Left ventricular fluid kinetic energy time curves in heart failure from cardiovascular magnetic resonance 4D flow data

Background: Measurement of intracardiac kinetic energy (KE) provides new insights into cardiac hemodynamics and may improve assessment and understanding of heart failure. We therefore aimed to investigate left ventricular (LV) KE time curves in patients with heart failure and in controls. Methods: Patients with heart failure (n = 29, NYHA class I-IV) and controls (n = 12) underwent cardiovascular magnetic resonance (CMR) including 4D flow. The vortex-ring boundary was computed using Lagrangian coherent structures. The LV endocardium and vortex-ring were manually delineated and KE was calculated as 1/2mv(2) of the blood within the whole LV and the vortex ring, respectively. Results: The systolic average KE was higher in patients compared to controls (2.2 +/- 1.4 mJ vs 1.6 +/- 0.6 mJ, p = 0.048), but lower when indexing to EDV (6.3 +/- 2.2 mu J/ml vs 8.0 +/- 2.1 mu J/ml, p = 0.025). No difference was seen in diastolic average KE (3.2 +/- 2.3 mJ vs 2.0 +/- 0.8 mJ, p = 0.13) even when indexing to EDV (9.0 +/- 4.4 mu J/ml vs 10.2 +/- 3.3 mu J/ml, p = 0.41). In patients, a smaller fraction of diastolic average KE was observed inside the vortex ring compared to controls (72 +/- 6 % vs 54 +/- 9 %, p < 0.0001). Three distinctive KE time curves were seen in patients which were markedly different from findings in controls, and with a moderate agreement between KE time curve patterns and degree of diastolic dysfunction (Cohen's kappa = 0.49), but unrelated to NYHA classification (p = 0.12), or 6-minute walk test (p = 0.72). Conclusion: Patients with heart failure exhibit higher systolic average KE compared to controls, suggesting altered intracardiac blood flow. The different KE time curves seen in patients may represent a conceptually new approach for heart failure classification.