Evaluation of left ventricular blood flow kinetic energy in patients with acute myocardial infarction by 4D flow MRI: a preliminary study

Evaluation of left ventricular blood flow kinetic energy in patients with acute myocardial infarction by 4D flow MRI: a preliminary study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of left ventricular blood flow kinetic energy in patients with acute myocardial infarction by 4D flow MRI: a preliminary study Xiqing Niu, Yutong Dun, Guoce Li, Houning Zhang, Bin Zhang, Zhibin Pan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3891635/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To evaluate the intracavity left ventricular (LV) blood flow kinetic energy (KE) parameters using four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) in patients with acute myocardial infarction (AMI). Methods: Thirty AMI patients and twenty controls were examined via CMR, which included cine imaging, late gadolinium enhancement (LGE) and global heart 4D flow imaging. The KE parameters were correlated with the left ventricular end-diastolic volume (LVEDV) to obtain average, minimal, systolic, and diastolic KE as well as the proportion of LV in-plane KE (%). These parameters were compared between the AMI patients and controls and between the two subgroups. Results: Analysis of the LV blood flow KE parameters at different levels of the LV cavity and in different segments of the same level showed that the basal level had the highest blood flow KE while the apical level had the lowest in the control group. There were significant differences in diastolic, systolic and diastolic in-plane KE between the anterior wall and posterior wall (p>0.05). Compared with those in the control group, the average (10.7±3.3 μJ/mL vs. 14.7±3.6 μJ/mL, p<0.001), systolic (14.6±5.1 μJ/mL vs. 18.9±3.9 μJ/mL, p=0.003) and diastolic KE (7.9±2.5 μJ/mLvs. 10.6±3.8 μJ/mL, p=0.018) were significantly lower in the AMI group. The average KE in the infarct segment was lower than that in the noninfarct segment in the AMI group, while the proportion of systolic in-plane KE increased significantly (49.5±18.7 μJ/mL vs. 126.3±50.7 μJ/mL, p<0.001; 61.8%±11.5 vs. 42.9%±14.4, p=0.001). Conclusion: The 4D flow MRI technique can be used to quantitatively evaluate LV regional haemodynamic parameters. There were differences in the KE parameters of LV blood flow at different levels and in different segments of the same level in healthy people. In AMI patients, the average KE of the infarct segment decreased, while the proportion of systolic in-plane KE significantly increased. 4D flow MRI Myocardial infarction Kinetic energy In-plane kinetic energy MASS Figures Figure 1 Introduction After acute myocardial infarction (AMI), the myocardial systolic function of the infarct segment is weakened or lost, and left ventricular (LV) contraction becomes asymmetrical. Asymmetric contraction causes the LV wall to experience uneven blood tension, resulting in complex haemodynamic changes that may lead to adverse remodelling and subsequent left heart failure [ 1 – 3 ]. The effect of AMI on LV hemodynamic has been confirmed, and the quantification of LV hemodynamic is highly valuable for determining the prognosis of patients with myocardial infarction [ 4 – 6 ]. The kinetic energy (KE) of blood flow is an important parameter to evaluate. KE refers to the energy required to accelerate a certain amount of blood from a static state to a certain speed and is the energy accompanying blood flow [ 7 ]. The KE of blood flow includes both in-plane and through-plane components. In-plane KE is the sum of all KE values in the horizontal direction of the short axis from the base to the apex of the LV. In contrast, through-plane KE refers to the component of blood flow perpendicular to the short axis of the heart. At present, the