Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

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Abstract

Four-dimensional (4D) flow magnetic resonance imaging (MRI) enables quantification of kinetic energy (KE) in intraventricular blood flow. This provides a novel way to understand the cardiovascular physiology of the Fontan circulation. In this study, we aimed to quantify the KE in functional single ventricles. 4D flow MRI was acquired in eleven patients with Fontan circulation (median age 12 years, range 3–29) and eight healthy volunteers (median age 26 years, range 23–36). Follow-up MRI after surgical or percutaneous intervention was performed in 3 patients. Intraventricular KE was calculated throughout the cardiac cycle and indexed to stroke volume (SV). The systolic/diastolic ratio of KE in Fontan patients was similar to the ratio of the controls’ left ventricle (LV) or right ventricle (RV) depending on the patients’ ventricular morphology (Cohen´s κ = 1.0). Peak systolic KE/SV did not differ in patients compared to the LV in controls (0.016 ± 0.006 mJ/ml vs 0.020 ± 0.004 mJ/ml, p = 0.09). Peak diastolic KE/SV in Fontan patients was lower than in the LV of the control group (0.028 ± 0.010 mJ/ml vs 0.057 ± 0.011 mJ/ml, p < 0.0001). The KE during diastole showed a plateau in patients with aortopulmonary collaterals. This is to our knowledge the first study that quantifies the intraventricular KE of Fontan patients. KE is dependent on the morphology of the ventricle, and diastolic KE indexed to SV in patients is decreased compared to controls. The lower KE in Fontan patients may be a result of impaired ventricular filling.

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Asymmetric redirection of flow through the heart.

D Firmin, P Kilner, R Mohiaddin … (2000)

Through cardiac looping during embryonic development, paths of flow through the mature heart have direction changes and asymmetries whose topology and functional significance remain relatively unexplored. Here we show, using magnetic resonance velocity mapping, the asymmetric redirection of streaming blood in atrial and ventricular cavities of the adult human heart, with sinuous, chirally asymmetric paths of flow through the whole. On the basis of mapped flow fields and drawings that illustrate spatial relations between flow paths, we propose that asymmetries and curvatures of the looped heart have potential fluidic and dynamic advantages. Patterns of atrial filling seem to be asymmetric in a manner that allows the momentum of inflowing streams to be redirected towards atrio-ventricular valves, and the change in direction at ventricular level is such that recoil away from ejected blood is in a direction that can enhance rather than inhibit ventriculo-atrial coupling. Chiral asymmetry might help to minimize dissipative interaction between entering, recirculating and outflowing streams. These factors might combine to allow a reciprocating, sling-like, 'morphodynamic' mode of action to come into effect when heart rate and output increase during exercise.

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Four-dimensional blood flow-specific markers of LV dysfunction in dilated cardiomyopathy

Jonatan Eriksson, Ann F. Bolger, Tino Ebbers … (2012)

Aims Patients with mild heart failure (HF) who are clinically compensated may have normal left ventricular (LV) stroke volume (SV). Despite this, altered intra-ventricular flow patterns have been recognized in these subjects. We hypothesized that, compared with normal LVs, flow in myopathic LVs would demonstrate a smaller proportion of inflow volume passing directly to ejection and diminished the end-diastolic preservation of the inflow kinetic energy (KE). Methods and results In 10 patients with dilated cardiomyopathy (DCM) (49 ± 14 years, six females) and 10 healthy subjects (44 ± 17 years, four females), four-dimensional MRI velocity and morphological data were acquired. A previously validated method was used to separate the LV end-diastolic volume (EDV) into four flow components based on the blood's locations at the beginning and end of the cardiac cycle. KE was calculated over the cardiac cycle for each component. The EDV was larger (P = 0.021) and the ejection fraction smaller (P < 0.001) in DCM compared with healthy subjects; the SV was equivalent (DCM: 77 ± 19, healthy: 79 ± 16 mL). The proportion of the total LV inflow that passed directly to ejection was smaller in DCM (P = 0.000), but the end-diastolic KE/mL of the direct flow was not different in the two groups (NS). Conclusion Despite equivalent LVSVs, HF patients with mild LV remodelling demonstrate altered diastolic flow routes through the LV and impaired preservation of inflow KE at pre-systole compared with healthy subjects. These unique flow-specific changes in the flow route and energetics are detectable despite clinical compensation, and may prove useful as subclinical markers of LV dysfunction.

