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Hemodynamic forces using four-dimensional flow MRI : An independent biomarker of cardiac function in heart failure with left ventricular dyssynchrony?

Arvidsson, Per M. LU ; Töger, Johannes LU ; Pedrizzetti, Gianni ; Heiberg, Einar LU ; Borgquist, Rasmus LU ; Carlsson, Marcus LU and Arheden, Håkan LU (2018) In American Journal of Physiology - Heart and Circulatory Physiology 315(6). p.1627-1639
Abstract

Patients with heart failure with left ventricular (LV) dyssynchrony often do not respond to cardiac resynchronization therapy (CRT), indicating that the pathophysiology is insufficiently understood. Intracardiac hemodynamic forces computed from four-dimensional (4-D) flow MRI have been proposed as a new measure of cardiac function. We therefore aimed to investigate how hemodynamic forces are altered in LV dyssynchrony. Thirty-one patients with heart failure and LV dyssynchrony and 39 control subjects underwent cardiac MRI with the acquisition of 4-D flow. Hemodynamic forces were computed using Navier-Stokes equations and integrated over the manually delineated LV volume. The ratio between transverse (lateral-septal and... (More)

Patients with heart failure with left ventricular (LV) dyssynchrony often do not respond to cardiac resynchronization therapy (CRT), indicating that the pathophysiology is insufficiently understood. Intracardiac hemodynamic forces computed from four-dimensional (4-D) flow MRI have been proposed as a new measure of cardiac function. We therefore aimed to investigate how hemodynamic forces are altered in LV dyssynchrony. Thirty-one patients with heart failure and LV dyssynchrony and 39 control subjects underwent cardiac MRI with the acquisition of 4-D flow. Hemodynamic forces were computed using Navier-Stokes equations and integrated over the manually delineated LV volume. The ratio between transverse (lateral-septal and inferior-anterior) and longitudinal (apical-basal) forces was calculated for systole and diastole separately and compared with QRS duration, aortic valve opening delay, global longitudinal strain, and ejection fraction (EF). Patients exhibited hemodynamic force patterns that were significantly altered compared with control subjects, including loss of longitudinal forces in diastole (force ratio, control subjects vs. patients: 0.32 vs. 0.90, P < 0.0001) and increased transverse force magnitudes. The systolic force ratio was correlated with global longitudinal strain and EF (P < 0.01). The diastolic force ratio separated patients from control subjects (area under the curve: 0.98, P < 0.0001) but was not correlated to other dyssynchrony measures (P > 0.05 for all). Hemodynamic forces by 4-D flow represent a new approach to the quantification of LV dyssynchrony. Diastolic force patterns separate healthy from diseased ventricles. Different force patterns in patients indicate the possible use of force analysis for risk stratification and CRT implantation guidance. NEW & NOTEWORTHY In this report, we demonstrate that patients with heart failure with left ventricular dyssynchrony exhibit significantly altered hemodynamic forces compared with normal. Force patterns in patients mechanistically reflect left ventricular dysfunction on the organ level, largely independent of traditional dyssynchrony measures. Force analysis may help clinical decision making and could potentially be used to improve therapy outcomes.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Dyssynchrony, Four-dimensional flow, Heart failure, Hemodynamic force, Physiology
in
American Journal of Physiology - Heart and Circulatory Physiology
volume
315
issue
6
pages
1627 - 1639
publisher
American Physiological Society
external identifiers
  • pmid:30216113
  • scopus:85060145311
ISSN
0363-6135
DOI
10.1152/ajpheart.00112.2018
language
English
LU publication?
yes
id
27ed10a9-337a-455c-b8c8-d6245d55386c
date added to LUP
2019-02-05 09:52:50
date last changed
2020-07-08 04:41:02
@article{27ed10a9-337a-455c-b8c8-d6245d55386c,
  abstract     = {<p>Patients with heart failure with left ventricular (LV) dyssynchrony often do not respond to cardiac resynchronization therapy (CRT), indicating that the pathophysiology is insufficiently understood. Intracardiac hemodynamic forces computed from four-dimensional (4-D) flow MRI have been proposed as a new measure of cardiac function. We therefore aimed to investigate how hemodynamic forces are altered in LV dyssynchrony. Thirty-one patients with heart failure and LV dyssynchrony and 39 control subjects underwent cardiac MRI with the acquisition of 4-D flow. Hemodynamic forces were computed using Navier-Stokes equations and integrated over the manually delineated LV volume. The ratio between transverse (lateral-septal and inferior-anterior) and longitudinal (apical-basal) forces was calculated for systole and diastole separately and compared with QRS duration, aortic valve opening delay, global longitudinal strain, and ejection fraction (EF). Patients exhibited hemodynamic force patterns that were significantly altered compared with control subjects, including loss of longitudinal forces in diastole (force ratio, control subjects vs. patients: 0.32 vs. 0.90, P &lt; 0.0001) and increased transverse force magnitudes. The systolic force ratio was correlated with global longitudinal strain and EF (P &lt; 0.01). The diastolic force ratio separated patients from control subjects (area under the curve: 0.98, P &lt; 0.0001) but was not correlated to other dyssynchrony measures (P &gt; 0.05 for all). Hemodynamic forces by 4-D flow represent a new approach to the quantification of LV dyssynchrony. Diastolic force patterns separate healthy from diseased ventricles. Different force patterns in patients indicate the possible use of force analysis for risk stratification and CRT implantation guidance. NEW &amp; NOTEWORTHY In this report, we demonstrate that patients with heart failure with left ventricular dyssynchrony exhibit significantly altered hemodynamic forces compared with normal. Force patterns in patients mechanistically reflect left ventricular dysfunction on the organ level, largely independent of traditional dyssynchrony measures. Force analysis may help clinical decision making and could potentially be used to improve therapy outcomes.</p>},
  author       = {Arvidsson, Per M. and Töger, Johannes and Pedrizzetti, Gianni and Heiberg, Einar and Borgquist, Rasmus and Carlsson, Marcus and Arheden, Håkan},
  issn         = {0363-6135},
  language     = {eng},
  number       = {6},
  pages        = {1627--1639},
  publisher    = {American Physiological Society},
  series       = {American Journal of Physiology - Heart and Circulatory Physiology},
  title        = {Hemodynamic forces using four-dimensional flow MRI : An independent biomarker of cardiac function in heart failure with left ventricular dyssynchrony?},
  url          = {http://dx.doi.org/10.1152/ajpheart.00112.2018},
  doi          = {10.1152/ajpheart.00112.2018},
  volume       = {315},
  year         = {2018},
}