Kamani, C.H., Lwin, M., Botis, I. et al. (8 more authors) (2025) Left ventricular flow kinetics and myocardial deformation following acute infarction: Additional predictive value of cardiac magnetic resonance four-dimensional flow for left ventricular remodeling post-ST-elevation myocardial infarction. Journal of Cardiovascular Magnetic Resonance, 27 (2). 101905. ISSN: 1097-6647
Abstract
Background The exact mechanism underlying myocardial maladaptive changes post ST-elevation myocardial infarction (STEMI) remains unclear. We sought to assess the impact of the tissue=flow interaction on the development of adverse cardiac remodeling 12 months(M) after acute STEMI. Materials and methods Forty-nine first-STEMI patients (M:F = 26:13; mean age = 58 ± 10) prospectively underwent 3T cardiovascular magnetic resonance (CMR) acutely, at 3 months (3M) and 12M post-STEMI. The CMR protocol included left ventricular (LV) cine-images for LV end-diastolic (LVEDV) and end-systolic volumes, stroke volume (SV), and ejection fraction (LVEF); four-dimensional (4D)-flow and late gadolinium enhancement imaging. The 3M outcome measures included 4D-flow derived LV flow kinetic energy indexed to EDV (KEiEDV) and functional flow components [LV-KEiEDV, minimal- KEiEDV, diastolic- KEiEDV, and residual volume (RV), retained inflow, delayed ejection, direct flow (DF)]; global radial, circumferential, and longitudinal strain (GRS, GCS, GLS) by feature tracking (FT); infarct size (IS). Adverse LV remodeling (LVremod) was defined by a ≥20% increase in LVEDVi at 12M from baseline, in opposition to the non-remodeling group (LVnon-remod). Association between SV, FT-strain, KE, and 4D flow parameters was assessed, as well as predictors of adverse remodeling at 12M post-STEMI. Results There were 23 LVremod patients. At 3M post-STEMI, LVremod patients had significantly reduced LVEF, increased IS, abnormal FT-strain, systolic KEiEDV, DF, and RV compared to LVnon-remod patients. There was no significant difference in SV between the two groups. FT-strain parameters significantly correlated with DF (GRS: r = 0.62; GCS: r = −0.67; GLS: r = −0.58, all p < 0.001); RV (GRS: r = −0.56; GCS: r = 0.51; GLS: r = 0.53, all p < 0.001); peak-A-wave KEiEDV (GRS: r = 0.38, p = 0.008; GCS: r = −0.30, p = 0.038; GLS: r = −0.29, p = 0.04); systolic KEiEDV (GRS: r = 0.31, p = 0.033, GLS: r = −0.35, p = 0.012). DF outperformed conventional LV function parameters (SV and LVEF) in the LVremod prediction. DF and IS were the only independent predictors of 12M adverse remodeling after adjustment for LVEF, SV, FT-strain, and KEiEDV parameters. Conclusions Our study suggests a potential early interaction between FT-strain and 4D-flow parameters post-STEMI leading to the development of adverse remodeling. Within the limitations of our sample size, DF and IS were independent predictors of LV remodeling after adjustment for LVEF, SV, FT-strain, and KE parameters. These findings suggest that these parameters may contribute to further risk stratification at 3M for the development of adverse remodeling at 12M post-STEMI, above conventional LV function parameters. Larger studies are needed to confirm these results.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2025 The Authors. This is an open access article under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | CMR post MI, global FT strain parameters, 4D flow parameters, interaction of FT strain and 4D flow parameters, prediction of LV adverse remodeling at 12 months post STEMI |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) |
Funding Information: | Funder Grant number British Heart Foundation FS/13/71/30378 |
Depositing User: | Symplectic Publications |
Date Deposited: | 08 May 2025 16:02 |
Last Modified: | 12 Aug 2025 09:42 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jocmr.2025.101905 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:226394 |