Abstract 13435: Deranged Intra-Cardiac Blood Flow Components and Kinetic Energy in Dilated Cardiomyopathy Are an Additional Marker of Disease Severity and Correlate With Established Markers of Prognosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Victoria Stoll ◽  
Aaron Hess ◽  
Eylem Levelt ◽  
Jonatan Eriksson ◽  
Petter Dyverfeldt ◽  
...  
Keyword(s):  
Blood Flow ◽  
Kinetic Energy ◽  
Dilated Cardiomyopathy ◽  
Disease Severity ◽  
Myocardial Strain ◽  
Flow Patterns ◽  
Left Ventricular ◽  
4D Flow ◽  
Flow Components ◽  
Functional Components

Introduction: Heart failure (HF) due to dilated cardiomyopathy (DCM) is a complex syndrome in which numerous cellular, mechanical and flow processes/interactions become deranged. Insights into derangement of left ventricular intra-cardiac flow patterns and kinetic energy (KE) are now afforded by the use of 4D flow CMR. Previous studies have found derangements of intra-ventricular flow components and KE within DCM patients compared to healthy volunteers. Hypothesis: We hypothesised that increasing derangement in 4D flow measures would relate to: 1) decreased mechanical cardiac function, as assessed by myocardial strain, 2) increased levels of biochemical remodelling markers and 3) worsening patient symptoms and functional capacity. Methods: 26 idiopathic DCM patients (69% male, mean age 55±2 yr, LVEF 35±2%) and 10 controls (70% male, mean age 57±4yr, LVEF 68±1.2%) were assessed with 3T CMR. Results: The LV volume was divided into 4 functional components; direct flow (DF), delayed ejection flow (DEF), retained inflow (RI) and residual volume (RV). Compared to controls DCM’s had significantly decreased DF (11±1% vs 38±2%) and increased RV (51±2% vs 31±1%) (fig a). The KE at end diastole differed significantly for all flow components between groups (fig b). Circumferential strain was significantly impaired in DCM’s vs controls (-9.9±0.8% vs -19.7±0.5%, p<0.0001). DF KE correlated positively to the 6 minute walk test (6MWT) and strain, and negatively to the Minnesota HF questionnaire and BNP (fig c). Conclusions: DCM patients demonstrated less efficient blood flow patterns and deranged KE profiles. The greater the derangement of flow parameters from normal, the worse the myocardial strain, BNP, 6MWT and patient symptoms. This study suggests that flow parameter derangements are novel biomarkers of disease severity in DCM, correlating with established markers of prognosis such as BNP and 6MWT and may become useful in monitoring novel therapies and predicting prognosis.

scholarly journals Improved Efficiency of Intraventricular Blood Flow Transit Under Cardiac Stress: A 4D Flow Dobutamine CMR Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Jonathan Sundin ◽  
Jan Engvall ◽  
Eva Nylander ◽  
Tino Ebbers ◽  
Ann F. Bolger ◽  
...  
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Human Heart ◽  
Flow Patterns ◽  
Relative Increase ◽  
Dobutamine Infusion ◽  
Residual Volume ◽  
4D Flow ◽  
Lv Dysfunction ◽  
Flow Components

Introduction: The effects of heart rate, inotropy, and lusitropy on multidimensional flow patterns and energetics within the human heart remain undefined. Recently, reduced volume and end-diastolic kinetic energy (KE) of the portion of left ventricular (LV) inflow passing directly to outflow, Direct flow (DF), have been shown to reflect inefficient LV pumping and to be a marker of LV dysfunction in heart failure patients. In this study, we hypothesized that increasing heart rate, inotropy, and lusitropy would result in an increased efficiency of intraventricular blood flow transit. Therefore, we sought to investigate LV 4D blood flow patterns and energetics with dobutamine infusion.Methods: 4D flow and morphological cardiovascular magnetic resonance (CMR) data were acquired in twelve healthy subjects: at rest and with dobutamine infusion to achieve a target heart rate ~60% higher than the resting heart rate. A previously validated method was used for flow analysis: pathlines were emitted from the end-diastolic (ED) LV blood volume and traced forward and backward in time to separate four functional LV flow components. For each flow component, KE/mL blood volume at ED was calculated.Results: With dobutamine infusion there was an increase in heart rate (64%, p &lt; 0.001), systolic blood pressure (p = 0.02) and stroke volume (p = 0.01). Of the 4D flow parameters, the most efficient flow component (DF), increased its proportion of EDV (p &lt; 0.001). The EDV proportion of Residual volume, the blood residing in the ventricle over at least two cardiac cycles, decreased (p &lt; 0.001). The KE/mL at ED for all flow components increased (p &lt; 0.001). DF had the largest absolute and relative increase while Residual volume had the smallest absolute and relative increase.Conclusions: This study demonstrates that it is feasible to compare 4D flow patterns within the normal human heart at rest and with stress. At higher heart rate, inotropy and lusitropy, elicited by dobutamine infusion, the efficiency of intraventricular blood flow transit improves, as quantified by an increased relative volume and pre-systolic KE of the most efficient DF component of the LV volume. The change in these markers may allow a novel assessment of LV function and LV dysfunction over a range of stress.

