Key result
Medication linked to ~20% lower LV flow energy loss at one year, reflecting improved clinical status.
Why the study?
Blood flow analysis and energy loss as parameters to reflect clinical status in patients with dilated cardiomyopathy have not been established.
Case Report (n=1)
Absolute Event Rate: 0.322% vs 0.403%
Blood flow analysis and energy loss measured by CMR can serve as novel parameters to reflect clinical status and therapeutic effect in patients with dilated cardiomyopathy.
CMR energy loss may track therapeutic response in dilated cardiomyopathy; hypothesis-generating from one case, needs prospective validation.
A 52-year-old man was emergently admitted to our hospital for the treatment of congestive heart failure. Cardiac magnetic resonance imaging (CMR) showed left ventricle (LV) dilatation (LV end-diastolic volume: LVEDV 287 mL) and severe LV systolic dysfunction (LV ejection fraction: LVEF 18%). Coronary angiography showed no stenosis or obstruction. Endomyocardial biopsy showed only mild interstitial fibrosis leading to the diagnosis of idiopathic dilated cardiomyopathy (DCM). After 1 year of medication, LVEDV was deceased to 171 mL and LVEF improved to 34% by follow-up CMR. From the two CMR studies, intramural LV geometry was extracted with Steady-State Free Precession series, and phase-contrast CMR was superposed. Blood flow was visualized and flow energy loss (EL) with viscous dissipation was calculated in-house code. Before the medication, LV inflow showed a large vortex during diastole. Inside the well-organized vortex, flow dissipated small EL, but around the vortex, EL was prominently high (Panels A–D). After the medication, the size of vortex during diastole decreased, and located in the basal portion, and the vortex facilitated the smooth outflow. Energy loss in this improved LV was significantly low especially in the mid and apical portion (Panels E–H). Total EL during one cardiac cycle reduced from 0.403 to 0.322 W/m (Panels I and J). Blood flow patterns can change with the improvement LV muscular condition, resulting in EL decrease. Blood flow analysis and EL can be a novel parameter that reveal the clinical status in patients with DCM. Supplementary material is available at European Heart Journal online.
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Nabeta et al. (2014) conducted a case report in Idiopathic dilated cardiomyopathy (n=1). Medication vs. Baseline (before medication) was evaluated on Total flow energy loss (EL) during one cardiac cycle. After 1 year of medication, total flow energy loss during one cardiac cycle reduced from 0.403 to 0.322 W/m, reflecting improved left ventricular muscular condition and clinical status.
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