conventional imaging techniques for evaluating the characteristics of cardiac blood flow include echocardiography and two-dimensional (2D) phase contrast cardiovascular magnetic resonance. Compared with 2D phase contrast cardiovascular magnetic resonance imaging [ 8 ], four-dimensional flow magnetic resonance imaging (4D flow MRI) can detect the velocity along three spatial dimensions in the global cardiac cycle and achieve comprehensive visualization of left ventricular blood flow and quantification of kinetic energy [ 9 – 11 ]. The purpose of this study was to preliminarily investigate the changes in regional LV blood flow KE of AMI patients using 4D flow MRI technology. Materials and methods Study population Thirty patients with AMI and twenty age-/sex-matched healthy controls from Cangzhou Central Hospital were retrospectively evaluated between February 2022 and August 2023. The regional ethics committee approved this study (approval number: 2023-222-02), and the requirement for written informed consent was waived. The inclusion criteria for patients were as follows: a clinical diagnosis of AMI [ 12 ]; percutaneous coronary intervention (PCI) performed within 12 hours after the onset of chest pain; CMR imaging completed within one week after treatment; and no contraindications for cardiac MRI. The exclusion criteria for patients were as follows: a previous history of vascular reconstruction surgery (coronary artery bypass grafting or PCI); known cardiomyopathy or valvular heart disease; haemodynamic instability lasting more than 24 hours after PCI; poor-quality CMR images; or incomplete imaging data [ 3 ]. CMR examination All control subjects and patients were scanned in a 3.0T scanner (MR750, GE Healthcare, Signa Discovery) with a 16-channel phased array coil. All the subjects were trained to hold their breath at the end of expiration, and ECG gating and respiratory gating were monitored. CMR protocol and image acquisition The CMR protocol was as follows: Survey images were taken. The following cines were defined using the survey images:horizontal long-axis, 2-chamber, 4-chamber and the LV volume contiguous short-axis stack. All cines were acquired with a balanced steady-state free precession (bSSFP) procedure. The typical parameters for the bSSFP sequence were as follows: flip angle (FA) 60°, echo time (TE) 1.89 milliseconds, repetition time (TR) 3.74 milliseconds, field of view (FOV) 320–420 mm depending on patient size, slice thickness 8 mm, and 25 phases per cardiac cycle. LGE imaging was performed 15 min after gadolinium-based contrast agent injection in AMI patients only. LGE imaging was performed with a phase sensitive myocardial delayed enhancement (PSMDE) spoiled gradient recalled echo (FSPGR) sequence. The PSMDE sequence details are as follows: TE/TR, 2.46/5.3 msec; FA, 25°. For global heart 4D flow, the field of view (FOV) was planned in the transaxial plane to ensure that the global heart was within the FOV. 4D flow data were acquired with PC VIPR, a 3D radially undersampled, three-directional velocity-encoding technique [ 13 ]. The FOV and number of slices (i.e., the 3D volume) were adjusted according to the subject’s size. The scan parameters were as follows: TE, 2.0 ms; TR, 5.3 ms; FA, 14°; VENC, 150 cm/sec. Image analysis A GE AW4.7 postprocessing workstation was used to measure cardiac function parameters. The indices of left ventricular volume and cardiac function, including the left ventricular end diastolic volume index (LVEDVi), left ventricular end systolic volume index (LVESVi) and left ventricular ejection fraction (LVEF), which were corrected by body surface area, were obtained. The parameters of global blood flow KE were analysed using MASS (version 2021-EXP, Medis Medical Imaging). The calculation formula for KE was KE = 1/2 ρ blood × V voxel × v 2 , where