scholarly journals Reproducibility of left ventricular blood flow kinetic energy measured by four-dimensional flow CMR

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ciaran Grafton-Clarke ◽  
Saul Crandon ◽  
Jos J. M. Westenberg ◽  
Peter P. Swoboda ◽  
John P. Greenwood ◽  
...  
Keyword(s):  
Blood Flow ◽  
Kinetic Energy ◽  
Healthy Volunteers ◽  
Statistical Power ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
4D Flow ◽  
Energy Data ◽  
Dimensional Flow ◽  
4D Flow Cmr

Abstract Objectives Four-dimensional flow CMR allows for a comprehensive assessment of the blood flow kinetic energy of the ventricles of the heart. In comparison to standard two-dimensional image acquisition, 4D flow CMR is felt to offer superior reproducibility, which is important when repeated examinations may be required. The objective was to evaluate the inter-observer and intra-observer reproducibility of blood flow kinetic energy assessment using 4D flow of the left ventricle in 20 healthy volunteers across two centres in the United Kingdom and the Netherlands. Data description This dataset contains 4D flow CMR blood flow kinetic energy data for 20 healthy volunteers with no known cardiovascular disease. Presented is kinetic energy data for the entire cardiac cycle (global), the systolic and diastolic components, in addition to blood flow kinetic energy for both early and late diastolic filling. This data is available for reuse and would be valuable in supporting other research, such as allowing for larger sample sizes with more statistical power for further analysis of these variables.

scholarly journals Left Ventricular Blood Flow Kinetic Energy Assessment by 4D Flow Cardiovascular Magnetic Resonance: A Systematic Review of the Clinical Relevance

2020 ◽  
Vol 7 (3) ◽  
pp. 37
Author(s):  
Harjinder Kaur ◽  
Hosamadin Assadi ◽  
Samer Alabed ◽  
Donnie Cameron ◽  
Vassilios S. Vassiliou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Flow ◽  
Cardiovascular Magnetic Resonance ◽  
Heart Disease ◽  
Magnetic Resonance ◽  
Kinetic Energy ◽  
Left Ventricular ◽  
4D Flow ◽  
Hemodynamic Assessment ◽  
Lv Diastolic Function

Background: There is an emerging body of evidence that supports the potential clinical value of left ventricular (LV) intracavity blood flow kinetic energy (KE) assessment using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). The aim of this systematic review is to summarize studies evaluating LV intracavity blood flow KE quantification methods and its potential clinical significance. Methods: A systematic review search was carried out on Medline, Pubmed, EMBASE and CINAHL. Results: Of the 677 articles screened, 16 studies met eligibility. These included six (37%) studies on LV diastolic function, another six (37%) studies on heart failure or cardiomyopathies, three (19%) studies on ischemic heart disease or myocardial infarction and finally, one (6%) study on valvular heart disease, namely, mitral regurgitation. One of the main strengths identified by these studies is high reproducibility of LV blood flow KE hemodynamic assessment (mean coefficient of variability = 6 ±  2%) for the evaluation of LV diastolic function. Conclusions: The evidence gathered in this systematic review suggests that LV blood flow KE has great promise for LV hemodynamic assessment. Studies showed increased diagnostic confidence at no cost of additional time. Results were highly reproducible with low intraobserver variability.

scholarly journals Altered Diastolic Flow Patterns and Kinetic Energy in Subtle Left Ventricular Remodeling and Dysfunction Detected by 4D Flow MRI

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0161391 ◽  
Author(s):  
Emil Svalbring ◽  
Alexandru Fredriksson ◽  
Jonatan Eriksson ◽  
Petter Dyverfeldt ◽  
Tino Ebbers ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Flow Patterns ◽  
Left Ventricular ◽  
4D Flow Mri ◽  
4D Flow ◽  
Diastolic Flow ◽  
Flow Mri

scholarly journals Impact of Age and Diastolic Function on Novel, 4D flow CMR Biomarkers of Left Ventricular Blood Flow Kinetic Energy

