The kinetic energies of left ventricular 4D flow components correlate with established markers of prognosis and represent novel imaging biomarkers in both ischaemic and dilated cardiomyopathy

Background Despite different aetiology of myocardial damage in dilated cardiomyopathy (DCM) and ischaemic cardiomyopathy (IHD), cardiac remodelling occurs in both, culminating in the end result of a dilated left ventricle with impaired function. Cardiac remodelling is a complex process in which numerous cellular, mechanical and flow processes become deranged. Insights into changes of multidimensional flow patterns and kinetic energy (KE) within the left ventricle are now afforded by the use of 4D flow CMR. We hypothesised that greater derangements in 4D flow measures would relate to: 1) decreased mechanical cardiac function and dilatation, as assessed by LV ejection fraction (LVEF), LV myocardial strain and LV volumes, 2) increased levels of biochemical remodelling markers and 3) worsening patient symptoms and functional capacity. We hypothesised these changes to be independent of the initial aetiology of the myocardial damage, instead reflecting the self-propagating nature of cardiac remodelling.