What is the clinical evidence from this study?

Study design: Case-Control. Population: Myocardial Infarction (n=68). Intervention: Myocardial infarction (exposure) vs. Healthy controls. Primary outcome: Average left ventricular blood flow kinetic energy indexed to end-diastolic volume (LV KEiEDV) (p=0.02).

February 1, 2018Journal of Cardiovascular Magnetic ResonanceOpen Access

Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance

Q: What are the key findings of this study?

Myocardial infarction patients demonstrated significantly lower average left ventricular blood flow kinetic energy compared to healthy controls (6.5 vs 8.5 μJ/ml, P=0.02).

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Key result

MI patients show ~24% lower average LV blood flow kinetic energy versus healthy controls.

P=0.02
n=68

Why the study?

Does 4D flow CMR detect altered left ventricular blood flow kinetic energy in patients with myocardial infarction compared to healthy controls?

Study Design

Type

Case-Control (n=68)

Multicenter

Yes

Structured PICO

Does 4D flow CMR detect altered left ventricular blood flow kinetic energy in patients with myocardial infarction compared to healthy controls?

Population

68 subjects: 48 patients with myocardial infarction (22 acute STEMI treated by primary PCI within 12 hours, 26 chronic MI with ischemic scar on LGE) and 20 age/gender-matched healthy controls. Mean age 57 in MI group, 52 in controls. Exclusions: non-ischemic cardiomyopathy, severe valvular heart disease, eGFR < 30 ml/min/1.73m2, hemodynamic instability (Killip class III/IV requiring IV diuretics), and contraindications to CMR.

Intervention

Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) imaging

Comparator

Healthy controls with no history or symptoms of cardiovascular disease and normal LV ejection fraction

Outcome

Left ventricular (LV) blood flow kinetic energy (KE) parameters indexed to LV end-diastolic volume (KEiEDV), including averaged LV, minimal, systolic, diastolic, peak E-wave, and peak A-wave KEiEDV, as well as in-plane proportion of LV KE and time difference to peak E-wave KE propagationsurrogate

Main Result

Absolute Event Rate: 6.5% vs 8.5%

p-value: p=0.02

4D flow CMR demonstrates that myocardial infarction is associated with significant reductions in left ventricular systolic blood flow kinetic energy, which correlates with infarct size and the degree of LV impairment.

Limitations

Respiratory navigation was omitted for the 4D flow acquisition.
Temporal resolution of the 4D flow was 40 ms, which may affect the quality of KE and TD assessment.
MI patients received contrast whereas healthy controls did not, potentially introducing bias.
Scanner's electrocardiogram used to calculate time differences may result in less precise estimates.
Differences in physiological conditions between breath-hold cine and free-breathing 4D flow.
Results cannot be applied to patients with significant valvulopathy, cardiomyopathies and congenital heart disease.

Discussion

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Implication

4D flow CMR identifies altered LV flow post-MI; leaves open its prognostic role pending prospective validation.

Cite This Study

Garg et al. (2018) conducted a case-control in Myocardial Infarction (n=68). Myocardial infarction (exposure) vs. Healthy controls was evaluated on Average left ventricular blood flow kinetic energy indexed to end-diastolic volume (LV KEiEDV) (p=0.02). Myocardial infarction patients demonstrated significantly lower average left ventricular blood flow kinetic energy compared to healthy controls (6.5 vs 8.5 μJ/ml, P=0.02).

synapsesocial.com/papers/6a0f2bf204e2b0ba896ca10f https://doi.org/10.1186/s12968-018-0483-6

Topics

Cardiac MRI STEMI management

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Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider