Left Ventricular Diastolic Intraventricular Pressure Differences and Propagation Velocity with 4D-Flow MRI in Patients with Hypertrophic Cardiomyopathy
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Abstract
BackgroundTransthoracic echocardiography (TTE) remains the gold standard for assessing left ventricular (LV) diastolic dysfunction (DD), but noninvasive alternatives are needed to overcome geometric and acoustic limitations. 4D-Flow MRI enables comprehensive assessment of intraventricular pressure differences (IVPDs) and flow propagation velocity (VP). We aimed to evaluate 4D-Flow-derived IVPDs and VP in patients with hypertrophic cardiomyopathy (HCM).
MethodsThirty-eight HCM patients and 38 age- and sex-matched healthy controls underwent TTE and 4D-Flow MRI. Spatiotemporal maps of velocity and IVPDs, decomposed into inertial and convective components, were derived along the main inflow streamline from the mitral valve to the apex. Peak early filling rate (PEFR) was used to normalize IVPDs and VP.
ResultsWhile absolute peak flow rates were comparable, HCM patients exhibited significantly faster VP (100.4 vs. 60.2 cm/s, p < 0.01) and higher positive early E IVPD (1.40 vs. 0.92 mmHg, p < 0.01) compared to controls. Normalizing IVPDs by PEFR amplified group differences, revealing a markedly increased flow-normalized E-IVPD (5.13 vs. 2.94 x 10-3 mmHg{middle dot}ml-{superscript 1}{middle dot}s, p < 0.001) and deeper reverse ER IVPD (-6.06 vs. -4.61 x 10-3 mmHg{middle dot}ml-{superscript 1}{middle dot}s, p < 0.01) in HCM. These differences were primarily driven by the inertial components. Multivariable analysis demonstrated that ER IVPD is independently determined by PEFR and the TTE E/E ratio (r = 0.65, p < 0.001).
Conclusions4D-Flow MRI-derived, flow-normalized IVPDs and propagation velocity provide robust, noninvasive markers of altered LV chamber stiffness and impaired diastolic filling in HCM, offering deeper 3D hemodynamic insights into diastolic dysfunction.
Visual Abstract
O_FIG O_LINKSMALLFIG WIDTH=198 HEIGHT=200 SRC="FIGDIR/small/26365692v1_ufig1.gif" ALT="Figure 1"> View larger version (74K): [email protected]@e00985org.highwire.dtl.DTLVardef@911e16org.highwire.dtl.DTLVardef@14e5fac_HPS_FORMAT_FIGEXP M_FIG C_FIG
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BibTeX
@misc{stipechi2026left,
title = {{Left Ventricular Diastolic Intraventricular Pressure Differences and Propagation Velocity with 4D-Flow MRI in Patients with Hypertrophic Cardiomyopathy}},
author = {L. V. Stipechi and D. Craiem and U. Gencer and M. E. Casciaro and J.-S. Hulot and A. Hagege and G. Soulat and E. Mousseaux},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.15.26365692},
url = {https://www.medrxiv.org/content/10.64898/2026.10.15.26365692v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Left Ventricular Diastolic Intraventricular Pressure Differences and Propagation Velocity with 4D-Flow MRI in Patients with Hypertrophic Cardiomyopathy
AU - L. V. Stipechi
AU - D. Craiem
AU - U. Gencer
AU - M. E. Casciaro
AU - J.-S. Hulot
AU - A. Hagege
AU - G. Soulat
AU - E. Mousseaux
PY - 2026
DA - 2026/10/15
PB - medRxiv
DO - 10.64898/2026.10.15.26365692
UR - https://www.medrxiv.org/content/10.64898/2026.10.15.26365692v1
AB - BackgroundTransthoracic echocardiography (TTE) remains the gold standard for assessing left ventricular (LV) diastolic dysfunction (DD), but noninvasive alternatives are needed to overcome geometric and acoustic limitations. 4D-Flow MRI enables comprehensive assessment of intraventricular pressure differences (IVPDs) and flow propagation velocity (VP). We aimed to evaluate 4D-Flow-derived IVPDs and VP in patients with hypertrophic cardiomyopathy (HCM). MethodsThirty-eight HCM patients and 38 age- and sex-matched healthy controls underwent TTE and 4D-Flow MRI. Spatiotemporal maps of velocity and IVPDs, decomposed into inertial and convective components, were derived along the main inflow streamline from the mitral valve to the apex. Peak early filling rate (PEFR) was used to normalize IVPDs and VP. ResultsWhile absolute peak flow rates were comparable, HCM patients exhibited significantly faster VP (100.4 vs. 60.2 cm/s, p < 0.01) and higher positive early E IVPD (1.40 vs. 0.92 mmHg, p < 0.01) compared to controls. Normalizing IVPDs by PEFR amplified group differences, revealing a markedly increased flow-normalized E-IVPD (5.13 vs. 2.94 x 10-3 mmHg{middle dot}ml-{superscript 1}{middle dot}s, p < 0.001) and deeper reverse ER IVPD (-6.06 vs. -4.61 x 10-3 mmHg{middle dot}ml-{superscript 1}{middle dot}s, p < 0.01) in HCM. These differences were primarily driven by the inertial components. Multivariable analysis demonstrated that ER IVPD is independently determined by PEFR and the TTE E/E ratio (r = 0.65, p < 0.001). Conclusions4D-Flow MRI-derived, flow-normalized IVPDs and propagation velocity provide robust, noninvasive markers of altered LV chamber stiffness and impaired diastolic filling in HCM, offering deeper 3D hemodynamic insights into diastolic dysfunction. Visual Abstract O_FIG O_LINKSMALLFIG WIDTH=198 HEIGHT=200 SRC="FIGDIR/small/26365692v1_ufig1.gif" ALT="Figure 1"> View larger version (74K): [email protected]@e00985org.highwire.dtl.DTLVardef@911e16org.highwire.dtl.DTLVardef@14e5fac_HPS_FORMAT_FIGEXP M_FIG C_FIG
ER -