Four-dimensional blood flow-specific markers of LV dysfunction in dilated cardiomyopathy
Jonatan Eriksson, Ann F Bolger, Tino Ebbers, Carl-Johan Carlhäll, Jonatan Eriksson, Ann F Bolger, Tino Ebbers, Carl-Johan Carlhäll
Abstract
Aims: Patients with mild heart failure (HF) who are clinically compensated may have normal left ventricular (LV) stroke volume (SV). Despite this, altered intra-ventricular flow patterns have been recognized in these subjects. We hypothesized that, compared with normal LVs, flow in myopathic LVs would demonstrate a smaller proportion of inflow volume passing directly to ejection and diminished the end-diastolic preservation of the inflow kinetic energy (KE).
Methods and results: In 10 patients with dilated cardiomyopathy (DCM) (49 ± 14 years, six females) and 10 healthy subjects (44 ± 17 years, four females), four-dimensional MRI velocity and morphological data were acquired. A previously validated method was used to separate the LV end-diastolic volume (EDV) into four flow components based on the blood's locations at the beginning and end of the cardiac cycle. KE was calculated over the cardiac cycle for each component. The EDV was larger (P = 0.021) and the ejection fraction smaller (P < 0.001) in DCM compared with healthy subjects; the SV was equivalent (DCM: 77 ± 19, healthy: 79 ± 16 mL). The proportion of the total LV inflow that passed directly to ejection was smaller in DCM (P = 0.000), but the end-diastolic KE/mL of the direct flow was not different in the two groups (NS).
Conclusion: Despite equivalent LVSVs, HF patients with mild LV remodelling demonstrate altered diastolic flow routes through the LV and impaired preservation of inflow KE at pre-systole compared with healthy subjects. These unique flow-specific changes in the flow route and energetics are detectable despite clinical compensation, and may prove useful as subclinical markers of LV dysfunction.
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References
- Stewart S, MacIntyre K, Hole DJ, Capewell S, McMurray JJ. More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail. 2001;3:315–22. .
- Hill JA, Olson EN. Cardiac plasticity. N Engl J Med. 2008;58:1370–80. .
- Richter Y, Edelman ER. Cardiology is flow. Circulation. 2006;113:2679–82. .
- Kilner PJ, Yang GZ, Wilkes AJ, Mohiaddin RH, Firmin DN, Yacoub MH. Asymmetric redirection of flow through the heart. Nature. 2000;404:759–61. .
- Mohiaddin RH. Flow patterns in the dilated ischemic left ventricle studied by MR imaging with velocity vector mapping. J Magn Reson Imaging. 1995;5:493–8. .
- Hong GR, Pedrizzetti G, Tonti G, Li P, Wei Z, Kim JK, et al. Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image velocimetry. JACC Cardiovasc Imaging. 2008;1:705–17. .
- Eriksson J, Dyverfeldt P, Engvall J, Bolger AF, Ebbers T, Carlhall CJ. Quantification of presystolic blood flow organization and energetics in the human left ventricle. Am J Physiol Heart Circ Physiol. 2011;300:H2135–41. .
- Wigström L, Ebbers T, Fyrenius A, Karlsson M, Engvall J, Wranne B, et al. Particle trace visualization of intracardiac flow using time-resolved 3D phase contrast MRI. Magn Reson Med. 1999;41:793–9. .
- Eriksson J, Carlhäll CJ, Dyverfeldt P, Engvall J, Bolger AF, Ebbers T. Semi-automatic quantification of 4D left ventricular blood flow. J Cardiovasc Magn Reson. 2010;12:9. .
- Bolger AF, Heiberg E, Karlsson M, Wigström L, Engvall J, Sigfridsson A, et al. Transit of blood flow through the human left ventricle mapped by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2007;9:741–7. .
- Markl M, Kilner PJ, Ebbers T. Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:7. .
- Carlhäll CJ, Bolger A. Passing strange: flow in the failing ventricle. Circ Heart Fail. 2010;3:326–31. .
- Fredriksson AG, Zajac J, Eriksson J, Dyverfeldt P, Bolger AF, Ebbers T, et al. 4-D blood flow in the human right ventricle. Am J Physiol Heart Circ Physiol. 2011;301:H2344–50. .
- Markl M, Geiger J, Kilner PJ, Foll D, Stiller B, Beyersdorf F, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of cardiovascular flow paths in volunteers and patients with Fontan circulation. Eur J Cardiothorac Surg. 2011;39:206–12. .
- Carlsson M, Heiberg E, Toger J, Arheden H. Quantification of left and right ventricular kinetic energy using four-dimensional intracardiac magnetic resonance imaging flow measurements. Am J Physiol Heart Circul Physiol. 2012;302:H893–900. .
- Oh JK, Hatle L, Tajik AJ, Little WC. Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography. J Am Coll Cardiol. 2006;47:500–6. .
- Heiberg E, Sjögren J, Ugander M, Carlsson M, Engblom H, Arheden H. Design and validation of Segment—freely available software for cardiovascular image analysis. BMC Med Imaging. 2010;10:1. .
- Hove JR, Koster RW, Forouhar AS, Acevedo-Bolton G, Fraser SE, Gharib M. Intracardiac fluid forces are an essential epigenetic factor for embryonic cardiogenesis. Nature. 2003;421:172–7. .
- Taber LA. Mechanical aspects of cardiac development. Prog Biophys Mol Biol. 1998;69:237–55. .
- Colucci WS. Molecular and cellular mechanisms of myocardial failure. Am J Cardiol. 1997;80:15L–25. .
- Pasipoularides A, Shu M, Shah A, Womack MS, Glower DD. Diastolic right ventricular filling vortex in normal and volume overload states. Am J Physiol Heart Circ Physiol. 2003;284:H1064–72.
- Maze SS, Kotler MN, Parry WR. Flow characteristics in the dilated left ventricle with thrombus: qualitative and quantitative Doppler analysis. J Am Coll Cardiol. 1989;13:873–81. .
- Sigfridsson A, Petersson S, Johan Carlhall C, Ebbers T. Spiral readouts for 4D flow MRI. J Cardiovasc Magn Reson. 2012;14:1–2. .
Source: PubMed