ρ blood represents the density of blood (1.06 g/cm3), V voxel represents the voxel volume, and v represents the velocity magnitude. At each time point, the KE of each voxel is summed to obtain the total KE of LV blood flow, and the KE value of each voxel in the global cardiac cycle is summed to obtain the time-resolved curve of KE to determine the physiological parameters. All KE parameters were indexed to the LVEDV, and the units were µJ/mL (KEi EDV ) [ 14 ]. Kinetic energy analysis of regional blood flow MASS automatically quantified the blood flow KE parameters in 16 segments of the heart in all subjects according to American Heart Association standards. In this study, the subjects' hearts were divided into 3 levels (base, mid-ventricle and apex), and each level was divided into 4 segments (anterior wall, posterior wall, septal wall and lateral wall). The differences in regional blood flow KE at different levels and in different segments of the same level of the heart cavity in the healthy control group were used as the reference for the AMI group. In the AMI group, the segment with the largest area of myocardial infarction was defined as the infarct segment, and the contralateral myocardium was defined as the noninfarct segment. Statistical analysis All analyses were performed using SPSS® Statistics. The normally distributed data are expressed as the mean ± standard deviation (SD), and two-independent sample t tests were used. Data with a nonnormal distribution are represented by the interquartile range (IQR), and the Mann‒Whitney U test was used. Categorical data are presented as numbers and proportions. The comparison of different levels and different segments in the control group was performed by one-way ANOVA, and the difference in regional blood flow KE in the AMI group was compared by paired t test or Wilcoxon signed rank sum test. A two-tailed p value of less than 0.05 was considered to indicate statistical significance. Results Patient demographic characteristics There were no significant differences in heart rate (67.1 ± 15.7 beats/min vs. 73.0 ± 8.8 beats/min, P = 0.057) between the AMI patients and the control group. Healthy controls and the AMI group were matched for age (54 ± 9 years vs. 58 ± 9 years, P = 0.133). The CMR volume parameters of the AMI patients were significantly greater than those of the control group, while the LVEF was significantly lower (48.9%±13.0 vs. 67.1%±9.4) (Table 1 ). Table 1 Comparison of demographic data between controls and AMI patients Controls (n = 20) AMI patients (n = 30) t/χ2 P Sex (male: female) a 11:9 18:12 0.123 0.726 Hypertension (%) a 65 60 0.127 0.721 Age (years) 27.5 ± 4.2 58.1 ± 9.7 -1.528 0.017 Heart rate (bpm) 73.0 ± 8.8 67.1 ± 15.7 1.95 0.057 LVEF (%) 67.1 ± 9.4 48.9 ± 13.0 1.198 < 0.001 LVEDVi (ml/m 2 ) 67.5 ± 17.4 99.8 ± 19.8 -6.487 < 0.001 LVESVi (ml/m 2 ) 26.4 ± 8.6 52.3 ± 15.3 0.030 < 0.001 The values are presented as the mean ± standard deviation (SD). a Values are expressed as counts (n). LV measurements are indexed to body surface area. Abbreviations: LVEF, left ventricular ejection fraction. LVEDVi, left ventricular end-diastolic volume (indexed). LVESVi, left ventricular end-systolic volume (indexed). KE parameter results Global blood flow KE for the two groups The average LV KEi EDV and systolic and diastolic KE in AMI patients were significantly lower than those in the control group (10.7 ± 3 µJ/ml vs. 14.7 ± 3 µJ/ml, P < 0.01; 14.6 ± 5.1 µJ/ml vs. 18.9 ± 3.9 µJ/ml, P = 0.003; and 7.9 ± 2.5 µJ/ml vs. 10.6 ± 3.8 µJ/ml, P = 0.003, respectively). No significant difference was found in the minimum or in-plane KE proportion between the AMI patients and the control group (3.2 ± 1.1 µJ/ml vs. 3.7 ± 0.9 µJ/ml, P = 0.117; 32.0%±11.4 vs. 30.9%±12.2, P = 0.742) (Table 2 , Fig. 1 ). Table 2 Comparison of LV blood flow KE