Left ventricular flow dynamics by cardiac imaging techniques in heart failure patients: state of the art

The evaluation of left ventricular (LV) flow dynamics is a novel approach to assessing LV function that goes beyond traditional metrics. This approach has been applied to patients with heart failure (HF), providing valuable insights that are discussed in this review, with the aim of enhancing our understanding of LV function in the context of the HF syndrome.

The analysis of LV flow dynamics is typically conducted using ultrasound and magnetic resonance imaging (MRI) techniques, primarily including particle image velocimetry echocardiography, Vector Flow Imaging, HyperDoppler, and four-dimensional flow MRI. A variety of parameters can be obtained that describe the geometry of the LV vortex, vorticity, kinetic energy, energy dispersion, as well as the amplitude and direction of the hemodynamic forces within the LV cavity.

In normal subjects, vortex formation plays a crucial role in optimizing LV filling, diastolic-systolic coupling, and energy transfer during systolic ejection. In patients with HF, alterations in vortex structure and dynamics have been associated with both systolic and diastolic LV dysfunction, demonstrating the potential to diagnose early LV dysfunction. Furthermore, these alterations have been linked to LV remodeling and thrombus formation. Several studies have also explored intracardiac flow metrics as biomarkers for guiding HF treatments, including pharmacological interventions, cardiac resynchronization therapy, and LV assist devices.

Currently available data suggest that the evaluation of LV flow dynamics can have diagnostic and prognostic utility in HF. However, large-scale, multicenter, and prospective studies are needed, particularly to validate therapeutic implications.