Impact of Age and Diastolic Function on Novel, 4D flow CMR Biomarkers of Left Ventricular Blood Flow Kinetic Energy

Crandon, Saul; Westenberg, Jos J.M.; Swoboda, Peter; Fent, Graham; Foley, James Rj; Chew, Pei G.; Brown, Louise A.; Saunderson, Christopher; Mohammad, Atif; Greenwood, John P.; Geest, Rob J. van der; Dall’Armellina, Erica; Plein, Sven; Garg, Pankaj

doi:10.1038/s41598-018-32707-5

Cited by 46 publications

(37 citation statements)

References 36 publications

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“…Further prospective studies are warranted to investigate and ascertain the phenotype of the patients with breathlessness, raised NTproBNP, and normal TTE. Cardiovascular magnetic resonance imaging has demonstrated some promise to better categorise diastolic function [29][30][31][32][33][34] ; however, this needs further invasive catheter-based validation studies. Third, this study did not record the cause of death.…”

Section: Limitationsmentioning

confidence: 99%

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

et al. 2020

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Aims Clinical outcomes for patients suspected of having heart failure (HF) who do not meet the diagnostic criteria of any type of HF by echocardiography remain unknown. The aim of this study was to investigate the clinical predictors of all-cause mortality in patients with suspected HF, a raised N-terminal pro-b-type natriuretic peptide (NTproBNP) and who do not meet the diagnostic criteria of any type of HF by echocardiography. Methods and results Relevant data were taken from the Sheffield HEArt Failure (SHEAF) registry (222349P4). The inclusion criteria were presence of symptoms raising suspicion of HF, NTproBNP > 400 pg/mL, and preserved left ventricular function. Exclusion criteria were any type of HF by echocardiography. The outcome was defined as all-cause mortality. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and clinical variables; 1031 patients were identified with NTproBNP > 400 pg/mL but who did not have echocardiographic evidence of HF. All-cause mortality was 21.5% (222 deaths) over the mean follow-up (FU) period of 6 ± 2 years. NTproBNP was similar in patients who were alive or dead (P = 0.96). However, age (HR 1, P < 0.01), chronic kidney disease (CKD, HR 1.2, P < 0.01), chronic pulmonary obstructive disease (COPD, HR 1.6, P < 0.01), dementia (HR 5.9, P < 0.01), male gender (HR 1.4, P < 0.01), first-degree atrioventricular block (HR 2.1, P < 0.01), left axis deviation (HR 1.6, P = 0.04), and diabetes (HR 1.4, P = 0.03) were associated with all-cause mortality. In multivariate regression, age, gender, CKD stage, COPD, and dementia were independently associated with mortality. In patients with NTproBNP > 627 pg/mL, NYHA class predicted death (II, 19.6%; III, 27.4%; IV, 66.7%; P < 0.01). Conclusions Patients with no HF on echocardiography but raised NTproBNP suffer excess mortality particularly in the presence of certain clinical variables. Age, male gender, worsening CKD stage, presence of COPD, and dementia are independently associated with all-cause mortality in these patients. An NTproBNP > 627 pg/mL coupled with NYHA class could identify patients at greatest risk of death.

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Section: Limitationsmentioning

confidence: 99%

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

et al. 2020

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“…Of all studies, five [ 6 , 9 , 10 , 11 , 12 ] commented about the reproducibility. Further details of individual papers are highlighted in the discussion section and a detailed breakdown for each study is provided in the Supplemental Material .…”

Section: Resultsmentioning

confidence: 99%

“…Compared with children and young adults, older adults had a lower early peak diastolic KE ( p < 0.0001 and p = 0.025) respectively. In another study, Crandon et al [ 9 ] suggested that 4D CMR biomarkers of LV blood flow KE showed stronger association with age than the corresponding 2D metrics, peak E-wave and A-wave velocities (r = −0.51 vs. −0.17 and r = 0.65 vs. 0.46). Fifty-three healthy volunteers underwent standard CMR and 4D flow acquisition.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Blood Flow Kinetic Energy Assessment by 4D Flow Cardiovascular Magnetic Resonance: A Systematic Review of the Clinical Relevance

