A regression model comprising acute microvascular obstruction and A-wave kinetic energy strongly predicted adverse LV-remodeling at 3 months (AUC 0.82; 95% CI 0.7-0.9; p<0.001).
Cohort (n=69)
Does 4D LV blood flow energetics assessment predict adverse LV-remodelling in revascularised STEMI patients?
Assessment of LV hemodynamics using 4D flow CMR kinetic energy mapping, specifically A-wave kinetic energy and microvascular obstruction, independently predicts adverse LV remodeling early after acute STEMI.
Estimación del efecto: AUC 0.82 (95% CI 0.7-0.9)
valor p: p=<0.001
Introduction Myocardial infraction (MI) leads to complex changes in left ventricular (LV) haemodynamics. It remains unknown how four-dimensional (4D) acute changes in LV-cavity blood flow kinetic energy (KE) affect LV remodelling. We hypothesised that LV blood flow energetics is independently associated with adverse LV-remodelling. Methods We recruited 69 revascularised ST-elevation MI patients. All patients underwent cardiovascular magnetic resonance (CMR) at 1.5 T within 48 hours and at 3 months. CMR included cines, early/late gadolinium enhancement and whole-heart 4D flow. CMR analysis included: LV volumes, infarct size (IS,%), microvascular obstruction (MVO,%), two-dimensional, retrospective valve tracking derived mitral inflow metrics and 4D KE components. KE was derived using novel, semi-automated method by using endocardial contours on short-axis cines to extract intra-cavity velocity profile. Adverse LV-remodelling was defined as increase in LV end-diastolic volume by 15%. Results Thirteen (19%) patients developed adverse LV-remodelling. Demographics were comparable between patients with/without remodelling. Baseline CMR in adverse LV-remodelling-group showed significantly lower EF, LV KE, Systolic, A-wave, in-plane KEs and increased MVO (pConclusion LV haemodynamic assessment by novel, semi-automated, 4D KE mapping adds incremental value to predict adverse LV-remodelling. A-wave KE and MVO size early after acute MI are independently associated with adverse LV-remodelling.
Garg et al. (Tue,) conducted a cohort in ST-elevation myocardial infarction (n=69). 4D left ventricular blood flow kinetic energy mapping via CMR was evaluated on Adverse LV-remodelling (increase in LV end-diastolic volume by 15%) (AUC 0.82, 95% CI 0.7-0.9, p=<0.001). A regression model comprising acute microvascular obstruction and A-wave kinetic energy strongly predicted adverse LV-remodeling at 3 months (AUC 0.82; 95% CI 0.7-0.9; p<0.001).
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