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Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2018

Open Access 01-12-2018 | Research

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

Authors: 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 S. M. Elbaz, Abdallah Al-Mohammad, Jos J. M. Westenberg, John P. Greenwood, Rob J. van der Geest, Sven Plein, Erica Dall’Armellina

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2018

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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 KEiEDV. 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 KEiEDV 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 KEiEDV were lower in MI (P < 0.05). In logistic-regression analysis, systolic KEiEDV (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 KEiEDV 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 KEiEDV. 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 KEiEDV and the TD. These three blood flow KE parameters may offer novel methods to identify and describe this patient population.
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Metadata
Title
Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance
Authors
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 S. M. Elbaz
Abdallah Al-Mohammad
Jos J. M. Westenberg
John P. Greenwood
Rob J. van der Geest
Sven Plein
Erica Dall’Armellina
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2018
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-018-0483-6

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