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4 Four-dimensional left ventricular blood flow energetics independently predict adverse remodelling post st-elevation myocardial infarction

Heart (British Cardiac Society), 2018-05, Vol.104 (Suppl 5), p.A7 [Peer Reviewed Journal]

2018, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions ;Copyright: 2018 © 2018, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions ;ISSN: 1355-6037 ;EISSN: 1468-201X ;DOI: 10.1136/heartjnl-2018-BCVI.19

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  • Title:
    4 Four-dimensional left ventricular blood flow energetics independently predict adverse remodelling post st-elevation myocardial infarction
  • Author: Garg, Pankaj ; van der Geest, Rob J ; Swoboda, Peter P ; Crandon, Saul ; Fent, Graham J ; Foley, James RJ ; Dobson, Laura E ; Musa, Tarique Al ; Onciul, Sebastian ; Vijayan, Sethumadhavan ; Chew, Pei G ; Brown, Louise AE ; Bissell, Malenka ; Hassell, Mariëlla ECJ ; Nijveldt, Robin ; Elbaz, Mohammed SM ; Westenberg, Jos JM ; Dall’Armellina, Erica ; Greenwood, John P ; Plein, Sven
  • Subjects: Automation
  • Is Part Of: Heart (British Cardiac Society), 2018-05, Vol.104 (Suppl 5), p.A7
  • Description: IntroductionMyocardial infraction (MI) leads to complex changes in left ventricular (LV) haemodynamics. It remains unknown how four-dimensional (4D) acute changes in LV-cavity blood flow kinetic energy (KE) affect LV remodelling. We hypothesised that LV blood flow energetics is independently associated with adverse LV-remodelling.MethodsWe recruited 69 revascularised ST-elevation MI patients. All patients underwent cardiovascular magnetic resonance (CMR) at 1.5 T within 48 hours and at 3 months. CMR included cines, early/late gadolinium enhancement and whole-heart 4D flow. CMR analysis included: LV volumes, infarct size (IS,%), microvascular obstruction (MVO,%), two-dimensional, retrospective valve tracking derived mitral inflow metrics and 4D KE components. KE was derived using novel, semi-automated method by using endocardial contours on short-axis cines to extract intra-cavity velocity profile. Adverse LV-remodelling was defined as increase in LV end-diastolic volume by 15%.ResultsThirteen (19%) patients developed adverse LV-remodelling. Demographics were comparable between patients with/without remodelling. Baseline CMR in adverse LV-remodelling-group showed significantly lower EF, LV KE, Systolic, A-wave, in-plane KEs and increased MVO (p<0.05). In stepwise-regression analysis, only acute MVO (beta=0.17±0.06, p<0.05) and acute A-wave KE (beta=−0.17±0.08, p<0.05) independently predicted adverse remodelling at 3 months. A regression-model comprising of acute MVO and A-wave KE had high predictive value for adverse LV-remodelling (area under the curve=0.82, 95% confidence interval=0.7–0.9, p<0.001).ConclusionLV haemodynamic assessment by novel, semi-automated, 4D KE mapping adds incremental value to predict adverse LV-remodelling. A-wave KE and MVO size early after acute MI are independently associated with adverse LV-remodelling.
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 1355-6037
    EISSN: 1468-201X
    DOI: 10.1136/heartjnl-2018-BCVI.19
  • Source: ProQuest Central
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