Left ventricular flow kinetics and myocardial deformation following acute infarction: Additional predictive value of cardiac magnetic resonance four-dimensional flow for left ventricular remodeling post-ST-elevation myocardial infarction

Figures

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  Fig. 1. Overview of the study timeline and assessments. V0 represents STEMI onset. CMR with feature tracking (FT) and 4D flow kinetic assessment was performed at V1 (3–5 days post-STEMI), V2 (3 months post-STEMI), and V3 (12 months post-STEMI). Remodeling groups were defined based on changes between the acute (V1) and 12 months (V3) CMR. 4D four-dimensional, STEMI ST-elevation myocardial infarction, CMR cardiovascular magnetic resonance

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  Fig. 2. Assessment of FT strain parameters. (A) Illustration of the manual contouring of the endocardial and epicardial borders in the end-diastolic frame for all short- and long-axis slices. Right ventricular insertion points were also manually defined within the LV. (B) 3D deformation model obtained from short- and long-axis images. (C) Illustration of LV mesh overlay in short- and long-axis images for quality control of tracking and segmentation. Illustration of the global results for: GCS (D), GRS (E), GLS (F) as well as the segmental GLS results (G) FT feature tracking, LV left ventricular, GCS global circumferential strain, GRS global radial strain, GLS global longitudinal strain

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  Fig. 3. (A, B) Illustration of the 4D flow post processing. (A) Illustration of the manual contouring of the endocardial and epicardial borders. The segmentation was performed for all short-axis cine images. (B) Registration process between short-axis cine images and 4D flow data to correct for any patient movement between acquisitions. (C, D) Illustration of the 4D flow components: (C) direct flow (green line): blood flowing into the LV during diastole and exiting the LV during systole in the examined cardiac cycle. Retained volume (yellow line): blood flowing into the LV during diastole and not exiting the LV during systole in the examined cardiac cycle. Delayed ejection (flow (blue line): blood starting and remaining within the LV during diastole, and exiting during systole. Residual volume (red line): blood remaining within the LV for a minimum of two cardiac cycles. (D) LV blood flow KE curves during the cardiac cycle. Red curve represents LV endocardium. Blue curve represents basal LV myocardial segments. Green curve represents mid LV myocardial segments. White curve represents apical LV myocardial curves. Minimal KEiEDV average KE of the LV flow at any time point during the whole…

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  Fig. 4. Correlations between direct flow and myocardial deformation at 3 months. (A) GRS vs direct flow (%); (B) GCS vs direct flow (%); (C) GLS vs direct flow (%). (D) Subgroup analysis of 4D flow-derived direct flow between LVremod and LVnon-remod patients. Patients prone to develop adverse cardiac remodeling at 12 months post STEMI (blue circle) had significantly lower percentage of direct flow at 3 months post STEMI in comparison to those without adverse cardiac remodeling at 12 months post STEMI (red circle). GCS global circumferential strain, GLS global longitudinal strain, GRS global radial strain, LVremod adverse left ventricular remodeling at 12 months post STEMI, LVnon-remod no adverse left ventricular remodeling at 12 months post STEMI, STEMI ST-elevation myocardial infarction, 4D four-dimensional

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  Fig. 5. Correlation between residual volume and myocardial deformation at 3 months. (A) GRS vs residual flow, (B) GCS vs residual flow, (C) GLS vs residual flow. (D) Subgroup analysis of 4D flow-derived residual flow between LVremod and LVnon-remod patients. Patients prone to develop adverse cardiac remodeling at 12 months post STEMI (blue circle) had significantly higher percentage of residual volume at 3 months post STEMI in comparison to those without adverse cardiac remodeling at 12 months post STEMI (blue circle). GCS global circumferential strain, GLS global longitudinal strain, GRS global radial strain, LVremod adverse left ventricular remodeling at 12 months post STEMI, LVnon-remod no adverse left ventricular remodeling at 12 months post STEMI, STEMI ST-elevation myocardial infarction, 4D four-dimensional