Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy.
Cardiac magnetic resonance
Device response
Heart failure with reduced ejection fraction
Left bundle branch block
Pacemaker
Journal
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
ISSN: 1532-429X
Titre abrégé: J Cardiovasc Magn Reson
Pays: England
ID NLM: 9815616
Informations de publication
Date de publication:
25 08 2023
25 08 2023
Historique:
received:
22
04
2023
accepted:
10
07
2023
medline:
28
8
2023
pubmed:
25
8
2023
entrez:
24
8
2023
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 37620886
doi: 10.1186/s12968-023-00955-8
pii: 10.1186/s12968-023-00955-8
pmc: PMC10463519
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
45Informations de copyright
© 2023. The Author(s).
Références
Europace. 2021 Aug 6;23(8):1324-1342
pubmed: 34037728
Am J Physiol Heart Circ Physiol. 2018 Dec 1;315(6):H1627-H1639
pubmed: 30216113
J Magn Reson Imaging. 2016 Apr;43(4):833-42
pubmed: 26417641
Eur Heart J. 2013 Dec;34(46):3547-56
pubmed: 23900696
J Biomech. 2017 Jul 26;60:203-210
pubmed: 28711164
Front Cardiovasc Med. 2019 May 14;6:59
pubmed: 31139633
Eur Heart J Cardiovasc Imaging. 2015 Jan;16(1):1-11
pubmed: 25525063
Eur J Heart Fail. 2006 Jun;8(4):433-40
pubmed: 16507349
Eur Heart J. 2011 Jul;32(14):1720-9
pubmed: 21609974
Sci Rep. 2022 Mar 7;12(1):4017
pubmed: 35256713
JACC Clin Electrophysiol. 2020 Oct;6(10):1300-1309
pubmed: 33092758
JACC Cardiovasc Imaging. 2022 Dec;15(12):2151-2153
pubmed: 36481085
BMC Med Imaging. 2010 Jan 11;10:1
pubmed: 20064248
Sci Rep. 2017 Jun 7;7(1):2971
pubmed: 28592851
Circulation. 2010 Sep 7;122(10):985-92
pubmed: 20733097
Europace. 2017 Nov 01;19(11):1833-1840
pubmed: 28025231
Radiology. 2015 Apr;275(1):245-54
pubmed: 25325326
J Cardiovasc Magn Reson. 2013 May 01;15:35
pubmed: 23634753
Physiol Rep. 2016 Feb;4(3):
pubmed: 26841965
J Am Coll Cardiol. 2009 Mar 17;53(11):976-81
pubmed: 19281930
J Biomech. 2015 Jan 21;48(2):388-91
pubmed: 25529139
J Cardiovasc Magn Reson. 2011 Oct 04;13:55
pubmed: 21970399
Am J Physiol Heart Circ Physiol. 2016 Jan 1;310(1):H113-22
pubmed: 26497965
J Am Coll Cardiol. 2012 Jun 19;59(25):2366-73
pubmed: 22698490
Eur Heart J Cardiovasc Imaging. 2016 Feb;17(2):203-9
pubmed: 26060201
Acta Radiol. 2019 Mar;60(3):327-337
pubmed: 30479136
Eur Heart J Cardiovasc Imaging. 2019 Jan 1;20(1):66-74
pubmed: 29481687
Am J Physiol Heart Circ Physiol. 2017 Feb 1;312(2):H314-H328
pubmed: 27770000
Circ Cardiovasc Imaging. 2021 Jul;14(7):e012350
pubmed: 34287001
J Magn Reson Imaging. 2017 Nov;46(5):1516-1525
pubmed: 28225577
Am J Cardiol. 2011 Mar 15;107(6):927-34
pubmed: 21376930
PLoS One. 2018 Apr 5;13(4):e0195597
pubmed: 29621344
Eur Heart J. 2021 Sep 21;42(36):3599-3726
pubmed: 34447992
J Am Coll Cardiol. 2009 May 26;53(21):1944-59
pubmed: 19460607
J Am Coll Cardiol. 2012 Apr 24;59(17):1509-18
pubmed: 22405632
CMAJ. 2011 Mar 8;183(4):421-9
pubmed: 21282316
Sci Rep. 2022 Nov 19;12(1):19933
pubmed: 36402861
J Am Heart Assoc. 2021 Dec 21;10(24):e023417
pubmed: 34889114