Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics

Garg, Pankaj, van der Geest, Rob J., Swoboda, Peter P., Crandon, Saul, Fent, Graham J., Foley, James R. J., Dobson, Laura E., Al Musa, Tarique, Onciul, Sebastian, Vijayan, Sethumadhavan, Chew, Pei G., Brown, Louise A. E., Bissell, Malenka, Hassell, Mariëlla E. C. J., Nijveldt, Robin, Elbaz, Mohammed S. M., Westenberg, Jos J. M., Dall'Armellina, Erica, Greenwood, John P. and Plein, Sven (2019) Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics. European Heart Journal – Cardiovascular Imaging, 20 (1). pp. 108-117. ISSN 2047-2404

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Abstract

Aims The main aim of this study was to characterize changes in the left ventricular (LV) blood flow kinetic energy (KE) using four-dimensional (4D) flow cardiovascular magnetic resonance imaging (CMR) in patients with myocardial infarction (MI) with/without LV thrombus (LVT). Methods and results This is a prospective cohort study of 108 subjects [controls = 40, MI patients without LVT (LVT− = 36), and MI patients with LVT (LVT+ = 32)]. All underwent CMR including whole-heart 4D flow. LV blood flow KE wall calculated using the formula: KE=12 ρblood . Vvoxel . v2⁠, where ρ = density, V = volume, v = velocity, and was indexed to LV end-diastolic volume. Patient with MI had significantly lower LV KE components than controls (P < 0.05). LVT+ and LVT− patients had comparable infarct size and apical regional wall motion score (P > 0.05). The relative drop in A-wave KE from mid-ventricle to apex and the proportion of in-plane KE were higher in patients with LVT+ compared with LVT− (87 ± 9% vs. 78 ± 14%, P = 0.02; 40 ± 5% vs. 36 ± 7%, P = 0.04, respectively). The time difference of peak E-wave KE demonstrated a significant rise between the two groups (LVT−: 38 ± 38 ms vs. LVT+: 62 ± 56 ms, P = 0.04). In logistic-regression, the relative drop in A-wave KE (beta = 11.5, P = 0.002) demonstrated the strongest association with LVT. Conclusion Patients with MI have reduced global LV flow KE. Additionally, MI patients with LVT have significantly reduced and delayed wash-in of the LV. The relative drop of distal intra-ventricular A-wave KE, which represents the distal late-diastolic wash-in of the LV, is most strongly associated with the presence of LVT.

Item Type: Article
Additional Information: A correction has been published: European Heart Journal - Cardiovascular Imaging, Volume 20, Issue 1, January 2019, Page 117, https://doi.org/10.1093/ehjci/jey148 There were three errors in the originally published version: 1. Affiliation 3 was incorrect in the original version and should have read ‘Radboudumc, Department of Cardiology, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.’ 2. Under the heading ‘CMR examination’, the abbreviation ‘MR’ has been spelt out as ‘mitral regurgitation’ but should have read ‘magnetic resonance’. 3. Under the heading ‘Haemodynamic analysis’, the abbreviation ‘MR’ stands for ‘mitral regurgitation’.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 19 Nov 2021 01:40
Last Modified: 07 Dec 2021 17:35
URI: https://ueaeprints.uea.ac.uk/id/eprint/82227
DOI: 10.1093/ehjci/jey121

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