Key result
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).
Why the study?
Does 4D LV blood flow energetics assessment predict adverse LV-remodelling in revascularised STEMI patients?
Cohort (n=69)
Does 4D LV blood flow energetics assessment predict adverse LV-remodelling in revascularised STEMI patients?
Effect estimate: AUC 0.82 (95% CI 0.7-0.9)
p-value: p=<0.001
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.
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 (p<0.05). In stepwise-regression analysis, only acute MVO (beta=0.17±0.06, p<0.05) and acute A-wave KE (beta=−0.17±0.08, p<0.05) independently predicted adverse remodelling at 3 months. A regression-model comprising of acute MVO and A-wave KE had high predictive value for adverse LV-remodelling (area under the curve=0.82, 95% confidence interval=0.7–0.9, p<0.001). Conclusion 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.
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Garg et al. (2018) 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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