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Mechanical dyssynchrony alters left ventricular flow energetics in failing hearts with LBBB: a 4D flow CMR pilot study.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.ORCID iD: 0000-0003-1395-8296
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2018 (English)In: International Journal of Cardiac Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 34, no 4, p. 587-596Article in journal (Refereed) Published
Abstract [en]

The impact of left bundle branch block (LBBB) related mechanical dyssynchrony on left ventricular (LV) diastolic function remains unclear. 4D flow cardiovascular magnetic resonance (CMR) has provided reliable markers of LV dysfunction: reduced volume and kinetic energy (KE) of the portion of LV inflow which passes directly to outflow (Direct Flow) has been demonstrated in failing hearts compared to normal hearts. We sought to investigate the impact of mechanical dyssynchrony on diastolic function by comparing 4D flow in myopathic LVs with and without LBBB. CMR data were acquired at 3 T in 22 heart failure patients; 11 with LBBB and 11 without LBBB matched according to several demographic and clinical parameters. An established 4D flow analysis method was used to separate the LV end-diastolic (ED) volume into functional flow components based on the blood's timing and route through the heart cavities. While the Direct Flow volume was not different between the groups, the KE possessed at ED was lower in LBBB patients (P = 0.018). Direct Flow entering the LV during early diastolic filling possessed less KE at ED in LBBB patients compared to non-LBBB patients, whereas no intergroup difference was observed during late filling. Pre-systolic KE of LV Direct Flow was reduced in patients with LBBB compared to matched patients with normal conduction. These intriguing findings propose that 4D flow specific measures can serve as markers of LV mechanical dyssynchrony in heart failure patients, and could possibly be investigated as predictors of response to cardiac resynchronization therapy.

Place, publisher, year, edition, pages
Springer, 2018. Vol. 34, no 4, p. 587-596
Keyword [en]
4D flow CMR, Heart failure, Left bundle branch block, Left ventricular mechanical dyssynchrony
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-145873DOI: 10.1007/s10554-017-1261-5ISI: 000427902300012PubMedID: 29098524OAI: oai:DiVA.org:liu-145873DiVA, id: diva2:1194993
Note

Funding agencies: Swedish Heart and Lung Foundation [20140398]; Swedish Research Council [621-2014-6191]; European Research Council [310612]

Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-26

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Zajac, JakubEriksson, JonatanAlehagen, UrbanEbbers, TinoBolger, Ann FCarlhäll, Carljohan
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesCenter for Medical Image Science and Visualization (CMIV)Department of Clinical Physiology in LinköpingDepartment of Cardiology in Linköping
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