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Altered Diastolic Flow Patterns and Kinetic Energy in Subtle Left Ventricular Remodeling and Dysfunction Detected by 4D Flow MRI
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 8, 1-12 p., e0161391Article in journal (Refereed) Published
Abstract [en]

Aims: 4D flow magnetic resonance imaging (MRI) allows quantitative assessment of left ventricular (LV) function according to characteristics of the dynamic flow in the chamber. Marked abnormalities in flow components volume and kinetic energy (KE) have previously been demonstrated in moderately dilated and depressed LVs compared to healthy subjects. We hypothesized that these 4D flow-based measures would detect even subtle LV dysfunction and remodeling.

Methods and Results: We acquired 4D flow and morphological MRI data from 26 patients with chronic ischemic heart disease with New York Heart Association (NYHA) class I and II and with no to mild LV systolic dysfunction and remodeling, and from 10 healthy controls. A previously validated method was used to separate the LV end-diastolic volume (LVEDV) into functional components: direct flow, which passes directly to ejection, and non-ejecting flow, which remains in the LV for at least 1 cycle. The direct flow and non-ejecting flow proportions of end-diastolic volume and KE were assessed. The proportions of direct flow volume and KE fell with increasing LVEDV-index (LVEDVI) and LVESV-index (LVESVI) (direct flow volume r = -0.64 and r = -0.74, both Pamp;lt;0.001; direct flow KE r = -0.48, P = 0.013, and r = -0.56, P = 0.003). The proportions of non-ejecting flow volume and KE rose with increasing LVEDVI and LVESVI (non-ejecting flow volume: r = 0.67 and r = 0.76, both Pamp;lt;0.001; non-ejecting flow KE: r = 0.53, P = 0.005 and r = 0.52, P = 0.006). The proportion of direct flow volume correlated moderately to LVEF (r = 0.68, P amp;lt; 0.001) and was higher in a sub-group of patients with LVEDVI amp;gt; 74 ml/m(2) compared to patients with LVEDVI amp;lt; 74 ml/m(2) and controls (both Pamp;lt;0.05).

Conclusion: Direct flow volume and KE proportions diminish with increased LV volumes, while non-ejecting flow proportions increase. A decrease in direct flow volume and KE at end-diastole proposes that alterations in these novel 4D flow-specific markers may detect LV dysfunction even in subtle or subclinical LV remodeling.

Place, publisher, year, edition, pages
Public Library of Science , 2016. Vol. 11, no 8, 1-12 p., e0161391
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Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:liu:diva-131684DOI: 10.1371/journal.pone.0161391ISI: 000381487600091PubMedID: 27532640OAI: oai:DiVA.org:liu-131684DiVA: diva2:1014867
Note

Funding Agencies|Swedish Heart Lung foundation [20140398]; Swedish Research Council [2014-6191]; European Union FP7 [223615]; Medical Research Council of Southeast Sweden [FORSS-35141, FORSS-88731, FORSS-157921]; County Council of Ostergotland/Heart and Medicine Center [20090120]

Available from: 2016-10-03 Created: 2016-09-30 Last updated: 2016-11-02Bibliographically approved

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Svalbring, EmilFredriksson, AlexandruEriksson, JonatanDyverfeldt, PetterEbbers, TinoBolger, Ann FEngvall, JanCarlhäll, Carljohan
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesCenter for Medical Image Science and Visualization (CMIV)Department of Clinical Physiology in Linköping
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