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The intraventricular pressure difference (IVPD) between the base and apex of the left ventricle (LV) is a key determinant of diastolic filling, and particularly challenging in patients with hypertrophic cardiomyopathy (HCM). IVPD has traditionally been estimated non-invasively using Color Doppler M-mode echocardiography. However, this method is limited by its one-dimensional velocity sampling along a line within the LV. In recent years, 4D-Flow cardiac magnetic resonance imaging (MRI), which captures the temporal evolution of blood flow velocities in three spatial directions (3D + t), has emerged as a promising alternative. In this study, we present a technique for estimating and visualizing IVPD maps using 4D-Flow MRI. To evaluate this approach, we retrospectively analyzed 14 patients with HCM, divided into mild and severe groups according to disease progression. Total IVPD at the peak of the E-wave and its inertial and convective components were compared between groups. The severe HCM group exhibited significantly lower E-IVPD values than the mild group (0.9 ± 0.5 mmHg vs. 1.7 ± 0.5 mmHg; p < 0.05). A similar trend was observed for the inertial component, Ein-IVPD (1.1 ± 0.5 mmHg versus 2.2 ± 0.5 mmHg, p < 0.01) whereas convective component was similar (−0.9 ± 0.8 vs −0.9 ± 0.4, p = 0.63). This study demonstrates the feasibility of generating IVPD maps non-invasively using 4D-Flow and suggests that pressure difference between the mitral valve and the apex decrease with HCM progression. This could potentially offer new insights into diastolic dysfunction.

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Non-Invasive Intraventricular Pressure Differences Estimated with 4D-Flow Cardiac MRI in Patients with Hypertrophic Cardiomyopathy

  • 会议论文

  • 发表日期：

    2025年

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  • Luz V. Stipechi,
  • Mariano Ezequiel Casciaro,
  • Elie Mousseaux,
  • Damian Craiem

摘要

The intraventricular pressure difference (IVPD) between the base and apex of the left ventricle (LV) is a key determinant of diastolic filling, and particularly challenging in patients with hypertrophic cardiomyopathy (HCM). IVPD has traditionally been estimated non-invasively using Color Doppler M-mode echocardiography. However, this method is limited by its one-dimensional velocity sampling along a line within the LV. In recent years, 4D-Flow cardiac magnetic resonance imaging (MRI), which captures the temporal evolution of blood flow velocities in three spatial directions (3D + t), has emerged as a promising alternative. In this study, we present a technique for estimating and visualizing IVPD maps using 4D-Flow MRI. To evaluate this approach, we retrospectively analyzed 14 patients with HCM, divided into mild and severe groups according to disease progression. Total IVPD at the peak of the E-wave and its inertial and convective components were compared between groups. The severe HCM group exhibited significantly lower E-IVPD values than the mild group (0.9 ± 0.5 mmHg vs. 1.7 ± 0.5 mmHg; p < 0.05). A similar trend was observed for the inertial component, Ein-IVPD (1.1 ± 0.5 mmHg versus 2.2 ± 0.5 mmHg, p < 0.01) whereas convective component was similar (−0.9 ± 0.8 vs −0.9 ± 0.4, p = 0.63). This study demonstrates the feasibility of generating IVPD maps non-invasively using 4D-Flow and suggests that pressure difference between the mitral valve and the apex decrease with HCM progression. This could potentially offer new insights into diastolic dysfunction.