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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2023 | Cardiac Resynchronization Therapy | Research

Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy

Authors: Karin Pola, Anders Roijer, Rasmus Borgquist, Ellen Ostenfeld, Marcus Carlsson, Zoltan Bakos, Håkan Arheden, Per M. Arvidsson

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2023

Abstract

Background

Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT.

Methods

Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier–Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders.

Results

Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio > 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8).

Conclusion

Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice.

Graphical Abstract

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Title: Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy
Authors: Karin Pola
Anders Roijer
Rasmus Borgquist
Ellen Ostenfeld
Marcus Carlsson
Zoltan Bakos
Håkan Arheden
Per M. Arvidsson
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Left Bundle Branch Block
Heart Failure
Transthoracic Echocardiography
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2023
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-023-00955-8

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Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

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