Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics

Pankaj Garg, Rob J. van der Geest, Peter P. Swoboda, Saul Crandon, Graham J. Fent, James R. J. Foley, Laura E. Dobson, Tarique Al Musa, Sebastian Onciul, Sethumadhavan Vijayan, Pei G. Chew, Louise A. E. Brown, Malenka Bissell, Mariëlla E. C. J. Hassell, Robin Nijveldt, Mohammed S. M. Elbaz, Jos J. M. Westenberg, Erica Dall'Armellina, John P. Greenwood, Sven Plein

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Aims The main aim of this study was to characterize changes in the left ventricular (LV) blood flow kinetic energy (KE) using four-dimensional (4D) flow cardiovascular magnetic resonance imaging (CMR) in patients with myocardial infarction (MI) with/without LV thrombus (LVT). Methods and results This is a prospective cohort study of 108 subjects [controls = 40, MI patients without LVT (LVT− = 36), and MI patients with LVT (LVT+ = 32)]. All underwent CMR including whole-heart 4D flow. LV blood flow KE wall calculated using the formula: KE=12 ρblood . Vvoxel . v2⁠, where ρ = density, V = volume, v = velocity, and was indexed to LV end-diastolic volume. Patient with MI had significantly lower LV KE components than controls (P < 0.05). LVT+ and LVT− patients had comparable infarct size and apical regional wall motion score (P > 0.05). The relative drop in A-wave KE from mid-ventricle to apex and the proportion of in-plane KE were higher in patients with LVT+ compared with LVT− (87 ± 9% vs. 78 ± 14%, P = 0.02; 40 ± 5% vs. 36 ± 7%, P = 0.04, respectively). The time difference of peak E-wave KE demonstrated a significant rise between the two groups (LVT−: 38 ± 38 ms vs. LVT+: 62 ± 56 ms, P = 0.04). In logistic-regression, the relative drop in A-wave KE (beta = 11.5, P = 0.002) demonstrated the strongest association with LVT. Conclusion Patients with MI have reduced global LV flow KE. Additionally, MI patients with LVT have significantly reduced and delayed wash-in of the LV. The relative drop of distal intra-ventricular A-wave KE, which represents the distal late-diastolic wash-in of the LV, is most strongly associated with the presence of LVT.
Original languageEnglish
Pages (from-to)108-117
Number of pages10
JournalEuropean Heart Journal – Cardiovascular Imaging
Issue number1
Early online date22 Aug 2018
Publication statusPublished - 1 Jan 2019

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