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Left Ventricular Flow Analysis
Victoria M Stoll1, Aaron T Hess1, Christopher T Rodgers1,2
1Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, United Kingdom (V.M.S., A.T.H., C.T.R., M.M.B., S.G.M., S.N.).
Insights
Altered left ventricular blood flow, specifically reduced direct flow kinetic energy (KE), independently predicts functional capacity in heart failure patients. This finding highlights 4-dimensional flow parameters as novel prognostic biomarkers.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Medical Imaging
Background:
- Cardiac remodeling post-myocardial insult can lead to heart failure.
- The link between left ventricular (LV) blood flow alterations, including kinetic energy (KE), and cardiac remodeling is not well understood.
- This study investigated the relationship between LV blood flow derangements and markers of cardiac remodeling, energetics, and patient prognosis.
Purpose of the Study:
- To determine if alterations in LV blood flow, specifically KE, correlate with cardiac remodeling.
- To assess the association between LV blood flow characteristics and biochemical markers, cardiac energetics, and patient-reported symptoms and functional capacity.
- To identify novel predictors of functional capacity in heart failure patients.
Main Methods:
- 34 dilated cardiomyopathy patients, 30 ischemic cardiomyopathy patients, and 36 controls underwent cardiac magnetic resonance imaging with 4-dimensional flow.
- Measurements included brain-type natriuretic peptide (BNP), 6-minute walk test (6MWT), and symptom quantification.
- LV flow was analyzed into components (direct flow, retained inflow, delayed ejection flow, residual volume), and average KE was calculated.
Main Results:
- Patients exhibited reduced direct flow proportion and direct-flow average KE compared to controls (P<0.0001).
- Residual volume proportion and average KE were increased in patients (P<0.0001).
- Direct-flow average KE and age were independent predictors of 6MWT performance (R²=0.466, P=0.002), outperforming ejection fraction and LV volumes.
Conclusions:
- Direct-flow average KE is an independent predictor of functional capacity in heart failure patients.
- Intracardiac 4-dimensional flow parameters represent novel biomarkers for monitoring heart failure therapies and prognosis.
- These findings suggest a significant role for hemodynamic assessment in understanding and managing heart failure progression.
Background:
Cardiac remodeling, after a myocardial insult, often causes progression to heart failure. The relationship between alterations in left ventricular blood flow, including kinetic energy (KE), and remodeling is uncertain. We hypothesized that increasing derangements in left ventricular blood flow would relate to (1) conventional cardiac remodeling markers, (2) increased levels of biochemical remodeling markers, (3) altered cardiac energetics, and (4) worsening patient symptoms and functional capacity. Methods Thirty-four dilated cardiomyopathy patients, 30 ischemic cardiomyopathy patients, and 36 controls underwent magnetic resonance including 4-dimensional flow, BNP (brain-type natriuretic peptide) measurement, functional capacity assessment (6-minute walk test), and symptom quantification. A subgroup of dilated cardiomyopathy and control subjects underwent cardiac energetic assessment. Left ventricular flow was separated into 4 components: direct flow, retained inflow, delayed ejection flow, and residual volume. Average KE throughout the cardiac cycle was calculated.
Results:
Patients had reduced direct flow proportion and direct-flow average KE compared with controls ( P<0.0001). The residual volume proportion and residual volume average KE were increased in patients ( P<0.0001). Importantly, in a multiple linear regression model to predict the patient's 6-minute walk test, the independent predictors were age (β=-0.3015; P=0.019) and direct-flow average KE (β=0.280, P=0.035; R2 model, 0.466, P=0.002). In contrast, neither ejection fraction nor left ventricular volumes were independently predictive.
Conclusions:
This study demonstrates an independent predictive relationship between the direct-flow average KE and a prognostic measure of functional capacity. Intracardiac 4-dimensional flow parameters are novel biomarkers in heart failure and may provide additive value in monitoring new therapies and predicting prognosis.
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