Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine.
Department of Radiology, Hamamatsu University School of Medicine.
Int Heart J. 2021;62(6):1287-1296. doi: 10.1536/ihj.20-792.
Left ventricular thrombus (LVT) has been identified to be crucial in patients with reduced ejection fraction (EF). Three-dimensional cine phase-contrast magnetic resonance imaging (4D flow MRI) can visualize the intra-LV vortex during diastole and quantify the maximum flow velocity (Vmax) at the apex. In this study, we investigated whether the change in the intra-LV vortex was associated with the presence of LVT in patients with cardiac disease.In total, 36 patients (63.5 ± 11.9 years, 28 men, 12/24 with/without LVT) with diffuse LV dysfunction underwent 4D flow MRI. The relative vortex area using streamline images and Vmax of blood flow toward the apex at the apical left ventricle were evaluated. The correlation between the relative vortex area and Vmax was assessed using Pearson's correlation coefficient. The ability to detect LVT was evaluated using the area under the curve (AUC) of the receiver operating characteristic.The relative vortex area was found to be smaller (27 ± 10% versus 45 ± 11%, P = 0.000026), whereas Vmax at the apical left ventricle was lower (19.1 ± 4.4 cm/second versus 27.4 ± 8.9 cm/second, P = 0.0006) in patients with LVT. Vmax at the apical left ventricle demonstrated significant correlations with the relative vortex area (r = 0.43, P = 0.01) and relative transverse length of the vortex (r = 0.45, P = 0.007). The AUC was 0.91 for the relative vortex area, whereas it was 0.80 for Vmax in the apical left ventricle.A smaller LV vortex and lower flow velocity at the LV apex were associated with LVT in patients with reduced EF.
左心室血栓（LVT）已被确定在射血分数降低（EF）的患者中至关重要。三维电影相位对比磁共振成像（4D 流 MRI）可在舒张期可视化左室内涡旋，并定量测量心尖处的最大流速（Vmax）。在这项研究中，我们研究了LV 内涡旋的变化是否与心脏病患者 LVT 的存在有关。共有 36 名（63.5 ± 11.9 岁，28 名男性，12/24 名有/无 LVT）弥漫性左心室功能障碍患者接受了 4D 流 MRI 检查。使用流线图像评估相对涡旋面积和朝向左心室心尖的血流 Vmax。使用 Pearson 相关系数评估相对涡旋面积与 Vmax 之间的相关性。使用受试者工作特征曲线下的面积（AUC）评估检测 LVT 的能力。结果发现，LVT 患者的相对涡旋面积较小（27 ± 10%对 45 ± 11%，P = 0.000026），而左心室心尖处的 Vmax 较低（19.1 ± 4.4 cm/秒对 27.4 ± 8.9 cm/秒，P = 0.0006）。左心室心尖处的 Vmax 与相对涡旋面积（r = 0.43，P = 0.01）和涡旋的相对横向长度（r = 0.45，P = 0.007）呈显著相关。相对涡旋面积的 AUC 为 0.91，而左心室心尖处的 Vmax 的 AUC 为 0.80。EF 降低的患者中，LV 涡旋较小和 LV 心尖处的流速较低与 LVT 相关。
