Key result
Chronic MI linked to ~16-point lower direct LV flow compared to healthy controls.
Why the study?
Left ventricular thrombus formation frequently complicates myocardial infarction, but how global left ventricular flow characteristics relate to this phenomenon remains uncertain.
Does chronic myocardial infarction with or without left ventricular thrombus alter left ventricular flow components and energetics measured by 4D flow CMR compared to healthy controls?
Cohort (n=28)
Yes
Does chronic myocardial infarction with or without left ventricular thrombus alter left ventricular flow components and energetics measured by 4D flow CMR compared to healthy controls?
Absolute Event Rate: 22% vs 38%
p-value: p=<0.001
4D flow CMR identifies distinct left ventricular hemodynamic alterations, including reduced energetics and altered vorticity, in chronic MI patients with and without left ventricular thrombus.
Reduced direct LV flow on 4D flow CMR in chronic MI may flag thrombus risk; leaves open its value for risk stratification or management.
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.
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Demirkıran et al. (2022) conducted a cohort in Chronic myocardial infarction with or without left ventricular thrombus (n=28). Chronic myocardial infarction with or without left ventricular thrombus vs. Healthy controls was evaluated on Left ventricular direct flow component (% of end-diastolic volume) (p=<0.001). Chronic myocardial infarction patients had a significantly smaller proportion of direct left ventricular flow compared to healthy controls (22% vs 38%, p<0.001), with irregular vorticity fields noted in those with left ventricular thrombus.
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