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Saul Crandon ◽  
Jos J. M. Westenberg ◽  
Peter P. Swoboda ◽  
Graham J. Fent ◽  
James R. J. Foley ◽  
...  
Keyword(s):  
Blood Flow ◽  
Kinetic Energy ◽  
Diastolic Function ◽  
Left Ventricular ◽  
4D Flow ◽  
4D Flow Cmr

scholarly journals Longitudinal change in left ventricular 4D flow kinetic energy after myocardial infarction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
H Ben-Arzi ◽  
A Das ◽  
C Kelly ◽  
RJ Van Der Geest ◽  
A Chowdhary ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Kinetic Energy ◽  
Left Ventricular ◽  
Three Dimensions ◽  
Longitudinal Change ◽  
P Value ◽  
4D Flow ◽  
Longitudinal Changes ◽  
Funding Sources ◽  
End Diastolic Volume

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation HRUK Background. Four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) imaging provides quantification of intra-cavity left ventricular (LV) flow kinetic energy (KE) parameters in three dimensions. Myocardial infarction (MI) is known to cause acute alterations in intra-cardiac blood flow but assessments of longitudinal changes are lacking. Purpose. Assess longitudinal changes in LV flow post ST-elevation myocardial infarction (STEMI). Method. Twenty acutely reperfused STEMI patients (13 men, 7 women, mean age 54 ± 9 years) underwent 3T CMR acutely (within 5-7 days) and 3 months post-MI.  CMR protocol included functional imaging, late gadolinium enhancement and 4D flow. Using Q-MASS, LV KE parameters were derived and indexed to LV end-diastolic volume (LVKEiEDV). Based on acute ejection fraction (EF), patients were grouped as follows: preserved (pEF) EF &gt;50%, reduced (rEF) EF &lt;50% including mild (rEF= 40-49%), moderate to severe (EF &lt;40%) impairment.  Results. Out of 20 patients, 13 had rEF acutely (7 mild rEF, 6 moderate to severe rEF). Acute LVKEiEDV parameters varied significantly between pEF and rEF (Table). At 3 months, pEF and mild rEF patients showed a significant (P &lt; 0.05) reduction in average, systolic and peak-A wave LVKEiEDV. Mild rEF patients also had significant (P &lt; 0.05) reduction in minimal and peak-E wave LVKEiEDV. However in patients with moderate to severe rEF in the acute scan, there were no significant change by 3 months (Figure). Conclusion. Following MI, 4D flow LVKE derived biomarkers significantly decreased over time in pEF and mild rEF groups but not in moderate to severe rEF group. 4D flow assessment might provide incremental prognostic value beyond EF assessment alone. Table pEF (n = 7) rEF (n = 13) V1 V2 P-value V1 V2 P-value EF(%) 56 ± 5 55 ± 4 0.40 41 ± 7 47 ± 9 0.01 Infarct Size(%) 31 ± 20 15 ± 9 0.04 18 ± 13† 16 ± 11 0.41 LV KEiEDV parameters Average(µJ/ml) 9 ± 2 7 ± 2 0.02 10 ± 3† 8 ± 3 0.01 Minimal(µJ/ml) 1 ± 0.6 1 ± 0.5 0.46 1.3 ± 0.5 1 ± 0.6 0.03 Systolic(µJ/ml) 10 ± 4 7 ± 2 &lt;0.01 12 ± 4† 7 ± 3 &lt;0.01 Diastolic(µJ/ml) 8 ± 3 7 ± 2 0.13 9 ± 3 8 ± 3 0.09 Peak-E wave(µJ/ml) 22 ± 9 23 ± 8 0.44 20 ± 7 18 ± 10 0.23 Peak-A wave(µJ/ml) 18 ± 10 11 ± 4 0.04 17 ± 9 14 ± 7 0.02 †P &lt; 0.05 V1 comparison between pEF and rEF Abstract Figure

scholarly journals Three-Dimensional Left Ventricular Torsion in Patients With Dilated Cardiomyopathy　― A Marker of Disease Severity ―

2017 ◽  
Vol 81 (4) ◽  
pp. 529-536 ◽  
Author(s):  
Krunoslav Michael Sveric ◽  
Stefan Ulbrich ◽  
Mohamed Rady ◽  
Tobias Ruf ◽  
Heda Kvakan ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Disease Severity ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Left Ventricular Torsion ◽  
Ventricular Torsion
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