Evaluation of myocardial microcirculation perfusion in patients with hypertrophic obstructive cardiomyopathy after Liwen procedure by myocardial contrast echocardiography
Yao Lu, Zuo Lei, Wang Jing, Lu Xiaonan, Zhao Jia, He Jin, Lei Changhui, Ta Shengjun, Liu Liwen
Abstract
ObjectiveTo quantitatively evaluate myocardial microcirculation perfusion changes after percutaneous intracardiac septal radiofrequency ablation (PIMSRA, Liwen procedure) in patients with obstructive hypertrophic cardiomyopathy (HOCM) using myocardial contrast echocardiography (MCE) and to further establish the effect of the procedure and predict the long-term prognosis of patients.
MethodsA total of 45 patients with HOCM treated by the Liwen procedure in the First Affiliated Hospital of Air Force Medical University (Xijing Hospital) from July 2019 to June 2020 were included. MCE was performed before and 6 months after surgery, respectively. Time-intensity perfusion curve analysis was performed using QLab 10.8 offline software to obtain quantitative parameters of myocardial microcirculation perfusion including myocardial blood volume (A value), myocardial blood flow velocity (β value), and myocardial blood flow (A×β value), then the changes in parameters before and after the procedure were compared.
ResultsAfter the Liwen procedure, the mean septal thickness and mean left ventricular free wall thickness were significantly reduced, accompanied by a significant reduction in the left ventricular outflow tract pressure gradient (LVOT-PG) and mitral regurgitation length, and a significant improvement in mitral systolic antegrade motion (SAM) (all P<0.001). In addition, the left ventricular ejection fraction (LVEF) did not deteriorate significantly (P=0.560) and the E/e′ ratio decreased after the procedure (P=0.015). Besides, the A values of both the ventricular septum and the left ventricular free wall were not significantly changed compared to those before procedure (P>0.05), whereas the β values and A×β values were obviously increased (P<0.05).
ConclusionsMyocardial blood velocity and myocardial blood flow in the septum and left ventricular free wall were significantly increased in patients with HOCM after the Liwen procedure, suggesting a significant improvement in myocardial microcirculation perfusion. MCE provides a non-invasive quantitative evaluation parameters of myocardial microcirculation perfusion for the Liwen procedure for the treatment of HOCM.
Key words:
Contrast-enhanced ultrasound; Myocardial contrast echocardiography; Myocardial microcirculation; Myocardial blood perfusion; Percutaneous intramyocardial septal radiofrequency ablation
Contributor Information
Yao Lu
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
Zuo Lei
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
Wang Jing
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
Lu Xiaonan
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
Zhao Jia
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
He Jin
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
Lei Changhui
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
Ta Shengjun
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
Liu Liwen
Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Hypertrophic Cardiomyopathy International Cooperation Center, the First Affiliated Hospital of Air Force Medical University (Xijing Hospital)
Multidisciplinary Consultation Center of Hypertrophic Cardiomyopathy, Shaanxi Province
Multidisciplinary Clinic and Genetic Counseling Center of Hypertrophic Cardiomyopathy, Xijing Hospital, Xi′an 710032, China