parameters between controls and AMI patients Controls (n = 20) AMI patients (n = 30) t P LV KEi EDV (µJ/ml) 14.7 ± 3.6 10.7 ± 3.3 4.006 < 0.001 Minimal KEi EDV (µJ/ml) 3.7 ± 0.9 3.2 ± 1.1 0.609 0.117 Systolic KEi EDV (µJ/ml) 18.9 ± 3.9 14.6 ± 5.1 3.172 0.003 Diastolic KEi EDV (µJ/ml) 10.6 ± 3.8 7.9 ± 2.5 2.973 0.010 In-plane KE (%) 30.9 ± 12.2 32.0 ± 11.4 -0.331 0.742 Blood flow KE at different levels in the control group As shown in Table 3 , blood flow KE parameters were different at different levels in the same patient. The average, systolic and diastolic KE in the basal segment (6.7 ± 1.8 µJ/ml, 8.5 ± 2.7 µJ/ml, and 5.4 ± 2.1 µJ/ml, respectively) were significantly greater than those in the middle segment (4.9 ± 2.1 µJ/ml, 5.9 ± 2.6 µJ/ml, and 4.5 ± 2.2 µJ/ml, respectively) and apical segment (1.7 ± 0.6 µJ/ml, 2.0 ± 0.7 µJ/ml, and 1.6 ± 0.6 µJ/ml, respectively), and the values in the apical segment were the lowest (all p < 0.05). Table 3 Blood flow KE at different levels of the LV cavity in controls Base Mid-ventricle Apex F P Average KEi EDV 6.7 ± 1.8 4.9 ± 2.1 a 1.7 ± 0.6 ab 45.799 < 0.001 Systolic KEi EDV 8.5 ± 2.7 5.9 ± 2.6 a 2.0 ± 0.7 ab 42.645 < 0.001 Diastolic KEi EDV 5.4 ± 2.1 4.5 ± 2.2 1.6 ± 0.6 ab 24.536 < 0.001 In-plane KE (%) 33.6 ± 7.7 32.6 ± 13.5 41.0 ± 18.5 2.159 0.125 Systolic in-plane KE (%) 37.7 ± 8.8 30.2 ± 15.1 34.1 ± 19.0 1.220 0.303 Diastolic in-plane KE (%) 28.8 ± 10.0 35.9 ± 13.5 48.4 ± 18.5 ab 9.122 < 0.001 a Compared with the basal level, P < 0.05; b compared with the middle level, P < 0.05; pairwise comparisons were calibrated by Bonferroni multiple correction. Blood flow KE in different segments in the control group Comparisons of LV blood flow KE parameters in different segments at the same level in the control group are shown in Table 4 . The systolic KE and systolic in-plane KE were significantly different, while the diastolic KE and diastolic in-plane KE were not significantly different. According to pairwise comparisons of the anterior wall, posterior wall, septal wall and lateral wall, the systolic blood flow KE in the anterior wall and septal wall was significantly greater than that in the corresponding segments. The systolic in-plane KE was not significantly different between the anterior and posterior walls but was significantly different between the septal and lateral walls. Table 4 Blood flow KE at different segments of the LV cavity in controls Anterior Posterior Septal Lateral F P Systolic KEi EDV (µJ/ml) Base Mid-ventricle Apex 247.5 ± 127.0 b 67.6 ± 43.8 ac 292.5 ± 203.3 b 78.8 ± 53.2 acb 17.052 < 0.001 154.8 ± 75.5 b 86.6 ± 53.2 ac 147.2 ± 78.4 b 88.6 ± 45.6 ac 6.450 0.001 55.1 ± 20.6 61.8 ± 27.5 54.4 ± 20.4 62.3 ± 28.7 0.599 0.618 Diastolic KEi EDV (µJ/ml) Base Mid-ventricle Apex 117.8 ± 69.0 154.0 ± 113.0 85.6 ± 46.0 159.5 ± 126.0 2.681 0.053 87.4 ± 42.3 92.2 ± 43.0 74.3 ± 38.7 86.1 ± 36.8 0.723 0.542 39.1 ± 17.2 41.9 ± 19.7 38.4 ± 17.1 43.2 ± 19.9 0.305 0.821 Systolic in-plane KE (%) Base Mid-ventricle Apex 42.9 ± 13.0 47.5 ± 10.7 c 37.2 ± 14.0 b 52.2 ± 12.7 ac 5.192 0.003 32.5 ± 17.5 33.0 ± 16.4 23.7 ± 12.0 41.2 ± 19.7 c 3.717 0.015 31.4 ± 19.4 30.7 ± 16.7 30.3 ± 15.1 35.0 ± 22.6 0.269 0.848 Diastolic in-plane KE (%) Base Mid-ventricle Apex 27.6 ± 8.3 26.2 ± 12.6 28.9 ± 11.5 22.3 ± 11.6 1.325 0.273 33.9 ± 13.7 35.4 ± 16.5 33.4 ± 12.2 33.9 ± 12.3 0.664 0.577 49.5 ± 15.1 49.1 ± 20.6 46.7 ± 18.9 55.4 ± 16.2 0.855 0.468 a Compared with the anterior segment, P < 0.05; b compared with the posterior segment, P < 0.05; c compared with the septal segment, P < 0.05; pairwise comparisons were calibrated by Bonferroni multiple correction. Regional blood flow KE in the AMI group In the AMI group, there were 2 cases of anterior wall infarction, 20 cases of posterior wall infarction (14 cases in the basal segment and 6 cases in the middle segment), 5 cases