Why the study?
Long-term adverse LV remodelling after STEMI carries poor prognosis and is difficult to predict, but acute 4D flow CMR can evaluate intra-cavity mechanical flow processes beyond LVEF.
Does acute 4D flow CMR predict long-term adverse LV remodelling in STEMI patients treated with primary PCI?
Does acute 4D flow CMR predict long-term adverse LV remodelling in STEMI patients treated with primary PCI?
Acute 4D flow CMR can identify abnormal intra-cavity flow dynamics, such as increased in-plane kinetic energy and residual volume, which predict long-term adverse LV remodelling following STEMI.
4D flow CMR parameters may identify post-STEMI remodelling risk; leaves open whether they improve stratification beyond standard metrics.
BACKGROUND: Despite advancements in percutaneous coronary intervention, a significant proportion of ST-elevation myocardial infarction (STEMI) survivors develop long-term adverse left ventricular (LV) remodelling, which is associated with poor prognosis. Adverse remodelling is difficult to predict, however four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) can measure various aspects of LV intra-cavity flow beyond LV ejection fraction and is well equipped for exploring the underlying mechanical processes driving remodelling. The aim for this study was to compare acute 4D flow CMR parameters between patients who develop adverse remodelling with patients who do not. METHODS: Fifty prospective 'first-event' STEMI patients underwent CMR 5 days post-reperfusion, which included cine-imaging, and 4D flow for assessing in-plane kinetic energy (KE), residual volume, peak-E and peak-A wave KE (indexed for LV end-diastolic volume [LVEDV]). All subjects underwent follow-up cine CMR imaging at 12 months to identify adverse remodelling (defined as 20% increase in LVEDV from baseline). Quantitative variables were compared using unpaired student's t-test. Tests were deemed statistically significant when p < 0.05. RESULTS: Patients who developed adverse LV remodelling by 12 months had significantly higher in-plane KE (54 ± 12 vs 42 ± 10%, p = 0.02), decreased proportion of direct flow (27 ± 9% vs 11 ± 4%, p < 0.01), increased proportion of delayed ejection flow (22 ± 9% vs 12 ± 2, p < 0.01) and increased proportion of residual volume after 2 consecutive cardiac cycles (64 ± 14 vs 34 ± 14%, p < 0.01), in their acute scan. CONCLUSION: Following STEMI, increased in-plane KE, reduced direct flow and increased residual volume in the acute scan were all associated with adverse LV remodelling at 12 months. Our results highlight the clinical utility of acute 4D flow in prognostic stratification in patients following myocardial infarction.
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Das et al. (2022) studied this question.
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