TY - JOUR
T1 - Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics
AU - Garg, Pankaj
AU - Van Der Geest, Rob J.
AU - Swoboda, Peter P.
AU - Crandon, Saul
AU - Fent, Graham J.
AU - Foley, James R.J.
AU - Dobson, Laura E.
AU - Al Musa, Tarique
AU - Onciul, Sebastian
AU - Vijayan, Sethumadhavan
AU - Chew, Pei G.
AU - Brown, Louise A.E.
AU - Bissell, Malenka
AU - Hassell, Mariëlla E.C.J.
AU - Nijveldt, Robin
AU - Elbaz, Mohammed
AU - Westenberg, Jos J.M.
AU - Dall'Armellina, Erica
AU - Greenwood, John P.
AU - Plein, Sven
N1 - Funding Information:
This work was supported by the British Heart Foundation 28409 to S.P.] and Dutch ZonMw [104003001 to J.W].
Publisher Copyright:
© 2018. For permissions. of LVT.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Left ventricular (LV) thrombus (LVT) remains a life-threatening complication of myocardial infarction (MI), being associated with a fivefold increased risk of systemic embolism.1 The risk for LVT is greater with anterior MI, low ejection fraction (EF), LV aneurysms, and apical akinesis or dyskinesis,1,2 but LVT formation can also be found in patients with smaller infarcts, inferior infarcts, and only mild to moderate LV systolic dysfunction.3 The development of LVT is a complex process involving substrates of the Virchow's triad: disturbance of flow (stasis or turbulence), hypercoagulability, and endothelial injury/dysfunction. Early echocardio- graphic studies have demonstrated that abnormal flow patterns are associated with LVT.4-6 However, comprehensive insight into flow changes in post-MI patients with LVT is lacking, partly because tests capable of examining the complex 3D intra-cavity flow have not been available in the past. The development of four-dimensional (4D) flow cardiovascular magnetic resonance imaging (CMR) now allowsmapping and quantification of intra-cavity LV flow kinetic energy (KE).7-12 LV blood flow KE appears to be reduced in patients with heart failure,13 and has the potential to provide new mechanistic insights into the pathophysiology of LVT formation in patients with ischaemic cardiomyopathy by detecting specific signatures of flow disturbance associated with LV flow stasis in LVT. The aim of this study was to use 4D flow CMR to map LV flow KE and characterize flow changes in patients with MI associated ischaemic cardiomyopathy with and without LVT. We hypothesized that patients with LVT show a re-distribution of LV flow KE resulting in reduced wash-in and wash-out of the LV. Furthermore, we aimed to investigate if LV flow KE mapping parameters are better associated with presence of LVT than the traditional risk factors for the development.
AB - Left ventricular (LV) thrombus (LVT) remains a life-threatening complication of myocardial infarction (MI), being associated with a fivefold increased risk of systemic embolism.1 The risk for LVT is greater with anterior MI, low ejection fraction (EF), LV aneurysms, and apical akinesis or dyskinesis,1,2 but LVT formation can also be found in patients with smaller infarcts, inferior infarcts, and only mild to moderate LV systolic dysfunction.3 The development of LVT is a complex process involving substrates of the Virchow's triad: disturbance of flow (stasis or turbulence), hypercoagulability, and endothelial injury/dysfunction. Early echocardio- graphic studies have demonstrated that abnormal flow patterns are associated with LVT.4-6 However, comprehensive insight into flow changes in post-MI patients with LVT is lacking, partly because tests capable of examining the complex 3D intra-cavity flow have not been available in the past. The development of four-dimensional (4D) flow cardiovascular magnetic resonance imaging (CMR) now allowsmapping and quantification of intra-cavity LV flow kinetic energy (KE).7-12 LV blood flow KE appears to be reduced in patients with heart failure,13 and has the potential to provide new mechanistic insights into the pathophysiology of LVT formation in patients with ischaemic cardiomyopathy by detecting specific signatures of flow disturbance associated with LV flow stasis in LVT. The aim of this study was to use 4D flow CMR to map LV flow KE and characterize flow changes in patients with MI associated ischaemic cardiomyopathy with and without LVT. We hypothesized that patients with LVT show a re-distribution of LV flow KE resulting in reduced wash-in and wash-out of the LV. Furthermore, we aimed to investigate if LV flow KE mapping parameters are better associated with presence of LVT than the traditional risk factors for the development.
KW - flow imaging
KW - fluid dynamics
KW - magnetic resonance imaging
KW - myocardial infarction
KW - thrombosis
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U2 - 10.1093/ehjci/jey121
DO - 10.1093/ehjci/jey121
M3 - Article
C2 - 30137274
AN - SCOPUS:85054148810
SN - 2047-2404
VL - 20
SP - 108
EP - 117
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 1
ER -