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. 2022 Feb;9(1):496-505.
doi: 10.1002/ehf2.13719. Epub 2021 Dec 23.

Impact of intraventricular haemodynamic forces misalignment on left ventricular remodelling after myocardial infarction

Domenico Filomena  1 , Sara Cimino  1 , Sara Monosilio  1 , Nicola Galea  2   3 , Giuseppe Mancuso  2 , Marco Francone  2 , Giovanni Tonti  4 , Gianni Pedrizzetti  5 , Viviana Maestrini  1 , Francesco Fedele  1 , Luciano Agati  1
Affiliations

Impact of intraventricular haemodynamic forces misalignment on left ventricular remodelling after myocardial infarction

Domenico Filomena et al. ESC Heart Fail. 2022 Feb.

Abstract

Aims: Altered left ventricular (LV) haemodynamic forces (HDFs) have been associated with positive and negative remodelling after pathogenic or therapeutic events. We aimed to identify LV HDFs patterns associated with adverse LV remodelling (aLVr) in reperfused segment elevation myocardial infarction (STEMI) patients.

Methods and results: Forty-nine acute STEMI patients underwent cardiac magnetic resonance (CMR) at 1 week (baseline) and after 4 months (follow-up). LV HDFs were computed at baseline from cine CMR long axis data sets, using a novel technique based on endocardial boundary tracking, both in apex-base (A-B) and latero-septal (L-S) directions. HDFs distribution was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). HDFs parameters were computed over the entire heartbeat, in systole and diastole. At baseline, aLVr patients had lower systolic L-S HDF (2.7 ± 0.9 vs. 3.6 ± 1%; P = 0.027) and higher diastolic L-S/A-B HDF ratio (28 ± 14 vs. 19 ± 6%; P = 0.03). At univariate logistic regression analysis, higher infarct size [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.01-1.1; P = 0.04], higher L-S/A-B HDFs ratio (OR 1.1; 95% CI 1.01-1.2; P = 0.05) and lower L-S HDFs (OR 0.41; 95% CI 0.2-0.9; P = 0.04) were associated with aLVr at follow-up. In the multivariable logistic regression analysis, diastolic L-S/A-B HDF ratio remained the only independent predictor of aLVr (OR 1.1; 95% CI 1.01-1.2; P = 0.04).

Conclusions: Misalignment of diastolic haemodynamic forces after STEMI is associated with aLVr after 4 months.

Keywords: Adverse remodelling; CMR; Haemodynamic forces; STEMI.

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Conflict of interest statement

All authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
From left to right: Cine CMR long axis data sets are used for left ventricular haemodynamic forces estimation. End‐systolic and end‐diastolic borders are traced and tracked frame‐by‐frame to allow endocardial border movement reconstruction in a three‐dimensional model. Apex‐to‐base and latero‐septal haemodynamic forces are estimated over time and graphically represented as curves. Haemodynamic forces distribution in a selected period of time is represented using a polar plot. 2C, two chamber view; 3C, three chamber view; 3D, three‐dimensional; 4C, four chamber view; A, apex; B, base; ED, end‐diastole; ES, end‐systole; HDFs, haemodynamic forces; L, lateral wall; MR, magnetic resonance; S, septum.
Figure 2
Figure 2
Polar plots representing diastolic haemodynamic forces distribution in two different patients. On the left: a patient without adverse remodelling at follow‐up; at baseline diastolic haemodynamic forces distribution were normally oriented with low diastolic latero‐septal over apex‐base ratio. On the right: a patient with adverse remodelling at follow‐up; at baseline, misaligned diastolic haemodynamic forces with high diastolic latero‐septal over apex‐base ratio. A, apex; B, base; HDFs, haemodynamic forces; L, lateral wall; S, septum.
See this image and copyright information in PMC

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