Mele Donato, Serio Lorenzo, Beccari Riccardo, Cecchetto Antonella, Nistri Stefano, Pedrizzetti Gianni
Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
Cardiac Unit, Ravenna33 Clinic, Via Bini, 1, 48124, Ravenna, Italy.
Cardiovasc Ultrasound. 2025 May 19;23(1):13. doi: 10.1186/s12947-025-00347-1.
The evaluation of left ventricular (LV) flow dynamics is a novel approach to assessing LV function that goes beyond traditional metrics. This approach has been applied to patients with heart failure (HF), providing valuable insights that are discussed in this review, with the aim of enhancing our understanding of LV function in the context of the HF syndrome.
The analysis of LV flow dynamics is typically conducted using ultrasound and magnetic resonance imaging (MRI) techniques, primarily including particle image velocimetry echocardiography, Vector Flow Imaging, HyperDoppler, and four-dimensional flow MRI. A variety of parameters can be obtained that describe the geometry of the LV vortex, vorticity, kinetic energy, energy dispersion, as well as the amplitude and direction of the hemodynamic forces within the LV cavity.
In normal subjects, vortex formation plays a crucial role in optimizing LV filling, diastolic-systolic coupling, and energy transfer during systolic ejection. In patients with HF, alterations in vortex structure and dynamics have been associated with both systolic and diastolic LV dysfunction, demonstrating the potential to diagnose early LV dysfunction. Furthermore, these alterations have been linked to LV remodeling and thrombus formation. Several studies have also explored intracardiac flow metrics as biomarkers for guiding HF treatments, including pharmacological interventions, cardiac resynchronization therapy, and LV assist devices.
Currently available data suggest that the evaluation of LV flow dynamics can have diagnostic and prognostic utility in HF. However, large-scale, multicenter, and prospective studies are needed, particularly to validate therapeutic implications.
评估左心室（LV）血流动力学是一种超越传统指标来评估左心室功能的新方法。这种方法已应用于心力衰竭（HF）患者，本综述将讨论由此获得的宝贵见解，目的是加深我们对心力衰竭综合征背景下左心室功能的理解。
左心室血流动力学分析通常使用超声和磁共振成像（MRI）技术进行，主要包括粒子图像测速超声心动图、向量流成像、超多普勒和四维流MRI。可以获得多种参数，这些参数描述了左心室涡流的几何形状、涡度、动能、能量色散，以及左心腔内血流动力学力的幅度和方向。
在正常受试者中，涡流形成在优化左心室充盈、舒张 - 收缩耦合以及收缩期射血期间的能量传递方面起着关键作用。在心力衰竭患者中，涡流结构和动力学的改变与左心室收缩和舒张功能障碍均有关联，显示出早期诊断左心室功能障碍的潜力。此外，这些改变与左心室重构和血栓形成有关。几项研究还探讨了心内血流指标作为指导心力衰竭治疗的生物标志物，包括药物干预、心脏再同步治疗和左心室辅助装置。
现有数据表明，评估左心室血流动力学在心力衰竭中可能具有诊断和预后价值。然而，需要大规模、多中心的前瞻性研究，特别是要验证其治疗意义。
