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Longitudinal Changes in Left Ventricular Blood Flow Kinetic Energy After Myocardial Infarction: Predictive Relevance for Cardiac Remodeling
Author(s) -
BenArzi Hadar,
Das Arka,
Kelly Christopher,
Geest Rob J.,
Plein Sven,
Dall'Armellina Erica
Publication year - 2022
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.28015
Subject(s) - cardiology , medicine , ejection fraction , myocardial infarction , stroke volume , cardiac magnetic resonance imaging , population , diastole , blood flow , magnetic resonance imaging , ventricular remodeling , clinical significance , heart failure , intracardiac injection , radiology , blood pressure , environmental health
Background Four‐dimensional (4D) flow cardiac magnetic resonance (cardiac MR) imaging provides quantification of intracavity left ventricular (LV) flow kinetic energy (KE) parameters in three dimensions. ST‐elevation myocardial infarction (STEMI) patients have been shown to have altered intracardiac blood flow compared to controls; however, how 4D flow parameters change over time has not been explored previously. Purpose Measure longitudinal changes in intraventricular flow post‐STEMI and ascertain its predictive relevance of long‐term cardiac remodeling. Study Type Prospective. Population Thirty‐five STEMI patients (M:F = 26:9, aged 56 ± 9 years). Field Strength/Sequence A 3 T/3D EPI‐based, fast field echo (FFE) free‐breathing 4D‐flow sequence with retrospective cardiac gating. Assessment Serial imaging at 3–7 days (V1), 3‐months (V2), and 12‐months (V3) post‐STEMI, including the following protocol: functional imaging for measuring volumes and 4D‐flow for calculating parameters including systolic and peakE‐wave LVKE, normalized to end‐diastolic volume (iEDV) and stroke volume (iSV). Data were analyzed by H.B. (3 years experience). Patients were categorized into two groups: preserved ejection fraction (pEF, if EF > 50%) and reduced EF (rEF, if EF < 50%). Statistical Tests Independent sample t‐tests were used to detect the statistical significance between any two cohorts. P < 0.05 was considered statistically significant. Results Across the cohort, systolic KEi sv was highest at V1 (28.0 ± 4.4 μJ/mL). Patients with rEF retained significantly higher systolic KEi sv than patients with pEF at V2 (18.2 ± 3.4 μJ/mL vs. 6.9 ± 0.6 μJ/mL, P < 0.001) and V3 (21.6 ± 5.1 μJ/mL vs. 7.4 ± 0.9 μJ/mL, P < 0.001). Patients with pEF had significantly higher peakE‐wave KEi EDV than rEF patients throughout the study (V1: 25.4 ± 11.6 μJ/mL vs. 18.1 ± 9.9 μJ/mL, P < 0.03, V2: 24.0 ± 10.2 μJ/mL vs. 17.2 ± 12.2 μJ/mL, P < 0.05, V3: 27.7 ± 14.8 μJ/mL vs. 15.8 ± 7.6 μJ/mL, P < 0.04). Data Conclusion Systolic KE increased acutely following MI; in patients with pEF, this decreased over 12 months, while patients with rEF, this remained raised. Compared to patients with pEF, persistently lower peakE‐wave KE in rEF patients is suggestive of early and fixed impairment in diastolic function. Evidence Level 1 Technical Efficacy Stage 3