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• Clinical Article •
Hemodynamic characterization of left ventricular thrombus in myocardial infarction patients based on 4D Flow MRI
YANG Pei  ZHAO Xiaodan  HU Mengyao  LENG Shuang  TAN Rusan  XIAO Xuan  WU Hailong  LI Shuhao  van der Geest ROB J.  ZHONG Liang  GONG Lianggeng 

DOI:10.12015/issn.1674-8034.2026.07.007.


[Abstract] Objective This study aimed to assess the left ventricular hemodynamic characteristics in patients with myocardial infarction (MI) and left ventricular thrombus (LVT) using four-dimensional flow magnetic resonance imaging (4D Flow MRI), and to explore their potential relationship with LVT formation.Materials and Methods A total of 45 subjects were enrolled, including 15 subjects in each group: MI with LVT [MI-LVT(+)], MI without LVT [MI-LVT(-)], and healthy controls. All participants underwent steady-state free precession and 4D Flow MRI scans. Left ventricular functional parameters, four flow components (direct flow, retained inflow, delayed ejection flow, and residual volume), and kinetic energy (KE) parameters, including global KE, peak systolic KE, systolic KE, diastolic KE, E-wave and A-wave peak KE, were quantitatively analyzed using MASS software. All KE parameters were normalized to left ventricular end-diastolic volume (LVEDV) (denoted as KEiEDV). Myocardial scar extent was assessed using CVI.42 software. Binary logistic regression analysis was used to identify variables independently associated with the presence of LVT, and receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic performance of 4D Flow MRI parameters.Results Compared with healthy controls, MI patients exhibited significant left ventricular remodeling, with increased left ventricular end-diastolic volume index (LVEDVi) and left ventricular end-systolic volume index (LVESVi) and decreased left ventricular ejection fraction (LVEF) (all P < 0.001). LVEF was lower in the MI-LVT(+) group compared with the MI-LVT(-) group (31% vs. 40%, P = 0.034). MI patients showed significantly reduced direct flow (P < 0.001) and increased residual volume (P < 0.001), with more pronounced changes observed in the MI-LVT(+) group (P < 0.05). All KEiEDV parameters were significantly reduced in the MI group (all P < 0.001); however, no statistically significant differences were found between the LVT subgroups. Logistic regression analysis showed that direct flow was independently associated with the presence of LVT. ROC curve analysis demonstrated an area under the curve of 0.747, with an optimal cutoff value of 16.24%, a sensitivity of 80.00%, and a specificity of 66.67%.Conclusions MI patients demonstrated notable LV remodeling and hemodynamic abnormalities compared to healthy controls. Reduced direct flow and increased residual flow were key characteristics, especially in patients with LVT. Overall KE parameters were decreased, especially in the MI-LVT(+) group. Direct flow is independently associated with the presence of LVT and can serve as a supplementary tool to conventional structural assessment, assisting clinicians in multi-dimensional risk stratification.
[Keywords] myocardial infarction；left ventricular thrombus；kinetic energy；four-dimensional flow magnetic resonance imaging；hemodynamics

YANG Pei1, 2, 3   ZHAO Xiaodan3   HU Mengyao1, 2, 3   LENG Shuang3   TAN Rusan3   XIAO Xuan1, 2   WU Hailong1, 2   LI Shuhao1, 2   van der Geest ROB J.4   ZHONG Liang3   GONG Lianggeng1, 2*  

1 Department of Radiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330006, China

2 Intelligent Medical Imaging of Jiangxi Key Laboratory, Nanchang 330006, China

3 National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore 169609, Singapore

4 Department of Radiology, Leiden University Medical Center, Leiden 2333 ZA, Netherlands

Corresponding author: GONG L G, E-mail: gong111999@163.com

Conflicts of interest   None.

Received  2025-11-12
Accepted  2026-07-12
DOI: 10.12015/issn.1674-8034.2026.07.007
DOI:10.12015/issn.1674-8034.2026.07.007.

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