Quantitative imaging in medicine and surgery · 2025
Left ventricular blood flow kinetic energy by 4D flow magnetic resonance imaging in patients with acute myocardial infarction after revascularization.
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Liu Ming-Xi, Liu Xin, Liu Yang, Liu Qi-Ming, Liang Lu, He Ji-Fang, Guo Xiao-Juan, An Jing, Yang Qi, Jiang Tao
Аннотация
BACKGROUND: Percutaneous coronary intervention (PCI) can quickly restore epicardial coronary blood flow in patients with acute ST-segment elevation myocardial infarction (STEMI) to rescue the ischemic myocardium but it also frequently results in microvascular damage and further myocyte necrosis. The changes in left ventricular (LV) hemodynamics in these patients after PCI are not clearly understood. The main objective of this study was to characterize the parameters of LV blood flow kinetic energy (KE) and to explore the predictive value of these parameters on 4D flow cardiac magnetic resonance (CMR) imaging for poor prognosis in patients with STEMI after PCI.
METHODS: This prospective study included 32 acute STEMI patients who underwent PCI and 21 healthy controls without heart or lung diseases. All participants underwent CMR examinations and were grouped based on the presence of anterior wall myocardial infarction, microvascular obstruction (MVO), and intra-myocardial hemorrhage (IMH) as well as the LV ejection fraction (EF). KE values were normalized to the LV end-diastolic volume (EDV) to obtain KEiEDV parameters for comparison between subgroups and the healthy control group. Correlation analysis was performed between KEiEDV parameters and multiple cardiac function parameters.
RESULTS: The delayed ejection flow component was significantly higher in the anterior group (F=3.847, P=0.028), MVO (F=6.035, P=0.004), IMH (F=4.164, P=0.021), and EF <50% groups (F=5.488, P=0.007) than in the control group and other subgroups. The direct flow component was lower in the anterior, MVO, and EF <50% groups than in the control group (P=0.024, 0.016, 0.049, respectively) and lower in the IMH group than in the non-IMH and control groups (F=5.285, P=0.008). The ratio of peak systolic KEiEDV of direct flow to the delayed ejection flow (Pd/Pde) was significantly lower in the MVO and IMH groups (P=0.006 and 0.006). Statistical differences were observed in the KEiEDV parameters related to diastolic function among the subgroups, especially in the non-MVO group. Some KEiEDV parameters were strongly or moderately correlated with parameters reflecting LV structure and function.
CONCLUSIONS: LV KEiEDV parameters can quantitatively reflect hemodynamic and energetics abnormalities in acute STEMI patients after PCI. The changes in the delayed ejection flow component, direct flow component, and Pd/Pde reflect the decrease of LV work efficiency and may explain based on hemodynamic insights, especially energetics, the key pathophysiology in these patients who are prone to a poor prognosis.
METHODS: This prospective study included 32 acute STEMI patients who underwent PCI and 21 healthy controls without heart or lung diseases. All participants underwent CMR examinations and were grouped based on the presence of anterior wall myocardial infarction, microvascular obstruction (MVO), and intra-myocardial hemorrhage (IMH) as well as the LV ejection fraction (EF). KE values were normalized to the LV end-diastolic volume (EDV) to obtain KEiEDV parameters for comparison between subgroups and the healthy control group. Correlation analysis was performed between KEiEDV parameters and multiple cardiac function parameters.
RESULTS: The delayed ejection flow component was significantly higher in the anterior group (F=3.847, P=0.028), MVO (F=6.035, P=0.004), IMH (F=4.164, P=0.021), and EF <50% groups (F=5.488, P=0.007) than in the control group and other subgroups. The direct flow component was lower in the anterior, MVO, and EF <50% groups than in the control group (P=0.024, 0.016, 0.049, respectively) and lower in the IMH group than in the non-IMH and control groups (F=5.285, P=0.008). The ratio of peak systolic KEiEDV of direct flow to the delayed ejection flow (Pd/Pde) was significantly lower in the MVO and IMH groups (P=0.006 and 0.006). Statistical differences were observed in the KEiEDV parameters related to diastolic function among the subgroups, especially in the non-MVO group. Some KEiEDV parameters were strongly or moderately correlated with parameters reflecting LV structure and function.
CONCLUSIONS: LV KEiEDV parameters can quantitatively reflect hemodynamic and energetics abnormalities in acute STEMI patients after PCI. The changes in the delayed ejection flow component, direct flow component, and Pd/Pde reflect the decrease of LV work efficiency and may explain based on hemodynamic insights, especially energetics, the key pathophysiology in these patients who are prone to a poor prognosis.