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Transit of blood flow through the human left ventricle mapped by cardiovascular magnetic resonance.

B Wranne, Lars Wigström, John-Peder Escobar Kvitting … (2006)

The transit of blood through the beating heart is a basic aspect of cardiovascular physiology which remains incompletely studied. Quantification of the components of multidirectional flow in the normal left ventricle (LV) is lacking, making it difficult to put the changes observed with LV dysfunction and cardiac surgery into context. Three dimensional, three directional, time resolved magnetic resonance phase-contrast velocity mapping was performed at 1.5 Tesla in 17 normal subjects, 6 female, aged 44+/-14 years (mean+/-SD). We visualized and measured the relative volumes of LV flow components and the diastolic changes in inflowing kinetic energy (KE). Of total diastolic inflow volume, 44+/-11% followed a direct, albeit curved route to systolic ejection (videos 1 and 2), in contrast to 11% in a subject with mildly dilated cardiomyopathy (DCM), who was included for preliminary comparison (video 3). In normals, 16+/-8% of the KE of inflow was conserved to the end of diastole, compared with 5% in the DCM patient. Blood following the direct route lost or transferred less of its KE during diastole than blood that was retained until the next beat (1.6+/-1.0 millijoules vs 8.2+/-1.9 millijoules, p<0.05); whereas, in the DCM patient, the reduction in KE of retained inflow was 18-fold greater than that of the blood tracing the direct route. Multidimensional flow mapping can measure the paths, compartmentalization and kinetic energy changes of blood flowing into the LV, demonstrating differences of KE loss between compartments, and potentially between the flows in normal and dilated left ventricles.

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Author and article information

Contributors

Marcus Carlsson: +4646173989 , marcus.carlsson@med.lu.se

Journal

Journal ID (nlm-ta): Pediatr Cardiol

Journal ID (iso-abbrev): Pediatr Cardiol

Title: Pediatric Cardiology

Publisher: Springer US (New York )

ISSN (Print): 0172-0643

ISSN (Electronic): 1432-1971

Publication date (Electronic): 10 February 2017

Publication date PMC-release: 10 February 2017

Publication date (Print): 2017

Volume: 38

Issue: 4

Pages: 669-680

Affiliations

[1 ]Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden

[2 ]Department of Clinical Sciences Lund, Pediatric Heart Center, Skane University Hospital, Lund University, Lund, Sweden

[3 ]GRID grid.4514.4, Department of Biomedical Engineering, Faculty of Engineering, , Lund University, ; Lund, Sweden

[4 ]GRID grid.4514.4, Center for Mathematics, Faculty of Engineering, , Lund University, ; Lund, Sweden

[5 ]GRID grid.411843.b, Department of Medical Imaging and Physiology, , Skane University Hospital, ; Lund, Sweden

Article

Publisher ID: 1565

DOI: 10.1007/s00246-016-1565-6

PMC ID: 5388704

PubMed ID: 28184976

SO-VID: d3c75c05-15ce-42c8-b4be-c9b144c25ccf

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 26 August 2016

Date accepted : 30 December 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003793, Hjärt-Lungfonden;

Funded by: Region Skåne (SE)

Funded by: FundRef http://dx.doi.org/10.13039/501100007687, Svenska Läkaresällskapet;

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: fontan,congenital heart disease,kinetic energy,cmr,mri,magnetic resonance imaging

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: fontan, congenital heart disease, kinetic energy, cmr, mri, magnetic resonance imaging

Decreased Diastolic Ventricular Kinetic Energy in Young Patients with Fontan Circulation Demonstrated by Four-Dimensional Cardiac Magnetic Resonance Imaging

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Stroke MRI

Most cited references 30

Asymmetric redirection of flow through the heart.

Four-dimensional blood flow-specific markers of LV dysfunction in dilated cardiomyopathy

Transit of blood flow through the human left ventricle mapped by cardiovascular magnetic resonance.

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