Background
Methods
Study population
CMR examination
CMR protocol and image acquisition
4D flow data reconstruction method
4D flow error corrections and quality checks
Image analysis
Kinetic energy mapping
Global KE parameters | |
LV KEa | The average KE of the LV flow for the complete cardiac cycle. |
In-plane KE (%) | The proportion of in-plane KE of the LV, from the complete LV flow, for the complete cardiac cycle. |
Minimal KEa | The minimal KE of the LV flow at any time point during the complete cardiac cycle. |
Systolic KE parameters | |
Systolic KEa | The average KE of the LV flow during systole. |
Diastolic KE parameters | |
Diastolic KEa | The average KE of the LV flow during diastole. |
Peak E-wave KEa | The peak KE of the LV flow during early diastolic filling. |
Peak A-wave KEa | The peak KE of the LV flow during late diastolic filling. |
Time difference, TD | This is the time difference of peak E-wave flow KE from base to mid-ventricle. |
In-plane KE
Time difference (TD)
Minimal KE
Intra-/inter-observer variability
Statistical analysis
Results
Demographic characteristics
Controls (n = 20) | MI Patients(n = 48) | P-value† | P-value‡ | ||
---|---|---|---|---|---|
pEF (12) | rEF (36) | ||||
Age (years) | 52.3 ± 11.2 | 57.1 ± 10 | 57.3 ± 12 | 0.10 | 0.93 |
Gender (Male, n) | 12 | 9 | 30 | 0.07 | 0.53 |
Body surface area | 1.8 ± 0.2 | 1.9 ± 0.3 | 1.98 ± 0.4 | 0.69 | 0.68 |
Acute MI (n) | – | 8 | 27 | – | 0.58 |
Heart rate (bpm) | 65 ± 12 | 58 ± 10 | 66 ± 14 | 0.75 | 0.045 |
Standard CMR clinical parameters | |||||
LVMi (g/m2) | 51.0 ± 10.2 | 57.7 ± 16.6 | 62 ± 19 | 0.02 | 0.46 |
LVEDVi (ml/m2) | 81.6 ± 15.6 | 80 ± 10 | 103 ± 30 | 0.02 | 0.01 |
LVESVi (ml/m2) | 30.0 ± 7.4 | 32 ± 6 | 64 ± 30 | < 0.01 | < 0.01 |
SVi (ml/m2) | 51.6 ± 10.7 | 48 ± 5 | 38 ± 9 | < 0.01 | < 0.01 |
EF (%) | 63.1 ± 5.6 | 60 ± 3 | 39 ± 11 | < 0.01 | < 0.01 |
IS (% of LV) | – | 12.3 ± 9 | 25 ± 12 | – | < 0.01 |
CI (L/min/m2) | 3.3 ± 0.9 | 2.7 ± 0.47 | 2.5 ± 4.6 | 0.03 | 0.11 |
LV KEiEDV parameters | |||||
LV (μJ/ml) | 8.5 ± 2.7 | 7 ± 4 | 6.3 ± 3 | 0.02a | 0.11 |
Minimal (μJ/ml) | 0.95 ± 0.63 | 0.5 ± 0.3 | 0.8 ± 0.6 | 0.02a | 0.02 |
Systolic (μJ/ml) | 9.2 ± 3.8 | 8.4 ± 6 | 6.4 ± 2 | < 0.01a | < 0.01 |
Diastolic (μJ/ml) | 7.5 ± 4.2 | 7 ± 3 | 6.3 ± 3.5 | 0.29 | 0.92 |
E-wave (μJ/ml) | 22.0 ± 10.2 | 19 ± 8 | 15 ± 9 | 0.02a | 0.30 |
A-wave (μJ/ml) | 12.5 ± 5.6 | 14 ± 9 | 10.6 ± 7 | 0.22 | < 0.01 |
In-plane LV (%) | 36.5 ± 7.2 | 31 ± 4.4 | 38 ± 8 | 0.84 | < 0.01 |
TD (msecs) | 11 ± 31 | 33.6 ± 12 | 34.2 ± 52 | < 0.01a | 0.21 |
Baseline CMR data
Global LV flow KE in MI
Association with cardiac haemodynamic parameters
KE parameters | Heart rate | Stroke volume | Cardiac index | |||
