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

Garg, Pankaj; Crandon, Saul; Swoboda, Peter; Fent, Graham; Foley, James R.; Chew, Pei G.; Brown, Louise A.; Vijayan, Sethumadhavan; Hassell, Mariëlla E.C.J.; Nijveldt, Robin; Bissell, Malenka M.; Elbaz, Mohammed; Al‐Mohammad, Abdallah; Westenberg, Jos J.M.; Greenwood, John P.; Geest, Rob J. van der; Plein, Sven; Dall’Armellina, Erica

doi:10.1186/s12968-018-0483-6

Cited by 79 publications

(104 citation statements)

References 42 publications

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“…Further prospective studies are warranted to investigate and ascertain the phenotype of the patients with breathlessness, raised NTproBNP, and normal TTE. Cardiovascular magnetic resonance imaging has demonstrated some promise to better categorise diastolic function [29][30][31][32][33][34] ; however, this needs further invasive catheter-based validation studies. Third, this study did not record the cause of death.…”

Section: Limitationsmentioning

confidence: 99%

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

et al. 2020

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Aims Clinical outcomes for patients suspected of having heart failure (HF) who do not meet the diagnostic criteria of any type of HF by echocardiography remain unknown. The aim of this study was to investigate the clinical predictors of all-cause mortality in patients with suspected HF, a raised N-terminal pro-b-type natriuretic peptide (NTproBNP) and who do not meet the diagnostic criteria of any type of HF by echocardiography. Methods and results Relevant data were taken from the Sheffield HEArt Failure (SHEAF) registry (222349P4). The inclusion criteria were presence of symptoms raising suspicion of HF, NTproBNP > 400 pg/mL, and preserved left ventricular function. Exclusion criteria were any type of HF by echocardiography. The outcome was defined as all-cause mortality. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and clinical variables; 1031 patients were identified with NTproBNP > 400 pg/mL but who did not have echocardiographic evidence of HF. All-cause mortality was 21.5% (222 deaths) over the mean follow-up (FU) period of 6 ± 2 years. NTproBNP was similar in patients who were alive or dead (P = 0.96). However, age (HR 1, P < 0.01), chronic kidney disease (CKD, HR 1.2, P < 0.01), chronic pulmonary obstructive disease (COPD, HR 1.6, P < 0.01), dementia (HR 5.9, P < 0.01), male gender (HR 1.4, P < 0.01), first-degree atrioventricular block (HR 2.1, P < 0.01), left axis deviation (HR 1.6, P = 0.04), and diabetes (HR 1.4, P = 0.03) were associated with all-cause mortality. In multivariate regression, age, gender, CKD stage, COPD, and dementia were independently associated with mortality. In patients with NTproBNP > 627 pg/mL, NYHA class predicted death (II, 19.6%; III, 27.4%; IV, 66.7%; P < 0.01). Conclusions Patients with no HF on echocardiography but raised NTproBNP suffer excess mortality particularly in the presence of certain clinical variables. Age, male gender, worsening CKD stage, presence of COPD, and dementia are independently associated with all-cause mortality in these patients. An NTproBNP > 627 pg/mL coupled with NYHA class could identify patients at greatest risk of death.

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Section: Limitationsmentioning

confidence: 99%

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

et al. 2020

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“…However, Doppler echocardiography is limited in spatial coverage (imaging planes are restricted by patient anatomy) and non-specific velocity direction encoding. Another study, using time-resolved, three-dimensional (3D) phase contrast MRI with 3-directional velocity encoding (“4D flow MRI” [8, 9]) in 48 patients with acute or chronic myocardial infarction (MI), found reduced LV kinetic energy in MI patients compared to age/sex-matched controls [10].…”

Section: Introductionmentioning

confidence: 99%

Reduced regional flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI

et al. 2019

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BackgroundAcute myocardial infarction (AMI) alters left ventricular (LV) hemodynamics, resulting in decreased global LV ejection fraction and global LV kinetic energy. We hypothesize that anterior AMI effects localized alterations in LV flow and developed a regional approach to analyze these local changes with 4D flow MRI.Methods4D flow cardiac magnetic resonance (CMR) data was compared between 12 anterior AMI patients (11 males; 66 ± 12yo; prospectively acquired in 2016–2017) and 19 healthy volunteers (10 males; 40 ± 16yo; retrospective from 2010 to 2011 study). The LV cavity was contoured on short axis cine steady-state free procession CMR and partitioned into three regions: base, mid-ventricle, and apex. 4D flow data was registered to the short axis segmentation. Peak systolic and diastolic through-plane flows were compared region-by-region between groups using linear models of flow with age, sex, and heart rate as covariates.ResultsPeak systolic flow was reduced in anterior AMI subjects compared to controls in the LV mid-ventricle (fitted reduction = 3.9 L/min; P = 0.01) and apex (fitted reduction = 1.4 L/min; P = 0.02). Peak diastolic flow was also lower in anterior AMI subjects compared to controls in the apex (fitted reduction = 2.4 L/min; P = 0.01).ConclusionsA regional method to analyze 4D LV flow data was applied in anterior AMI patients and controls. Anterior AMI patients had reduced regional flow relative to controls.

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“…Each slice in the LV segmentation was assigned to one of three equal-length segments divided along the LV long axis: base, mid-ventricle, and apex ( Figure 1 Where N t is the number of cardiac time frames, ρ blood is the density of blood (1.06 g/cm 3 ), V vox is the voxel volume, and v vox is the velocity magnitude. KE avg was then indexed to EDV (KEi EDV ) as in Garg et al [10]. KE was not computed on a regional scale because the squared velocity term results in a measurement dominated by high-velocity voxels, which is therefore highly sensitive to noise in slowflow regions (such as the LV apex) with a full-ventricle high velocity encoding imaging approach.…”

Section: Image Analysismentioning

confidence: 99%

Reduced flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI

Corrado

Macdonald

François

et al. 2020

Preprint

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Background : Acute myocardial infarction (AMI) alters left ventricular (LV) hemodynamics, resulting in decreased global LV ejection fraction and global LV kinetic energy. We hypothesize that anterior AMI effects localized alterations in LV flow and developed a regional approach to analyze these local changes with 4D flow MRI. Methods : 4D flow cardiac magnetic resonance (CMR) data was compared between 12 anterior AMI patients (11 males; 66±12yo; prospectively acquired in 2016-2017) and 19 healthy volunteers (10 males; 40±16yo; retrospective from 2010-2011 study). The LV cavity was contoured on short axis cine steady-state free procession CMR and partitioned into three regions: base, mid-ventricle, and apex. 4D flow data was registered to the short axis segmentation. Peak systolic and diastolic through-plane flows were compared region-by-region between groups using linear models of flow with age, sex, and heart rate as covariates. Results : Peak systolic flow was reduced in anterior AMI subjects compared to controls in the LV mid-ventricle (fitted reduction = 3.9 L/min; P=0.01) and apex (fitted reduction = 1.4 L/min; P=0.02). Peak diastolic flow was also lower in anterior AMI subjects compared to controls in the apex (fitted reduction = 2.4 L/min; P=0.01). Conclusions : A regional method to analyze 4D LV flow data was applied in anterior AMI patients and controls. Anterior AMI patients had reduced regional flow relative to controls.

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

Cited by 79 publications

References 42 publications

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

Reduced regional flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI

Reduced flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI

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