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Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy

Pola, Karin LU ; Roijer, Anders LU ; Borgquist, Rasmus LU orcid ; Ostenfeld, Ellen LU orcid ; Carlsson, Marcus LU ; Bakos, Zoltan LU ; Arheden, Håkan LU and Arvidsson, Per M. LU (2023) In Journal of Cardiovascular Magnetic Resonance 25.
Abstract

Background: Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT. Methods: Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier–Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole.... (More)

Background: Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT. Methods: Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier–Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders. Results: Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio > 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8). Conclusion: Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice. Graphical Abstract: [Figure not available: see fulltext.]

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac magnetic resonance, Device response, Heart failure with reduced ejection fraction, Left bundle branch block, Pacemaker
in
Journal of Cardiovascular Magnetic Resonance
volume
25
article number
45
publisher
BioMed Central (BMC)
external identifiers
  • pmid:37620886
  • scopus:85168651075
ISSN
1097-6647
DOI
10.1186/s12968-023-00955-8
language
English
LU publication?
yes
id
33d6c627-ea37-48f5-9754-5a3842484bbb
date added to LUP
2023-10-20 15:17:30
date last changed
2024-04-19 02:41:29
@article{33d6c627-ea37-48f5-9754-5a3842484bbb,
  abstract     = {{<p>Background: Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT. Methods: Patients with heart failure, EF &lt; 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier–Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders. Results: Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio &gt; 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8). Conclusion: Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice. Graphical Abstract: [Figure not available: see fulltext.]</p>}},
  author       = {{Pola, Karin and Roijer, Anders and Borgquist, Rasmus and Ostenfeld, Ellen and Carlsson, Marcus and Bakos, Zoltan and Arheden, Håkan and Arvidsson, Per M.}},
  issn         = {{1097-6647}},
  keywords     = {{Cardiac magnetic resonance; Device response; Heart failure with reduced ejection fraction; Left bundle branch block; Pacemaker}},
  language     = {{eng}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Journal of Cardiovascular Magnetic Resonance}},
  title        = {{Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy}},
  url          = {{http://dx.doi.org/10.1186/s12968-023-00955-8}},
  doi          = {{10.1186/s12968-023-00955-8}},
  volume       = {{25}},
  year         = {{2023}},
}