Impact of intraventricular haemodynamic forces misalignment on left ventricular remodelling after myocardial infarction

Abstract

Aims Altered left ventricular (LV) haemodynamic forces (HDFs) have been associated with positive and negative remodelling after pathogenic or therapeutic events. We aimed to identify LV HDFs patterns associated with adverse LV remodelling (aLVr) in reperfused segment elevation myocardial infarction (STEMI) patients. Methods and results Forty‐nine acute STEMI patients underwent cardiac magnetic resonance (CMR) at 1 week (baseline) and after 4 months (follow‐up). LV HDFs were computed at baseline from cine CMR long axis data sets, using a novel technique based on endocardial boundary tracking, both in apex‐base (A‐B) and latero‐septal (L‐S) directions. HDFs distribution was evaluated by L‐S over A‐B HDFs ratio (L‐S/A‐B HDFs ratio %). HDFs parameters were computed over the entire heartbeat, in systole and diastole. At baseline, aLVr patients had lower systolic L‐S HDF (2.7 ± 0.9 vs. 3.6 ± 1%; P = 0.027) and higher diastolic L‐S/A‐B HDF ratio (28 ± 14 vs. 19 ± 6%; P = 0.03). At univariate logistic regression analysis, higher infarct size [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.01–1.1; P = 0.04], higher L‐S/A‐B HDFs ratio (OR 1.1; 95% CI 1.01–1.2; P = 0.05) and lower L‐S HDFs (OR 0.41; 95% CI 0.2–0.9; P = 0.04) were associated with aLVr at follow‐up. In the multivariable logistic regression analysis, diastolic L‐S/A‐B HDF ratio remained the only independent predictor of aLVr (OR 1.1; 95% CI 1.01–1.2; P = 0.04). Conclusions Misalignment of diastolic haemodynamic forces after STEMI is associated with aLVr after 4 months.

Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using T1 Mapping Technique and Papillary Longitudinal Strain

“…Many studies have demonstrated that multiple factors play a role in this complex adaptative phenomenon by using CMR [ 34 ]. However, it is still unknown if iPPM may facilitate adverse remodeling or the redistribution of intracavitary hemodynamic forces, which appears to be one of the leading mechanisms of remodeling [ 35 ]. Further studies with follow-up imaging and a larger cohort are needed to clarify these relationships and to assess the real prognostic value of iPPM.…”

Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis

“…In HFrEF patients HDFs are significantly lower and misaligned, diverging from the normal apex-to-base direction toward the latero-septal one ( 29 ). A recent pathophysiological model suggested a link between HDFs misalignment/re-alignment and adverse-remodeling/reverse-remodeling ( 27 , 28 ). Cardiac endothelial mechano-receptors can distinguish changes in shear stress vectors (tangential vs. perpendicular direction) and activate ultrastructural adaptive responses, such as turnover of contractile proteins and regulation of myofibril orientation ( 30 ).…”

Abnormal Diastolic Hemodynamic Forces: A Link Between Right Ventricular Wall Motion, Intracardiac Flow, and Pulmonary Regurgitation in Repaired Tetralogy of Fallot

“…HDF analysis can differentiate heart failure patients with preserved ejection fraction compared to controls with similar ejection fraction ( 11 ), reveal subclinical dysfunction due to cardiotoxicity from anthracycline chemotherapy ( 30 ), and it was the first left ventricular parameter to testify the impact of precapillary pulmonary hypertension on cardiac function ( 31 ). As HDF drives the intraventricular pressure gradient exchanged within the myocardium, stimulation of mechanoreceptors may provoke activation of intracellular pathways involved in cardiac adaptation and remodeling ( 32 , 33 ). Identification of subtle kinetic dysfunction is also possible through HDF analysis, leading to detection of mechanical abnormalities in asymptomatic patients ( 11 ).…”