Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac
Karin Pola1, Anders Roijer2, Rasmus Borgquist3
1Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
Insights
Hemodynamic forces (HDF) can predict response to cardiac resynchronization therapy (CRT) in heart failure patients with left bundle branch block (LBBB). A higher diastolic HDF ratio indicates a lower likelihood of benefiting from CRT.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Imaging
Background:
- Cardiac resynchronization therapy (CRT) is used for heart failure patients with left bundle branch block (LBBB).
- Current CRT selection criteria are imprecise, leading to suboptimal treatment responses.
- Hemodynamic forces (HDF) are proposed as a potential marker for CRT response.
Purpose of the Study:
- To investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT.
- To assess the utility of HDF in identifying patients likely to benefit from CRT.
Main Methods:
- 22 patients with heart failure, EF < 35%, and LBBB underwent cardiac magnetic resonance (CMR) with 4D flow before CRT.
- LV HDF were computed using Navier-Stokes equations, and transverse/longitudinal HDF ratios were calculated for systole and diastole.
- CRT responders were defined by a ≥15% reduction in end-systolic volume 6 months post-CRT.
Main Results:
- Non-responders had significantly smaller systolic HDF in the inferior-anterior direction and diastolic HDF in the apex-base direction compared to responders.
- Non-responders exhibited a significantly larger diastolic HDF ratio (0.89 vs. 0.67).
- ROC analysis showed an AUC of 0.88 for the diastolic HDF ratio in identifying non-responders (sensitivity 57%, specificity 100% for ratio > 0.87).
Conclusions:
- The hemodynamic force ratio shows potential as a marker to identify heart failure patients with LBBB unlikely to benefit from CRT.
- Larger studies are needed to validate HDF analysis for clinical practice implementation.
Background:
Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT.
Methods:
Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier-Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders.
Results:
Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio > 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8).
Conclusion:
Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice.
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