Exploring the hemodynamic changes of the ascending aorta before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy by CMR 4D Flow technology
Exploring the hemodynamic changes of the ascending aorta before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy by CMR 4D Flow technology
目的 基于心脏磁共振四维血流(CMR4D Flow)技术探究梗阻性肥厚型心肌病(HOCM)室间隔心肌切除术前、术后升主动脉(AAo)血流动力学变化情况.方法 前瞻性纳入2021年5月至2022年9月于广东省人民医院接受室间隔心肌切除术的HOCM患者.同期纳入年龄、性别匹配的健康志愿者(对照组).对照组与HOCM患者术前、术后6个月均接受CMR检查(包括电影序列及4D Flow序列),应用CMR 4D flow技术评估AAo术前、术后血流模式(涡流、螺旋流)、最大能量损失(ELmax)及平均能量损失(ELavg)变化情况,HOCM患者进行实验室检查[包括氨基末端B型脑钠肽前体(NT-proBNP)及高敏肌钙蛋白T(hsTnT)].同时探讨HOCM患者术后能量损失与实验室生物标志物改善程度的相关性.结果 共纳入15例HOCM患者与15例健康志愿者.(1)血流模式方面,HOCM患者术前螺旋流程度显著高于对照组(P=0.001),但术后差异无统计学意义(P=0.059).HOCM患者术前、术后涡流程度均高于对照组(均P＜0.05).(2)能量损失方面,HOCM患者术前 AAo 的 ELmax[21.17(14.30～28.10)mW vs 10.17(7.66～13.07)mW,P＜0.001]、ELavg[4.87(3.46～5.77)mW vs 2.27(2.19～2.27)mW,P=0.023]均高于对照组,但术后与对照组相比差异无统计学意义(均P＞0.05).与术前相比,HOCM患者术后AAo的ELmax[12.33(8.70～17.41)mW]、ELavg[3.10(2.25～4.40)mW]明显降低(均P=0.001).(3)相关性分析表明,室间隔心肌切除术后AAo的ELmax与hsTNT改善程度呈正相关(r=0.587,P=0.021),与NT-pro BNP改善程度之间无显著相关性(r=0.229,P=0.413).结论 HOCM患者术后AAo血流紊乱程度减轻,ELmax、ELavg均显著降低,且术后AAo的ELmax与hsTNT改善程度呈正相关,提示ELmax可能可应用于患者的预后评估.
Abstract
Objective To investigate the hemodynamic changes in the ascending aorta(AAo)before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy(HOCM)using cardiac magnetic resonance four-dimensional blood flow(CMR 4D Flow)technology.Methods HOCM patients who underwent interventricular septal myocardial resection at Guangdong Provincial People's Hospital from May 2021 to September 2022 were prospectively included.Age and gender matched healthy volunteers(control group)were included during the same period.Both the control group and HOCM patients underwent CMR examination(including cine sequence and 4D Flow sequence)before and 6 months after surgery.CMR 4D flow technology was used to evaluate changes in AAo preoperative and postoperative blood flow patterns(eddy currents,spiral flow),maximum energy loss(ELmax),and average energy loss(ELavg).HOCM patients underwent laboratory tests,including N-terminal pro-brain natriuretic peptide(N-proBNP)and high-sensitivity troponin T(hsTnT).At the same time,the correlation between postoperative energy loss in HOCM patients and the degree of improvement in laboratory biomarkers was explored.Results A total of 15 HOCM patients and 15 healthy volunteers were included.(1)In terms of blood flow patterns,the preoperative spiral flow degree of HOCM patients was significantly higher than that of the control group(P=0.001),but the postoperative difference was not statistically significant(P=0.059).The degree of eddy currents in HOCM patients before and after surgery was higher than that in the control group(all P＜0.05).(2)In terms of energy loss,the preoperative ELmax[21.17(14.30-28.10)mW vs 10.17(7.66-13.07)mW,P＜0.001]and ELavg[4.87(3.46-5.77)mW vs 2.27(2.19-2.27)mW,P=0.023]of HOCM patients were higher than those of the control group,but there was no statistically significant difference between the postoperative and control groups(all P＞0.05).Compared with preoperative,the postoperative ELmax[12.33(8.70-17.41)mW]and ELavg[3.10(2.25-4.40)mW]of AAo in HOCM patients were significantly reduced(mean P=0.001).(3)Correlation analysis showed that there was a positive correlation(r=0.587,P=0.021)between the ELmax of AAo and the degree of improvement in hsTNT after interventricular septum myocardial resection,but no significant correlation(r=0.229,P=0.413)with the degree of improvement in NT-pro BNP.Conclusions The degree of postoperative AAo blood flow disorder in HOCM patients is reduced,and ELmax and ELavg are significantly reduced.The ELmax of postoperative AAo is positively correlated with the degree of improvement in hsTNT,suggesting that ELmax may be applicable for prognostic evaluation of patients.
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