Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics

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

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)108-117
Number of pages10
JournalEuropean heart journal cardiovascular Imaging
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • flow imaging
  • fluid dynamics
  • magnetic resonance imaging
  • myocardial infarction
  • thrombosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Garg, P., Van Der Geest, R. J., Swoboda, P. P., Crandon, S., Fent, G. J., Foley, J. R. J., Dobson, L. E., Al Musa, T., Onciul, S., Vijayan, S., Chew, P. G., Brown, L. A. E., Bissell, M., Hassell, M. E. C. J., Nijveldt, R., Elbaz, M., Westenberg, J. J. M., Dall'Armellina, E., Greenwood, J. P., & Plein, S. (2019). Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics. European heart journal cardiovascular Imaging, 20(1), 108-117. https://doi.org/10.1093/ehjci/jey121