Left ventricular blood flow kinetic energy after myocardial infarction - Insights from 4D flow cardiovascular magnetic resonance

Pankaj Garg*, Saul Crandon, Peter P. Swoboda, Graham J. Fent, James R.J. Foley, Pei G. Chew, Louise A.E. Brown, Sethumadhavan Vijayan, Mariëlla E.C.J. Hassell, Robin Nijveldt, Malenka Bissell, Mohammed Elbaz, Abdallah Al-Mohammad, Jos J.M. Westenberg, John P. Greenwood, Rob J. Van Der Geest, Sven Plein, Erica Dall'Armellina

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background: Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics that are linked to clinical outcomes. We hypothesize that LV blood flow kinetic energy (KE) is altered in MI and is associated with LV function and infarct characteristics. This study aimed to investigate the intra-cavity LV blood flow KE in controls and MI patients, using cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow assessment. Methods: Forty-eight patients with MI (acute-22; chronic-26) and 20 age/gender-matched healthy controls underwent CMR which included cines and whole-heart 4D flow. Patients also received late gadolinium enhancement imaging for infarct assessment. LV blood flow KE parameters were indexed to LV end-diastolic volume and include: averaged LV, minimal, systolic, diastolic, peak E-wave and peak A-wave KEi EDV . In addition, we investigated the in-plane proportion of LV KE (%) and the time difference (TD) to peak E-wave KE propagation from base to mid-ventricle was computed. Association of LV blood flow KE parameters to LV function and infarct size were investigated in all groups. Results: LV KEi EDV was higher in controls than in MI patients (8.5 ± 3 μJ/ml versus 6.5 ± 3 μJ/ml, P = 0.02). Additionally, systolic, minimal and diastolic peak E-wave KEi EDV were lower in MI (P < 0.05). In logistic-regression analysis, systolic KEi EDV (Beta = - 0.24, P < 0.01) demonstrated the strongest association with the presence of MI. In multiple-regression analysis, infarct size was most strongly associated with in-plane KE (r = 0.5, Beta = 1.1, P < 0.01). In patients with preserved LV ejection fraction (EF), minimal and in-plane KEi EDV were reduced (P < 0.05) and time difference to peak E-wave KE propagation during diastole increased (P < 0.05) when compared to controls with normal EF. Conclusions: Reduction in LV systolic function results in reduction in systolic flow KEi EDV . Infarct size is independently associated with the proportion of in-plane LV KE. Degree of LV impairment is associated with TD of peak E-wave KE. In patient with preserved EF post MI, LV blood flow KE mapping demonstrated significant changes in the in-plane KE, the minimal KEi EDV and the TD. These three blood flow KE parameters may offer novel methods to identify and describe this patient population.

Original languageEnglish (US)
Article number61
JournalJournal of Cardiovascular Magnetic Resonance
Volume20
Issue number1
DOIs
StatePublished - Aug 30 2018

Keywords

  • 4D flow CMR
  • Flow quantification
  • Hemodynamics
  • Myocardial infarction

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Garg, P., Crandon, S., Swoboda, P. P., Fent, G. J., Foley, J. R. J., Chew, P. G., Brown, L. A. E., Vijayan, S., Hassell, M. E. C. J., Nijveldt, R., Bissell, M., Elbaz, M., Al-Mohammad, A., Westenberg, J. J. M., Greenwood, J. P., Van Der Geest, R. J., Plein, S., & Dall'Armellina, E. (2018). Left ventricular blood flow kinetic energy after myocardial infarction - Insights from 4D flow cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance, 20(1), [61]. https://doi.org/10.1186/s12968-018-0483-6