Association of left ventricular flow energetics with remodeling after myocardial infarction: New hemodynamic insights for left ventricular remodeling. (15th November 2022)

• Record Type: Journal Article
• Authors: Demirkiran, Ahmet; van der Geest, Rob J.; Hopman, Luuk H.G.A.; Robbers, Lourens F.H.J.; Handoko, M. Louis; Nijveldt, Robin; Greenwood, John P.; Plein, Sven; Garg, Pankaj
• Is Part Of: International journal of cardiology. Volume 367(2022)
• Page Start: 105
• Page End: 114
• Publication Date: 2022-11-15
• Subjects: Kinetic energy -- Left ventricular remodeling -- ST-segment elevation myocardial infarction; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.08.040
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Myocardial infarction leads to complex changes in left ventricular (LV) hemodynamics. It remains unknown how four-dimensional acute changes in LV-cavity blood flow kinetic energy affects LV-remodeling. Methods and results: In total, 69 revascularised ST-segment elevation myocardial infarction (STEMI) patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart four-dimensional flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction, mitral inflow, and blood flow KEi (kinetic energy indexed to end-diastolic volume) characteristics were obtained. Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume of at least 10%, 15%, and 20%. Twenty-four patients (35%) developed at least 10%, 17 patients (25%) at least 15%, 11 patients (16%) at least 20% LV-remodeling. Demographics and clinical history were comparable between patients with/without LV-remodeling. In univariable regression-analysis, A-wave KEi was associated with at least 10%, 15%, and 20% LV-remodeling (p = 0.03, p = 0.02, p = 0.02, respectively), whereas infarct size only with at least 10% LV-remodeling (p = 0.02). In multivariable regression-analysis, A-wave KEi was identified as an independent marker for at least 10%, 15%, and 20% LV-remodeling (p = 0.09, p < 0.01, p < 0.01, respectively), yet infarct size only for at least 10% LV-remodeling (p = 0.03). Conclusion: In patients with STEMI, LV hemodynamic assessment by LV blood flow kinetic energetics demonstrates a significant inverse association with adverse LV-remodeling. Late-diastolic LV blood flow kinetic energetics early after acute MI was independently associated with adverse LV-remodeling. Graphical abstract: The upper panel summarizes the established and novel potential CMR-derived contributors to adverse LV-remodeling. The bottom panel represents the late-diastolic LV blood flow KE maps on 4-chamber and 2-chamber views, LV blood flow KE curves, and mitral inflow curves for each identified adverse LV-remodeling level (mild: 10–15%, moderate: 15–20%, severe: >20%). With no adverse LV-remodeling, the level of kinetic energetics during late-diastole (A-wave) appears high compared to during early-diastole (E-wave). As LV-remodeling emerges and advances, the level of kinetic energetics during late-diastole (A-wave) reduces and becomes lower compared to during early-diastole (E-wave). The reduction in LV blood flow energetics during late diastole (A-wave) is visually appreciated on KE maps. Concerning mitral inflow, a similar switch pattern is observed between early diastole and late diastole, as LV-remodeling emerges and advances. Abbreviations: LV, left ventricular; LVEDV, left ventricular end-diastolic volume; KEi, kinetic energy indexed to LVEDV. Unlabelled Image Highlights: The link between left ventricular (LV) blood flow energetics and LV-remodeling after myocardial infarction is explored. This relationship is most apparent with late-diastolic (A-wave) LV blood flow energetics. A-wave LV blood flow energetics may provide additional value over infarct size as an indicator of severe LV-remodeling.