Left ventricular fluid kinetic energy time curves in heart failure from cardiovascular magnetic resonance 4D flow data

Mikael Kanski, Per M Arvidsson, Johannes Töger, Rasmus Borgquist, Einar Heiberg, Marcus Carlsson, Håkan Arheden, Mikael Kanski, Per M Arvidsson, Johannes Töger, Rasmus Borgquist, Einar Heiberg, Marcus Carlsson, Håkan Arheden

Abstract

Background: Measurement of intracardiac kinetic energy (KE) provides new insights into cardiac hemodynamics and may improve assessment and understanding of heart failure. We therefore aimed to investigate left ventricular (LV) KE time curves in patients with heart failure and in controls.

Methods: Patients with heart failure (n = 29, NYHA class I-IV) and controls (n = 12) underwent cardiovascular magnetic resonance (CMR) including 4D flow. The vortex-ring boundary was computed using Lagrangian coherent structures. The LV endocardium and vortex-ring were manually delineated and KE was calculated as ½mv(2) of the blood within the whole LV and the vortex ring, respectively.

Results: The systolic average KE was higher in patients compared to controls (2.2 ± 1.4 mJ vs 1.6 ± 0.6 mJ, p = 0.048), but lower when indexing to EDV (6.3 ± 2.2 μJ/ml vs 8.0 ± 2.1 μJ/ml, p = 0.025). No difference was seen in diastolic average KE (3.2 ± 2.3 mJ vs 2.0 ± 0.8 mJ, p = 0.13) even when indexing to EDV (9.0 ± 4.4 μJ/ml vs 10.2 ± 3.3 μJ/ml, p = 0.41). In patients, a smaller fraction of diastolic average KE was observed inside the vortex ring compared to controls (72 ± 6% vs 54 ± 9%, p < 0.0001). Three distinctive KE time curves were seen in patients which were markedly different from findings in controls, and with a moderate agreement between KE time curve patterns and degree of diastolic dysfunction (Cohen's kappa = 0.49), but unrelated to NYHA classification (p = 0.12), or 6-minute walk test (p = 0.72).

Conclusion: Patients with heart failure exhibit higher systolic average KE compared to controls, suggesting altered intracardiac blood flow. The different KE time curves seen in patients may represent a conceptually new approach for heart failure classification.

Figures

Fig. 1
Fig. 1
An example of kinetic energy (KE) in a patient with heart failure at three time-points during the cardiac cycle: peak systole (top panel), peak early diastolic filling (middle panel), and during atrial systole (bottom panel). Left column shows 2-chamber view (2CH), middle column shows 3-chamber view (3CH), and right column shows 4-chamber view (4CH). LA: Left atrium; LV: Left ventricle; RA: Right atrium; RV: Right ventricle; Ao: Aorta
Fig. 2
Fig. 2
Vortex-ring delineation using Lagrangian coherent structures (LCS). Left: LCS in 3-chamber view of the LV. Right: LCS in short-axis view. Delineation of LCS for each diastolic time frame during enables quantification of blood inside and outside the diastolic vortex
Fig. 3
Fig. 3
Systolic average kinetic energy (KE, left column), and diastolic average KE (right column) in controls (open boxes) and patients with heart failure (black circles). On the Y-axis, the upper panel of graphs shows KE; middle panel shows KE indexed to stroke volume (SV); and lower panel shows KE indexed to end-diastolic volume (EDV). Error bars show mean ± SD
Fig. 4
Fig. 4
Top panel: Variation of intracardiac KE during the cardiac cycle, starting at end-diastole. KE ± SEM is shown for controls (a) and patients with three different time curve patterns (b-d). Black circles indicate KE (mJ) inside the entire left ventricle, open red boxes indicate KE (mJ) inside of diastolic vortex, and blue triangles KE (mJ) outside of the vortex. Bottom panel: Aortic flow curves, from end-diastole to end-systole, and transmitral flow curves, starting at end-systole. KE = kinetic energy; HR = heart rate; LV = left ventricle; S = systole. Error bars are omitted from KE inside and outside of the diastolic vortex as well as for flow curves for clarity
Fig. 5
Fig. 5
Temporal average kinetic energy (KE) inside the diastolic vortex (panel a) and outside the diastolic vortex (panel b) for controls and patients with heart failure subdivided by KE time curve patterns. Panel (c) shows the ratio between temporal average KE inside of the diastolic vortex and temporal average KE inside + outside of the diastolic vortex. This shows that patients with heart failure have lower fraction of KE inside of the diastolic vortex compared to controls. Comparisons are performed using Kruskal-Wallis test. Error bars show mean±SD. * = p < 0.05; ** = p < 0.01; *** = p < 0.001; ****p < 0.0001

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