心肌梗死后左心室血流动能 - 4D 流心血管磁共振的见解。
Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance.
机构信息
Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK.
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
出版信息
J Cardiovasc Magn Reson. 2018 Aug 30;20(1):61. doi: 10.1186/s12968-018-0483-6.
BACKGROUND
Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics that are linked to clinical outcomes. We hypothesize that LV blood flow kinetic energy (KE) is altered in MI and is associated with LV function and infarct characteristics. This study aimed to investigate the intra-cavity LV blood flow KE in controls and MI patients, using cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow assessment.
METHODS
Forty-eight patients with MI (acute-22; chronic-26) and 20 age/gender-matched healthy controls underwent CMR which included cines and whole-heart 4D flow. Patients also received late gadolinium enhancement imaging for infarct assessment. LV blood flow KE parameters were indexed to LV end-diastolic volume and include: averaged LV, minimal, systolic, diastolic, peak E-wave and peak A-wave KEi. In addition, we investigated the in-plane proportion of LV KE (%) and the time difference (TD) to peak E-wave KE propagation from base to mid-ventricle was computed. Association of LV blood flow KE parameters to LV function and infarct size were investigated in all groups.
RESULTS
LV KEi was higher in controls than in MI patients (8.5 ± 3 μJ/ml versus 6.5 ± 3 μJ/ml, P = 0.02). Additionally, systolic, minimal and diastolic peak E-wave KEi were lower in MI (P < 0.05). In logistic-regression analysis, systolic KEi (Beta = - 0.24, P < 0.01) demonstrated the strongest association with the presence of MI. In multiple-regression analysis, infarct size was most strongly associated with in-plane KE (r = 0.5, Beta = 1.1, P < 0.01). In patients with preserved LV ejection fraction (EF), minimal and in-plane KEi were reduced (P < 0.05) and time difference to peak E-wave KE propagation during diastole increased (P < 0.05) when compared to controls with normal EF.
CONCLUSIONS
Reduction in LV systolic function results in reduction in systolic flow KEi. Infarct size is independently associated with the proportion of in-plane LV KE. Degree of LV impairment is associated with TD of peak E-wave KE. In patient with preserved EF post MI, LV blood flow KE mapping demonstrated significant changes in the in-plane KE, the minimal KEi and the TD. These three blood flow KE parameters may offer novel methods to identify and describe this patient population.
背景
心肌梗死（MI）导致左心室（LV）血流动力学的复杂变化，这些变化与临床结果相关。我们假设 MI 患者的 LV 血流动能（KE）发生改变，并且与 LV 功能和梗死特征相关。本研究旨在使用心血管磁共振（CMR）四维（4D）流评估来研究对照组和 MI 患者的腔内 LV 血流 KE。
方法
48 例 MI 患者（急性 22 例，慢性 26 例）和 20 名年龄/性别匹配的健康对照组接受了 CMR 检查，包括电影和全心 4D 流。患者还接受了钆延迟增强成像以评估梗死。LV 血流 KE 参数按 LV 舒张末期容积指数化，包括：平均 LV、最小、收缩、舒张、峰值 E 波和峰值 A 波 KEi。此外，我们还研究了 LV KE 的平面比例（%），并计算了从基底到心室中部的峰值 E 波 KE 传播的时间差（TD）。在所有组中都研究了 LV 血流 KE 参数与 LV 功能和梗死面积的关系。
结果
对照组的 LV KEi 高于 MI 患者（8.5±3μJ/ml 与 6.5±3μJ/ml，P=0.02）。此外，MI 患者的收缩期、最小和舒张期峰值 E 波 KEi 较低（P<0.05）。在逻辑回归分析中，收缩期 KEi（Beta=-0.24，P<0.01）与 MI 的存在具有最强的相关性。在多元回归分析中，梗死面积与平面 KE 相关性最强（r=0.5，Beta=1.1，P<0.01）。在左心室射血分数（EF）正常的患者中，与对照组相比，最小 KEi 和平面 KEi 降低（P<0.05），舒张期峰值 E 波 KE 传播的时间差增加（P<0.05）。
结论
LV 收缩功能的降低导致收缩期血流 KEi 的降低。梗死面积与腔内 LV KE 的平面比例独立相关。LV 损伤程度与峰值 E 波 KE 的 TD 相关。在 MI 后 EF 保留的患者中，LV 血流 KE 映射显示平面 KE、最小 KEi 和 TD 均有显著变化。这三个血流 KE 参数可能提供了识别和描述该患者群体的新方法。
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