Left ventricular four-dimensional blood flow distribution, energetics, and vorticity in chronic myocardial infarction patients with/without left ventricular thrombus

Demirkiran, Ahmet, Hassell, Mariëlla E. C. J., Garg, Pankaj ORCID: https://orcid.org/0000-0002-5483-169X, Elbaz, Mohammed S. M., Delewi, Ronak, Greenwood, John P., Piek, Jan J., Plein, Sven, van der Geest, Rob J. and Nijveldt, Robin (2022) Left ventricular four-dimensional blood flow distribution, energetics, and vorticity in chronic myocardial infarction patients with/without left ventricular thrombus. European Journal of Radiology, 150. ISSN 0720-048X

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Abstract

Background: Left ventricular thrombus (LVT) formation is a frequent and serious complication of myocardial infarction (MI). How global LV flow characteristics are related to this phenomenon is yet uncertain. In this study, we investigated LV flow differences using 4D flow cardiovascular magnetic resonance (CMR) between chronic MI patients with LVT [MI-LVT(+)] and without LVT [MI-LVT(-)], and healthy controls. Methods: In this prospective cohort study, the 4D flow CMR data were acquired in 19 chronic MI patients (MI-LVT(+), n = 9 and MI-LVT(-), n = 10) and 9 age-matched controls. All included subjects were in sinus rhythm. The following LV flow parameters were obtained: LV flow components (direct, retained, delayed, residual), mean and peak kinetic energy (KE) values (indexed to instantaneous LV volume), mean and peak vorticity values, and diastolic vortex ring properties (position, orientation, shape). Results: The MI patients demonstrated a significantly larger amount of delayed and residual flow, and a smaller amount of direct flow compared to controls (p = 0.02, p = 0.03, and p < 0.001, respectively). The MI-LVT(+) patients demonstrated numerically increased residual flow and reduced retained and direct flow in comparison to MI-LVT(-) patients. Systolic mean and peak LV blood flow KE values were significantly lower in MI patients compared to controls (p = 0.04, p = 0.03, respectively). Overall, the mean and peak LV vorticity values were significantly lower in MI patients compared to controls. The mean and peak systolic vorticity at the basal level were significantly higher in MI-LVT(+) than in MI-LVT(-) patients (p < 0.01, for both). The vortex ring core during E-wave in MI-LVT(+) group was located in a less tilted orientation to the LV compared to MI-LVT(-) group (p < 0.01). Conclusions: Chronic MI patients with LVT express a different distribution of LV flow components, irregular vorticity vector fields, and altered diastolic vortex ring geometric properties as assessed by 4D flow CMR. Larger prospective studies are warranted to further evaluate the significance of these initial observations.

Item Type: Article
Additional Information: Funding Information: This work was supported by the British Heart Foundation [FS/10/62/28409 to S.P.] and Dutch Technology Foundation (STW) , project number 11626 (JW, ME).
Uncontrolled Keywords: 4d flow cardiovascular magnetic resonance imaging,direct flow,kinetic energy,myocardial infarction,vortex ring,vorticity,radiology nuclear medicine and imaging ,/dk/atira/pure/subjectarea/asjc/2700/2741
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 07 Sep 2022 13:30
Last Modified: 25 Sep 2022 03:28
URI: https://ueaeprints.uea.ac.uk/id/eprint/87832
DOI: 10.1016/j.ejrad.2022.110233

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