---|---|---|---|---|---|---|
rho | P-Value | rho | P-Value | rho | P-Value | |
LV KEiEDV (μJ/ml) | 0.31 |
0.01
| 0.20 | 0.11 | 0.42 |
< 0.01
|
Minimal KEiEDV (μJ/ml) | 0.43 |
< 0.01
| − 0.07 | 0.58 | 0.06 | 0.64 |
Systolic KEiEDV (μJ/ml) | 0.05 | 0.70 | 0.45 |
< 0.01
| 0.48 |
< 0.01
|
Diastolic KEiEDV (μJ/ml) | 0.35 |
< 0.01
| 0.03 | 0.83 | 0.28 |
0.02
|
E-wave KEiEDV (μJ/ml) | 0.02 | 0.90 | 0.31 |
0.01
| 0.30 |
0.01
|
A-wave KEiEDV (μJ/ml) | 0.14 | 0.24 | −0.01 | 0.92 | 0.24 | 0.05 |
In-plane LV (%) | 0.06 | 0.63 | − 0.28 |
0.02
| −0.29 |
0.02
|
TD (msecs) | 0.09 | 0.45 | −0.31 |
0.01
| −0.23 | 0.06 |
LV systolic impairment and flow KE
(a) normal EF (n = 20) | (b) preserved EF (n = 12) | (c) Mild (n = 16) | (d) Moderate (n = 10) | (e) Severe (n = 10) | P-value | |
---|---|---|---|---|---|---|
Kinetic energy parameters normalised to LVEDV (KEiEDV) | ||||||
LV# | 8.5 ± 2.7 | 7 ± 2.9 | 6.3 ± 2.9 | 6.1 ± 1.2 | 6.8 ± 3.5 | 0.10 |
Minimal# | 0.95 ± 0.63b, c | 0.53 ± 0.29a, e | 0.56 ± 0.32a, e | 0.76 ± 0.37e | 1.48 ± 0.54b, c, d | < 0.01 |
Systolic | 9.2 ± 3.8c, d, e | 8.4 ± 5.1d, e | 6.8 ± 3.2a, d | 5.9 ± 1.5a, b, c | 5.7 ± 1.7a, b | < 0.01 |
Diastolic# | 7.5 ± 4.2 | 6.9 ± 2.4 | 5.6 ± 2.5 | 6.3 ± 2.3 | 7.5 ± 3.4 | 0.30 |
Peak E-wave | 22 ± 10.2 | 19.1 ± 6.9 | 14.1 ± 9.2 | 14.6 ± 7.3 | 17.3 ± 9.4 | 0.13 |
Peak A-wave | 12.5 ± 5.6e | 13.7 ± 7.7e | 11.4 ± 5.5 | 10.9 ± 6.2 | 8 ± 6.2a, b | 0.10 |
In-plane (%) | 36.5 ± 7.2b, e | 31.3 ± 3.9a, d, e | 35.5 ± 5.6e | 38.4 ± 7.5b | 41.4 ± 4a, b, c | < 0.01 |
TD (msec) | 11 ± 31b, d, e | 34 ± 11a, e | 26 ± 33d, e | 53 ± 28a, c | 90 ± 76a, b, c | < 0.01 |
Kinetic energy parameters normalised to SV (KEiSV) | ||||||
LV# | 13 ± 5e | 12 ± 7e | 12 ± 5e | 18 ± 6e | 29 ± 19a, b, c, d | < 0.01 |
Minimal# | 1.4 ± 0.9e | 0.9 ± 7e | 1.1 ± 0.9e | 1.9 ± 1.5e | 6 ± 4a, b, c, d | < 0.01 |
Systolic | 15 ± 5e | 15 ± 10e | 14 ± 6e | 16 ± 6e | 22 ± 5a, b, c, d | 0.03 |
Diastolic# | 11.6 ± 6d, e | 11.6 ± 5e | 11.6 ± 5e | 17 ± 10a, e | 34 ± 15a, b, c, d | < 0.01 |
Peak E-wave | 35 ± 14e | 33 ± 15e | 29.5 ± 19e | 39 ± 27 | 62 ± 52a, b, c | 0.02 |
Peak A-wave | 19 ± 10e | 23.5 ± 13 | 22 ± 1e | 32 ± 17 | 33 ± 27a, c | 0.03 |
Kinetic energy parameters without normalisation | ||||||
LV# | 1.3 ± 0.6e | 1.3 ± 1e | 1.1 ± 0.7e | 1.3 ± 0.5e | 1.9 ± 0.7a, b, c, d | 0.15 |
Minimal# | 0.14 ± 0.07b, e | 0.08 ± 0.09a, d, e | 0.13 ± 0.1e | 0.15 ± 0.1b, e | 0.36 ± 0.08a, b, c, d | < 0.01 |
Systolic | 1.45 ± 0.8 | 1.5 ± 1.3 | 1.3 ± 0.9 | 1.2 ± 0.3 | 1.7 ± 0.65 | 0.27 |
Diastolic# | 1.14 ± 0.8e | 1 ± 0.6e | 1 ± 0.6e | 1.3 ± 0.7 | 2.2 ± 0.9a, b, c | < 0.01 |
Peak E-wave | 3.5 ± 1.5 | 3 ± 1.5 | 2.3 ± 1.6 | 3 ± 2.2 | 4.3 ± 2.7 | 0.16 |