Kaur

Assadi

Alabed

et al. 2020

JCDD

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Background: There is an emerging body of evidence that supports the potential clinical value of left ventricular (LV) intracavity blood flow kinetic energy (KE) assessment using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). The aim of this systematic review is to summarize studies evaluating LV intracavity blood flow KE quantification methods and its potential clinical significance. Methods: A systematic review search was carried out on Medline, Pubmed, EMBASE and CINAHL. Results: Of the 677 articles screened, 16 studies met eligibility. These included six (37%) studies on LV diastolic function, another six (37%) studies on heart failure or cardiomyopathies, three (19%) studies on ischemic heart disease or myocardial infarction and finally, one (6%) study on valvular heart disease, namely, mitral regurgitation. One of the main strengths identified by these studies is high reproducibility of LV blood flow KE hemodynamic assessment (mean coefficient of variability = 6 ± 2%) for the evaluation of LV diastolic function. Conclusions: The evidence gathered in this systematic review suggests that LV blood flow KE has great promise for LV hemodynamic assessment. Studies showed increased diagnostic confidence at no cost of additional time. Results were highly reproducible with low intraobserver variability.

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“…The three-directional, 3D, cross-sectional velocity data acquired by 4D flow CMR allows quantification of flow and regurgitation in many novel ways. These methods could include particle tracing component analysis, intra-cavity energetics (24–26) RVT to quantify forward and regurgitant jet, 4D flow derived PISA, semi-quantitative streamline visualization and intra-cavity hemodynamic forces. The relevance of these methods needs to be tested and investigated to inform the severity of MR, left ventricular hemodynamics and predict adverse remodeling.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of 4D-Flow MRI Derived Mitral Regurgitation Quantification Methods

Fidock

Barker

Balasubramanian

et al. 2019

Front. Cardiovasc. Med.

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Background: Four-dimensional flow cardiac magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology that can be used to quantify mitral regurgitation (MR) volume. Current methods of quantification have demonstrated limitations in accurate analysis, particularly in difficult cases such as complex congenital heart disease. 4D flow CMR methods aim to circumvent these limitations and allow accurate quantification of MR volume even in complex cases. This systematic review aims to summarize the available literature on 4D flow CMR MR quantification methods and examine their ability to accurately classify MR severity. Methods: Structured searches were carried out on Medline and EMBASE in December 2018 to identify suitable research outcome studies. The titles and abstracts were screened for relevance, with a third adjudicator utilized when study suitability was uncertain. Results: Seven studies met the eligibility criteria and were included in the systematic review. The most widely used 4D flow MRI method was retrospective valve tracking (RVT) which was examined in five papers. The key finding of these papers was that RVT is a reliable and accurate method of regurgitant volume quantification. Conclusions: MR quantification through 4D flow MRI is both feasible and accurate. The evidence gathered suggests that for MR assessment, 4D flow MRI is potentially as accurate and reliable to echocardiography and may be complementary to this technique. Further work on MR quantification 4D flow image analysis is needed to determine the most accurate analysis technique and to demonstrate 4D flow MRI as a predictor of clinical outcome. PROSPERO Registration Number: CRD42019122837, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019122837

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Impact of Age and Diastolic Function on Novel, 4D flow CMR Biomarkers of Left Ventricular Blood Flow Kinetic Energy

Cited by 46 publications

References 36 publications

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

Left Ventricular Blood Flow Kinetic Energy Assessment by 4D Flow Cardiovascular Magnetic Resonance: A Systematic Review of the Clinical Relevance

A Systematic Review of 4D-Flow MRI Derived Mitral Regurgitation Quantification Methods

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