Key result
Late-diastolic LV blood flow kinetic energetics early post-MI linked to adverse LV remodeling.
Why the study?
It remained unknown how acute four-dimensional changes in left ventricular blood flow kinetic energy affect left ventricular remodeling following myocardial infarction.
Does left ventricular blood flow kinetic energy measured by 4D flow CMR early after STEMI predict adverse LV remodeling at 3 months?
Cohort (n=69)
Does left ventricular blood flow kinetic energy measured by 4D flow CMR early after STEMI predict adverse LV remodeling at 3 months?
p-value: p=<0.01
Late-diastolic LV blood flow kinetic energetics measured by 4D flow CMR early after acute STEMI is independently associated with adverse LV remodeling at 3 months.
May inform post-STEMI risk stratification; leaves open whether 4D flow CMR energetics adds value beyond standard measures.
BACKGROUND: Myocardial infarction leads to complex changes in left ventricular (LV) hemodynamics. It remains unknown how four-dimensional acute changes in LV-cavity blood flow kinetic energy affects LV-remodeling. METHODS AND RESULTS: In total, 69 revascularised ST-segment elevation myocardial infarction (STEMI) patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart four-dimensional flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction, mitral inflow, and blood flow KEi (kinetic energy indexed to end-diastolic volume) characteristics were obtained. Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume of at least 10%, 15%, and 20%. Twenty-four patients (35%) developed at least 10%, 17 patients (25%) at least 15%, 11 patients (16%) at least 20% LV-remodeling. Demographics and clinical history were comparable between patients with/without LV-remodeling. In univariable regression-analysis, A-wave KEi was associated with at least 10%, 15%, and 20% LV-remodeling (p = 0.03, p = 0.02, p = 0.02, respectively), whereas infarct size only with at least 10% LV-remodeling (p = 0.02). In multivariable regression-analysis, A-wave KEi was identified as an independent marker for at least 10%, 15%, and 20% LV-remodeling (p = 0.09, p < 0.01, p < 0.01, respectively), yet infarct size only for at least 10% LV-remodeling (p = 0.03). CONCLUSION: In patients with STEMI, LV hemodynamic assessment by LV blood flow kinetic energetics demonstrates a significant inverse association with adverse LV-remodeling. Late-diastolic LV blood flow kinetic energetics early after acute MI was independently associated with adverse LV-remodeling.
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Demirkıran et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=69). Four-dimensional flow cardiovascular magnetic resonance (A-wave KEi) was evaluated on Adverse LV-remodeling (increase in LV end-diastolic volume ≥10%, ≥15%, and ≥20%) (p=<0.01). Late-diastolic left ventricular blood flow kinetic energetics early after acute MI was independently associated with adverse LV-remodeling of at least 15% and 20% (p < 0.01).
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