Peak A-wave | 1.7 ± 0.6 | 2 ± 1.2 | 1.9 ± 1.1 | 2.1 ± 1.4 | 2.4 ± 2.1 | 0.35 |
Infarct size and flow KE
Univariate | Multivariate | ||||||||
---|---|---|---|---|---|---|---|---|---|
rho | Beta | 95% CI | SE | P-value | Beta | 95% CI | SE | P-value | |
LV KEiEDV | −0.29 | −1.4 | −3 to 2 | 0.8 | 0.09 | ||||
Minimal KEiEDV | 0.26 | 0.01 | 0 to 0.2 | 0.005 |
0.04
| ||||
Systolic KEiEDV | −0.48 | − 0.1 | − 0.2 to − 0.02 | 0.03 |
0.01
| ||||
Diastolic KEiEDV | −0.07 | − 0.02 | − 0.07 to 0.04 | 0.03 | 0.59 | ||||
Peak E-wave KEiEDV | −0.24 | −0.14 | − 0.3 to 0.03 | 0.08 | 0.09 | ||||
Peak A-wave KEiEDV | −0.37 | −0.14 | − 0.2 to − 0.02 | 0.05 |
0.02
| ||||
In-plane LV (%) | 0.5 | 1.1 | 0.5 to 1.7 | 0.3 |
0.001
| 1.1 | 0.5 to 1.7 | 0.3 | 0.001 |
TD (msec) | 0.33 | 1.1 | 0.2 to 2 | 0.4 |
0.02
|
Anterior versus inferior/posterior infarction
Inferior MI (n = 13) | Anterior MI (n = 35) | P-value | |
---|---|---|---|
Baseline CMR Parameters | |||
LVEDVi (ml/m2) | 83 ± 19 | 92 ± 26 | 0.56✝ |
LVESVi (ml/m2) | 45 ± 24 | 51 ± 24 | 0.8✝ |
SVi (ml/m2) | 41 ± 8 | 41 ± 15 | 0.26✝ |
EF (%) | 49 ± 10 | 43 ± 21 | 0.87✝ |
EDMi (g/m2) | 54 ± 8 | 56 ± 24 | 0.41✝ |
IS (%) | 14.4 ± 12 | 23 ± 18 | < 0.01 |
LV KE parameters | |||
LV KEiEDV | 6.6 ± 3.7 | 6.4 ± 2.2 | 0. 78✝ |
Minimal KEiEDV | 0.55 ± 0.63 | 0.74 ± 0.48 | 0.17✝ |
Systolic KEiEDV | 7.9 ± 3.5 | 6.4 ± 2.0 | 0.33✝ |
Diastolic KEiEDV | 6.7 ± 3.0 | 6.5 ± 3.0 | 0.68✝ |
Peak E-wave KEiEDV | 15.6 ± 10.7 | 16.6 ± 9.9 | 0.9✝ |
Peak A-wave KEiEDV | 11.6 ± 3.9 | 10.7 ± 7.3 | 0.63✝ |
In-plane LV (%) | 33 ± 6 | 38 ± 8 | 0.62✝ |
TD (msecs) | 30 ± 40 | 35 ± 38 | 0.28✝ |
Acute versus chronic MI
Acute MI (n = 22) | Chronic MI (n = 26) | P-value | |||
---|---|---|---|---|---|
Mean/Median | SD/IQR | Mean/Median | SD/IQR | ||
Age (years) | 55.00 | 11.36 | 59.27 | 10.98 | 0.19 |
Gender (Male) | 0.53 | ||||
Body surface area | 2.00 | 0.28 | 1.95 | 0.49 | 0.69 |
Heart rate (bpm) | 68 | 16 | 61 | 10 | 0.10 |
Baseline CMR results | |||||
IS (% of LV) | 24 | 14 | 20 | 11 | 0.22 |
LVEDVi (ml/m2) | 94 | 29 | 99 | 26 | 0.54 |
LVESVi (ml/m2) | 57 | 28 | 55 | 30 | 0.86 |
SVi (ml/m2) | 37 | 10 | 44 | 8 |
0.02
|
LVMi (g/m2) | 63 | 22 | 59 | 14 | 0.53 |
EF (%) | 42 | 12 | 46 | 14 | 0.24 |
Kinetic Energy Mapping results | |||||
LV KEiEDV | 6.7 | 2.5 | 6.4 | 2.0 | 0.71 |
Minimal KEiEDV | 0.8 | 0.7 | 0.6 | 0.5 | 0.53 |
Systolic KEiEDV | 6.7 | 2.3 | 6.7 | 2.9 | 0.68 |
Diastolic KEiEDV | 6.9 | 3.5 | 6.1 | 2.7 | 0.79 |
Peak E-wave KEiEDV | 15.6 | 11.7 | 16.6 | 8.7 | 0.76 |
Peak A-wave KEiEDV | 11.9 | 3.9 | 10.7 | 8.0 | 0.51 |
In-plane LV (%) | 37.2 | 7.2 | 33.1 | 8.3 | 0.75 |
TD (msecs) | 34.0 | 27.9 | 33.3 | 25.6 | 0.82 |