Left ventricular kinetic energy as a marker of mechanical dyssynchrony in failing hearts with LBBB: a 4D flow CMR study

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.

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

Scientific Reports ◽

10.1038/s41598-018-32707-5 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 13

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

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Stent interventions for pulmonary artery stenosis improve bi-ventricular flow efficiency in a swine model

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00709-4 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Ryan J. Pewowaruk ◽

Gregory P. Barton ◽

Cody Johnson ◽

J. Carter Ralphe ◽

Christopher J. Francois ◽

...

Keyword(s):

Ejection Fraction ◽

Pulmonary Artery ◽

Ventricular Function ◽

Intervention Group ◽

Left Ventricular ◽

Pulmonary Artery Stenosis ◽

Swine Model ◽

4D Flow ◽

4D Flow Cmr ◽

The Impact

Abstract Background Branch pulmonary artery (PA) stenosis (PAS) commonly occurs in patients with congenital heart disease (CHD). Prior studies have documented technical success and clinical outcomes of PA stent interventions for PAS but the impact of PA stent interventions on ventricular function is unknown. The objective of this study was to utilize 4D flow cardiovascular magnetic resonance (CMR) to better understand the impact of PAS and PA stenting on ventricular contraction and ventricular flow in a swine model of unilateral branch PA stenosis. Methods 18 swine (4 sham, 4 untreated left PAS, 10 PAS stent intervention) underwent right heart catheterization and CMR at 20 weeks age (55 kg). CMR included ventricular strain analysis and 4D flow CMR. Results 4D flow CMR measured inefficient right ventricular (RV) and left ventricular (LV) flow patterns in the PAS group (RV non-dimensional (n.d.) vorticity: sham 82 ± 47, PAS 120 ± 47; LV n.d. vorticity: sham 57 ± 5, PAS 78 ± 15 p < 0.01) despite the PAS group having normal heart rate, ejection fraction and end-diastolic volume. The intervention group demonstrated increased ejection fraction that resulted in more efficient ventricular flow compared to untreated PAS (RV n.d. vorticity: 59 ± 12 p < 0.01; LV n.d. vorticity: 41 ± 7 p < 0.001). Conclusion These results describe previously unknown consequences of PAS on ventricular function in an animal model of unilateral PA stenosis and show that PA stent interventions improve ventricular flow efficiency. This study also highlights the sensitivity of 4D flow CMR biomarkers to detect earlier ventricular dysfunction assisting in identification of patients who may benefit from PAS interventions.

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.282 ◽

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 >50%, reduced (rEF) EF <50% including mild (rEF= 40-49%), moderate to severe (EF <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 < 0.05) reduction in average, systolic and peak-A wave LVKEiEDV. Mild rEF patients also had significant (P < 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 <0.01 12 ± 4† 7 ± 3 <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 < 0.05 V1 comparison between pEF and rEF Abstract Figure

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P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography

European Heart Journal ◽

10.1093/eurheartj/ehz747.0196 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Ribeyrolles ◽

J L Monin ◽

A Rohnean ◽

C Diakov ◽

C Caussin ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Stroke Volume ◽

Left Ventricular ◽

Left Ventricular Stroke Volume ◽

4D Flow ◽

Mitral Flow ◽

4D Flow Cmr ◽

Mr Quantification ◽

Cine Cmr

Abstract Background Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification. Purpose Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach. Methods We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR. Results 33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]). Conclusion 4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.

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Scan–rescan reproducibility of diastolic left ventricular kinetic energy, viscous energy loss and vorticity assessment using 4D flow MRI: analysis in healthy subjects

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-017-1291-z ◽

2018 ◽

Vol 34 (6) ◽

pp. 905-920 ◽

Cited By ~ 6

Author(s):

Vivian P. Kamphuis ◽

Jos J. M. Westenberg ◽

Roel L. F. van der Palen ◽

Pieter J. van den Boogaard ◽

Rob J. van der Geest ◽

...

Keyword(s):

Kinetic Energy ◽

Energy Loss ◽

Healthy Subjects ◽

Left Ventricular ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri

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Unilateral branch pulmonary artery stenting in tetralogy of fallot improves ventricular function

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.066 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

MM Bissell ◽

L Mills ◽

DGW Cave ◽

R Foley ◽

JP Greenwood ◽

...

Keyword(s):

Kinetic Energy ◽

Ejection Fraction ◽

Pulmonary Artery ◽

Longitudinal Strain ◽

Left Ventricular ◽

Energy Curve ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Background Pulmonary artery stenosis (PAS) occurs commonly in patients with tetralogy of fallot (ToF). Cardiac function and especially left ventricular longitudinal strain has been identified as an important prognostic factor for long term survival in ToF. The clinical relevance of unilateral PAS to long-term bi-ventricular function is poorly understood. Purpose We sought to evaluate the effect of resolving unilateral pulmonary artery obstruction on right and left ventricular performance. Methods We prospectively included 40 patients with TOF between 2016 and 2020, 20 who underwent unilateral PAS stenting and as comparison 20 who underwent surgical pulmonary valve replacement (PVR). MRI data was acquired during routine clinical care before and around 6-12 months after the procedure. 4 PAS patients attended additional research scans acquiring ventricular 4D flow MRI data. 4D flow MRI data was compared to the average kinetic energy curve of 10 age-matched healthy volunteers. Results Of the 20 patients undergoing PAS, 2 also underwent percutaneous PVR and were excluded from the comparison analysis. All patients in the PAs group showed an improvement in branch PA flow differential post procedure. Patients undergoing PAS were younger than those undergoing PVR (median 12 vs 19 years, p < 0.001). Other baseline anatomical and functional parameters including right ventricular (RV) volume indexed to body surface are (RVEDV/BSA) were comparable (pre PAS median 151 [122,170] vs pre PVR 162 [140,191]; p = 0.217). While in the PVR group the right ventricular volumes reduced in both end-diastole and end-systole, in the PAS group RV function improved due to reduced end-systolic volume with largely stable end-diastolic volumes. Changes in the left ventricle (LV) were even more interesting. In the PVR group ejection fraction improved due to an increase in end-diastolic volume with no improvement in ventricular longitudinal strain. In contrast, in the PAS group LV ejection fraction improved by a reduction in end-systolic volume and the PAS group showed a small but significant improvement in LV longitudinal strain. In addition, ¾ patients undergoing 4D flow MRI assessment showed LV kinetic energy curve more similar to the healthy volunteer averaged LV kinetic energy curve after PAS. The 4th patient already had a near normal LV kinetic energy curve prior to PAS. Conclusion Unilateral PAS does not alter RV end-diastolic volumes but improves RV function. LV ejection fraction improvement is similar to that seen after PVR, but importantly PAS also improved LV longitudinal strain. This suggests that PAS might positively influence long term morbidity and mortality risk in ToF patients, but a larger multi-centre long term follow-up study is needed to confirm this.

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