Four-dimensional flow magnetic resonance imaging visualizes reverse vortex pattern and energy loss increase in left bundle branch block
Four-dimensional flow magnetic resonance imaging visualizes reverse vortex pattern and energy loss increase in left bundle branch block
复制标题
四维流磁共振成像显示左束支传导阻滞中的反向涡流模式和能量损失增加
DOI：
10.1093/europace/euab299
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Maekawa Yuichiro
中科院分区：
文献类型：
--
作者：
Miyajima Keisuke;Urushida Tsuyoshi;Ito Kazuki;Kin Fumihiko;Okazaki Ayako;Takashima Yasuyo;Watanabe Tomoyuki;Kawaguchi Yoshitaka;Wakabayashi Yasushi;Takehara Yasuo;Maekawa Yuichiro
目的应用四维血流磁共振成像（4D-flow MRI）技术对16例左束支分支传导阻滞（LBBB）患者和16例QRS时限正常的倾向积分匹配患者（非LBBB组）进行研究。评价左心室能量损失（EL）。在两组中，在左心室舒张期间观察从二尖瓣到心尖和左心室（LV）流出道的血流。在两组中也观察到漩涡。有两种模式的漩涡：单向顺时针旋转和逆时针旋转发生在从心脏收缩中期（反向模式）。在LBBB组中，观察到相反的模式（LBBB组94% vs. non-LBBB组19%，P < 0.001）。流线分析的观察者间一致性良好（kappa = 0.68）。LBBB组的最大EL显著高于非LBBB组[LBBB组12（11-15）mW，非LBBB组8.0（6.2-9.7）mW，P< 0.001]。因此，左心室中的涡流和EL的形状可以作为LBBB患者中LV机械不同步的标志物，并且可以作为对心脏起搏治疗的反应的预测因子进行研究。
AimsThis study aimed to investigate the intraventricular blood flow pattern of patients with left bundle branch block (LBBB) using four-dimensional flow magnetic resonance imaging (4D-flow MRI).Methods and resultsWe performed 4D-flow MRI for 16 LBBB patients (LBBB group) and 16 propensity score-matched patients with a normal QRS duration (non-LBBB group). The energy loss (EL) in the left ventricle was evaluated. In both groups, blood flow from the mitral valve to the apex of the heart and left ventricular (LV) outflow tract during LV diastole were observed. Vortices were also observed in both groups. There were two patterns of vortices: unidirectional clockwise rotation and counterclockwise rotation taking place from the mid-diastole to the systole (reverse pattern). The reverse pattern was observed significantly more frequently in the LBBB group (LBBB 94% vs. non-LBBB 19%,P< 0.001). The interobserver agreement for the streamline analysis was good (kappa = 0.68). The maximum EL was significantly higher in the LBBB group [LBBB 12 (11–15) mW vs. non-LBBB 8.0 (6.2–9.7) mW,P< 0.001].ConclusionLeft bundle branch block patients may suffer from inefficient LV haemodynamics reflected by non-physiological counterclockwise vortices and increased EL. Thus, the shape of the vortices and EL in the left ventricle can serve as markers of LV mechanical dyssynchrony in LBBB patients and could be investigated as predictors of response to cardiac resynchronization therapy.