of septal wall infarction, and 3 cases of lateral wall infarction. Because the sample size of patients with anterior and middle posterior wall infarctions was small, this study analysed only the difference in regional KE in patients with posterior basal myocardial infarction. As shown in Table 5 , the systolic and diastolic KE in the infarct segment were significantly lower than those in the noninfarct segment (49.5 ± 18.7 µJ/ml vs. 126.3 ± 50.7 µJ/ml, P < 0.001; 25.7 ± 9.1 µJ/ml vs. 44.5 ± 21.4 µJ/ml, P = 0.005). However, the proportion of systolic in-plane KE in the infarct segment was greater than that in the noninfarct segment (61.8% ± 11.5 vs. 42.9% ± 12.1, P = 0.001). There was no significant difference in the proportion of diastolic in-plane KE between the infarct and noninfarct segments (53.6% ± 19.0 vs. 43.2% ± 14.4, P = 0.203). Table 5 Paired t test results of blood flow KE in the basal segment of posterior wall AMI Noninfarct segment Infarct segment t P Systolic KEi EDV 126.3 ± 50.7 49.5 ± 18.7 -5.764 <0.001 Diastolic KEi EDV 44.5 ± 21.4 25.7 ± 9.1 -6.703 0.005 Systolic in-plane KE (%) 42.9 ± 12.1 61.8 ± 11.5 4.035 0.001 Diastolic in-plane KE (%) 43.2 ± 14.4 53.6 ± 19.0 1.339 0.203 Discussion Global blood flow KE in the control and AMI groups The KEi EDV parameter of LV blood flow was decreased in patients with AMI, which was consistent with the results of Pankaj et al. [ 1 ] and Kanski et al. [ 15 ]. After MI, the regional contractility of the myocardium is reduced, which reduces the regional pressure on the blood in the cavity and the pressure gradient between the LV and the aorta, thus reducing the total thrust of systolic blood flow, which ultimately manifests as a decrease in systolic KE. Another finding of the study by Pankaj Garg also supports this view: the LV stroke volume was related to the KEi EDV only at the end of systole in the infarction group but not in the control group. Blood flow KE at different levels in the control group Several studies have reported the application of MRI in detecting LV blood flow KE in healthy individuals. However, the current studies on blood flow KE parameters in healthy people have focused mainly on evaluating flow in the global heart chamber, while few studies have evaluated regional KE. In our study of 20 healthy subjects, the KE values at different levels were different: the basal segment had the largest values, while the apex had the smallest values, which may be related to the proximity of the base flow to the left ventricular outflow tract (LVOT). The jet through the aortic valve improved the KE of the basal segment flow. Previous studies have shown that the blood in the LV contains different components during the cardiac cycle; the residual volume refers to the volume that stays at the apex for more than one cardiac cycle, and the KE of the residual volume is small. Philip's research also revealed that the volume through the apex is significantly reduced [ 13 , 16 – 18 ]. Blood flow KE in different segments of the control group In this study, analysis of the blood flow KE in different segments at the same level in the control group showed no statistically significant differences in the diastolic KE, systolic in-plane KE or diastolic in-plane KE between the anterior and posterior walls of the heart cavity. The difference in blood flow KE between the septal and lateral walls was statistically significant only for diastolic KE and diastolic in-plane KE. Therefore, we preliminarily concluded that the blood flow KE parameters between the anterior and posterior walls were similar and that the flow status was more consistent. To compare the regional blood flow in the myocardial infarction group, we focused on analysing the anterior and posterior wall blood flow. LV flow has a complex motion and haemodynamic characteristics [ 19 – 22 ]. The statistically significant difference in systolic KE between the anterior and posterior walls in the control group may be related to the presence of an asymmetric vortex in the heart cavity during systole. Goyal studied the characteristics of the LV systolic vortex in healthy dogs and reported that the systolic vortex in the posterior basal region was more obvious than in the anterior region, which could explain the significant difference in systolic KE between the anterior and posterior walls of the heart cavity in our study [ 23 ]. Regional blood flow KE in the AMI group The blood flow KE in the infarct segment was lower than that in the noninfarct segment in AMI patients, and the proportion of in-plane KE was increased, which was consistent with Garg's findings [ 1 ]. In addition, Arka Das et al. [ 3 ] reported that patients with adverse ventricular remodelling had increased in-plane KE. The increase in the in-plane KE may be related to pathological blood flow. After MI, LV function is damaged, and the cardiac cavity begins to expand. However, progressive LV impairment and dilatation also cause increased sphericity, which in turn changes flow conditions inside the cavity to a ‘meta-stable’ state with a large, swirling vortex that encompasses the majority of the LV [ 2 ]. This vortex flow includes transverse thrusts, which increase the proportion of in-plane KE. In addition, our study revealed that there was no significant difference in diastolic in-plane KE between infarct and noninfarct segments. This finding is consistent with the findings of Arka, which may also be related to changes in diastolic blood flow. Suwa et al. [ 24 ] reported that patients with impaired LV function had a greater diastolic vortex than did those with normal LV function [ 24 ]. The purpose of this study was to analyse the changes in KE parameters of regional blood flow in the cardiac cavity of MI patients and to determine whether in-plane KE is highly important in blood flow near the cardiac cavity of the regionally infarcted myocardium. A pathological increase in in-plane KE may exert heterogeneous haemodynamic force on the LV wall, which leads to further expansion of the endocardium and increased endothelial dysfunction [ 25 – 28 ]. This pathological process may be related to the formation of ventricular aneurysms. Ventricular aneurysm [ 29 ] is a common complication of AMI. After infarction, necrotic myocardial cells are gradually replaced by fibrous scar tissue, and the infarcted myocardium becomes thinner and bulges outwards, possibly leading to abnormal movement during contraction. To date, there is a lack of research on the relationship between haemodynamic parameters and ventricular aneurysm formation in MI patients. Prospective studies are needed in the future, which may provide haemodynamic insights into the pathophysiology of remodelling after myocardial infarction. Study limitations First, this was a single-centre study with a small sample size; future studies should involve multiple centres and larger sample sizes to more accurately evaluate the changes in regional blood flow KE in infarct segments. Second, this study lacked comparisons with echocardiography data on diastolic function parameters such as E/A and E/e', and the value of KE parameters in evaluating diastolic function still needs to be further explored. Therefore, additional studies combined with ultrasound functional parameters are needed in the future to comprehensively evaluate cardiac haemodynamic changes in AMI patients. Conclusions This study provides a methodological reference for the regional analysis of LV flow parameters via 4D flow MRI. Differences in the KE parameters at different levels and in different segments of the same level in the LV cavity were found in healthy people. In AMI patients, the average KE in the