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CMR-derived left ventricular intraventricular pressure gradients identify different patterns associated with

Jacqueline L Vos1, Anne G Raafs2, Michiel T H M Henkens2

  • 1Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.

European Heart Journal. Cardiovascular Imaging
|May 3, 2023
PubMed

Insights

Intraventricular pressure gradients (IVPG) analysis in dilated cardiomyopathy (DCM) patients reveals that blood flow reversal predicts worse outcomes. Impaired IVPG and filling forces also indicate poor prognosis, independent of other factors.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Left ventricular (LV) blood flow is crucial for cardiac function and is influenced by intraventricular pressure gradients (IVPG).
  • Alterations in LV blood flow can precede adverse cardiac remodeling and functional decline in conditions like dilated cardiomyopathy (DCM).
  • Novel cardiac magnetic resonance (CMR) techniques for analyzing LV-IVPG offer potential for sensitive LV function assessment in DCM.

Purpose of the Study:

  • To investigate LV-IVPG patterns in DCM patients.
  • To determine the prognostic value of LV-IVPG analysis in DCM.
  • To explore the relationship between IVPG dynamics and adverse cardiovascular events.

Main Methods:

  • Quantitative analysis of LV-IVPG was performed using standard CMR cine images in 447 DCM patients.
  • Patients were monitored for major adverse cardiovascular events (MACE), including heart failure hospitalizations, arrhythmias, and cardiac death.
  • Statistical analysis, including hazard ratios, was used to assess the predictive value of IVPG parameters for outcomes.

Main Results:

  • A temporary LV-IVPG reversal during systolic-diastolic transition was observed in 38% of DCM patients.
  • Blood flow reversal, a consequence of IVPG reversal, predicted worse outcomes (HR = 2.57, P = 0.047).
  • In patients without pressure reversal, impaired overall LV-IVPG, systolic ejection force, and E-wave decelerative force independently predicted adverse outcomes.

Conclusions:

  • Blood flow reversal due to IVPG changes during the systolic-diastolic transition is a significant predictor of poor prognosis in DCM.
  • In the absence of blood flow reversal, weakened systolic ejection force, decelerative filling force, and overall IVPG are potent independent predictors of outcome in DCM patients.
  • LV-IVPG analysis using CMR provides valuable prognostic information beyond traditional clinical and imaging parameters in DCM.
Abstract

Keywords:
CMRdilated cardiomyopathyfeature trackingintraventricular pressure gradientleft atrial strainleft ventricular strain

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