and 11{\%} of normal patients (p <0.001). In both pre- and post-SAM frames, we measured a high angle of attack >60° of local vector flow onto the posterior surface of the leaflets whether the flow was ejection (59{\%}) or the early systolic isovolumic vortex (41{\%}). Ricochet of vector flow, rebounding off the leaflet into the cul-de-sac, was noted in 82{\%} of the obstructed HCM, 9{\%} of nonobstructive HCM, and none (0{\%}) of the control patients (p <0.001). Flow velocities in the LV outflow tract on the pre-SAM frame 1 and 2 mm from the tip of the anterior leaflet were low: 39 and 43 cm/s, respectively.Conclusions Early systolic flow impacts the posterior surfaces of protruding MVL initiating SAM in obstructive HCM.",
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T1 - Vector flow mapping in obstructive hypertrophic cardiomyopathy to assess the relationship of early systolic left ventricular flow and the mitral valve

AU - Ro, Richard

AU - Halpern, Dan

AU - Sahn, David

AU - Homel, Peter

AU - Arabadjian, Milla

AU - Lopresto, Charles

AU - Sherrid, Mark V.

PY - 2014/11/11

Y1 - 2014/11/11

N2 - Background The hydrodynamic cause of systolic anterior motion of the mitral valve (SAM) is unresolved.Objectives This study hypothesized that echocardiographic vector flow mapping, a new echocardiographic technique, would provide insights into the cause of early SAM in obstructive hypertrophic cardiomyopathy (HCM).Methods We analyzed the spatial relationship of left ventricular (LV) flow and the mitral valve leaflets (MVL) on 3-chamber vector flow mapping frames, and performed mitral valve measurements on 2-dimensional frames in patients with obstructive and nonobstructive HCM and in normal patients.Results We compared 82 patients (22 obstructive HCM, 23 nonobstructive HCM, and 37 normal) by measuring 164 LV pre- and post-SAM velocity vector flow maps, 82 maximum isovolumic vortices, and 328 2-dimensional frames. We observed color flow and velocity vector flow posterior to the MVL impacting them in the early systolic frames of 95% of obstructive HCM, 22% of nonobstructive HCM, and 11% of normal patients (p <0.001). In both pre- and post-SAM frames, we measured a high angle of attack >60° of local vector flow onto the posterior surface of the leaflets whether the flow was ejection (59%) or the early systolic isovolumic vortex (41%). Ricochet of vector flow, rebounding off the leaflet into the cul-de-sac, was noted in 82% of the obstructed HCM, 9% of nonobstructive HCM, and none (0%) of the control patients (p <0.001). Flow velocities in the LV outflow tract on the pre-SAM frame 1 and 2 mm from the tip of the anterior leaflet were low: 39 and 43 cm/s, respectively.Conclusions Early systolic flow impacts the posterior surfaces of protruding MVL initiating SAM in obstructive HCM.

AB - Background The hydrodynamic cause of systolic anterior motion of the mitral valve (SAM) is unresolved.Objectives This study hypothesized that echocardiographic vector flow mapping, a new echocardiographic technique, would provide insights into the cause of early SAM in obstructive hypertrophic cardiomyopathy (HCM).Methods We analyzed the spatial relationship of left ventricular (LV) flow and the mitral valve leaflets (MVL) on 3-chamber vector flow mapping frames, and performed mitral valve measurements on 2-dimensional frames in patients with obstructive and nonobstructive HCM and in normal patients.Results We compared 82 patients (22 obstructive HCM, 23 nonobstructive HCM, and 37 normal) by measuring 164 LV pre- and post-SAM velocity vector flow maps, 82 maximum isovolumic vortices, and 328 2-dimensional frames. We observed color flow and velocity vector flow posterior to the MVL impacting them in the early systolic frames of 95% of obstructive HCM, 22% of nonobstructive HCM, and 11% of normal patients (p <0.001). In both pre- and post-SAM frames, we measured a high angle of attack >60° of local vector flow onto the posterior surface of the leaflets whether the flow was ejection (59%) or the early systolic isovolumic vortex (41%). Ricochet of vector flow, rebounding off the leaflet into the cul-de-sac, was noted in 82% of the obstructed HCM, 9% of nonobstructive HCM, and none (0%) of the control patients (p <0.001). Flow velocities in the LV outflow tract on the pre-SAM frame 1 and 2 mm from the tip of the anterior leaflet were low: 39 and 43 cm/s, respectively.Conclusions Early systolic flow impacts the posterior surfaces of protruding MVL initiating SAM in obstructive HCM.

KW - echocardiography

KW - hypertrophic cardiomyopathy

KW - hypertrophic obstructive cardiomyopathy

KW - LVOT obstruction

KW - vector flow map

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