TY - JOUR
T1 - Left ventricular four-dimensional blood flow distribution, energetics, and vorticity in chronic myocardial infarction patients with/without left ventricular thrombus
AU - Demirkiran, Ahmet
AU - Hassell, Mariëlla E. C. J.
AU - Garg, Pankaj
AU - Elbaz, Mohammed S. M.
AU - Greenwood, John P.
AU - Piek, Jan J.
AU - Plein, Sven
AU - van der Geest, Rob J.
AU - Nijveldt, Robin
N1 - Funding Information: This work was supported by the British Heart Foundation [ FS/10/62/28409 to S.P.] and Dutch Technology Foundation (STW) , project number 11626 (JW, ME). Publisher Copyright: © 2022 The Author(s)
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Left ventricular thrombus (LVT) formation is a frequent and serious complication of myocardial infarction (MI). How global LV flow characteristics are related to this phenomenon is yet uncertain. In this study, we investigated LV flow differences using 4D flow cardiovascular magnetic resonance (CMR) between chronic MI patients with LVT [MI-LVT(+)] and without LVT [MI-LVT(-)], and healthy controls. Methods: In this prospective cohort study, the 4D flow CMR data were acquired in 19 chronic MI patients (MI-LVT(+), n = 9 and MI-LVT(-), n = 10) and 9 age-matched controls. All included subjects were in sinus rhythm. The following LV flow parameters were obtained: LV flow components (direct, retained, delayed, residual), mean and peak kinetic energy (KE) values (indexed to instantaneous LV volume), mean and peak vorticity values, and diastolic vortex ring properties (position, orientation, shape). Results: The MI patients demonstrated a significantly larger amount of delayed and residual flow, and a smaller amount of direct flow compared to controls (p = 0.02, p = 0.03, and p < 0.001, respectively). The MI-LVT(+) patients demonstrated numerically increased residual flow and reduced retained and direct flow in comparison to MI-LVT(-) patients. Systolic mean and peak LV blood flow KE values were significantly lower in MI patients compared to controls (p = 0.04, p = 0.03, respectively). Overall, the mean and peak LV vorticity values were significantly lower in MI patients compared to controls. The mean and peak systolic vorticity at the basal level were significantly higher in MI-LVT(+) than in MI-LVT(-) patients (p < 0.01, for both). The vortex ring core during E-wave in MI-LVT(+) group was located in a less tilted orientation to the LV compared to MI-LVT(-) group (p < 0.01). Conclusions: Chronic MI patients with LVT express a different distribution of LV flow components, irregular vorticity vector fields, and altered diastolic vortex ring geometric properties as assessed by 4D flow CMR. Larger prospective studies are warranted to further evaluate the significance of these initial observations.
AB - Background: Left ventricular thrombus (LVT) formation is a frequent and serious complication of myocardial infarction (MI). How global LV flow characteristics are related to this phenomenon is yet uncertain. In this study, we investigated LV flow differences using 4D flow cardiovascular magnetic resonance (CMR) between chronic MI patients with LVT [MI-LVT(+)] and without LVT [MI-LVT(-)], and healthy controls. Methods: In this prospective cohort study, the 4D flow CMR data were acquired in 19 chronic MI patients (MI-LVT(+), n = 9 and MI-LVT(-), n = 10) and 9 age-matched controls. All included subjects were in sinus rhythm. The following LV flow parameters were obtained: LV flow components (direct, retained, delayed, residual), mean and peak kinetic energy (KE) values (indexed to instantaneous LV volume), mean and peak vorticity values, and diastolic vortex ring properties (position, orientation, shape). Results: The MI patients demonstrated a significantly larger amount of delayed and residual flow, and a smaller amount of direct flow compared to controls (p = 0.02, p = 0.03, and p < 0.001, respectively). The MI-LVT(+) patients demonstrated numerically increased residual flow and reduced retained and direct flow in comparison to MI-LVT(-) patients. Systolic mean and peak LV blood flow KE values were significantly lower in MI patients compared to controls (p = 0.04, p = 0.03, respectively). Overall, the mean and peak LV vorticity values were significantly lower in MI patients compared to controls. The mean and peak systolic vorticity at the basal level were significantly higher in MI-LVT(+) than in MI-LVT(-) patients (p < 0.01, for both). The vortex ring core during E-wave in MI-LVT(+) group was located in a less tilted orientation to the LV compared to MI-LVT(-) group (p < 0.01). Conclusions: Chronic MI patients with LVT express a different distribution of LV flow components, irregular vorticity vector fields, and altered diastolic vortex ring geometric properties as assessed by 4D flow CMR. Larger prospective studies are warranted to further evaluate the significance of these initial observations.
KW - 4D flow cardiovascular magnetic resonance imaging
KW - Direct flow
KW - Kinetic energy
KW - Myocardial infarction
KW - Vortex ring
KW - Vorticity
UR - http://www.scopus.com/inward/record.url?scp=85125845893&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejrad.2022.110233
DO - https://doi.org/10.1016/j.ejrad.2022.110233
M3 - Article
C2 - 35278980
SN - 0720-048X
VL - 150
JO - European Journal of Radiology
JF - European Journal of Radiology
M1 - 110233
ER -