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

• Published in: Journal of cardiovascular magnetic resonance Vol. 25; no. 1; p. 45
• Main Authors: Pola, Karin, Roijer, Anders, Borgquist, Rasmus, Ostenfeld, Ellen, Carlsson, Marcus, Bakos, Zoltan, Arheden, Håkan, Arvidsson, Per M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 25-08-2023; BioMed Central Ltd; BioMed Central; Elsevier
• Subjects: Bundle-Branch Block; Cardiac and Cardiovascular Systems; Cardiac magnetic resonance; Cardiac patients; Cardiac Resynchronization Therapy; Clinical Medicine; Congestive heart failure; Device response; Diastole; Echocardiography; Heart; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - therapy; Heart failure with reduced ejection fraction; Hemodynamics; Humans; Kardiologi; Klinisk medicin; Left bundle branch block; Magnetic Resonance Imaging; Medical and Health Sciences; Medical equipment; Medical imaging; Medicin och hälsovetenskap; Pacemaker; Patients; Predictive Value of Tests; Reproducibility; Software; Statistical analysis; Systole; Ventricle; Ventricular Remodeling; United States > US; Minnesota; Device response; Left bundle branch block; Heart failure with reduced ejection fraction; Pacemaker; Cardiac magnetic resonance
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-023-00955-8

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.
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