infarct segment decreased, while the proportion of in-plane KE increased. This was a preliminary study analysing regional LV blood flow KE, and further exploration is needed to determine whether regional LV blood flow KE has predictive value for AMI. Declarations Funding This study was supported by the Medical Science Research Project of Hebei Province in China in 2024 (Approval number: 20241752), and chaired by Fenghai Liu. Competing interests The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was a retrospective study and was approved by the ethics committee of our hospital and exempted from informed consent. Consent to publish The authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 1a, 1b, 1c and 1d. Author’s contribution Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Xiqing Niu, Yutong Dun, Guoce Li, Houning Zhang, Bin Zhang, Zhibin Pan, Hao Bian, Liqing Kang . The first draft of the manuscript was written by Xiqing Niu and all authors commented on previous versions of the manuscript. The manuscript was reviewed by Fenghai Liu. All authors read and approved the final manuscript. References Pankaj G, Crandon S, Swoboda PP et al (2018) Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance. 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JACC Cardiovasc Imaging 2:709–716. https://doi.org/10.1016/j.jcmg.2009.01.015 Sengupta PP, Khandheria BK, Narula J (2008) Twist and untwist mechanics of the left ventricle. Heart Fail Clin 4:315–324. https://doi.org/10.1016/j.hfc.2008.03.001 Mele D, Smarrazzo V, Pedrizzetti G, Capasso F, Pepe M, Severino S, Luisi GA, Maglione M, Ferrari R (2019) Intracardiac flow analysis: techniques and potential clinical applications. J Am Soc Echocardiogr 32:319–332. https://doi.org/10.1016/j.echo.2018.10.018 Goya S, Wada T, Shimada K, Hirao D, Tanaka R (2018) The relationship between systolic vector flow mapping parameters and left ventricular cardiac function in healthy dogs. Heart Vessels 33:549–560. https://doi.org/10.1007/s00380-017-1093-1 Suwa K, Saitoh T, Takehara Y et al (2016) Intra-left ventricular flow dynamics in patients with preserved and impaired left ventricular function: analysis with 3D cine phase contrast MRI (4D-Flow). J Magn Reson Imaging 44:1493–1503. https://doi.org/10.1002/jmri.25315 Eriksson J, Zajac J, Alehagen U, Bolger AF, Ebbers T, Carlhäll CJ (2017) Left ventricular hemodynamic forces as a marker of mechanical dyssynchrony in heart failure patients with left bundle branch block. Sci Rep 7:2971. https://doi.org/10.1038/s41598-017-03089-x Eriksson J, Bolger AF, Ebbers T, Carlhäll CJ (2016) Assessment of left ventricular hemodynamic forces in healthy subjects and patients with dilated cardiomyopathy using 4D flow MRI. Physiol Rep 4:e12685. https://doi.org/10.14814/phy2.12685 Arvidsson PM, Töger J, Carlsson M, Steding-Ehrenborg K, Pedrizzetti G, Heiberg E, Arheden H (2017) Left and right ventricular hemodynamic forces in healthy volunteers and elite athletes assessed with 4D flow magnetic resonance imaging. Am J Physiol Heart Circ Physiol 312:H314–H328. https://doi.org/10.1152/ajpheart.00583.2016 Pedrizzetti G, Arvidsson PM, Töger J, Borgquist R, Domenichini F, Arheden H, Heiberg E (2017) On estimating intraventricular hemodynamic forces from endocardial dynamics: a comparative study with 4D flow MRI. J Biomech 60:203–210. https://doi.org/10.1016/j.jbiomech.2017.06.046 Subramanian K, Mahdi R, Singh H, Sood A, Mittal BR (2023) Perfusion defect with characteristic anterior wall indentation on myocardial perfusion imaging caused by a large left ventricular aneurysm. J Nucl Cardiol 30:2809–2812. https://doi.org/10.1007/s12350-023-03223-5 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3891635","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":269746688,"identity":"0816ad67-5ef0-418f-86e4-004c23f0451b","order_by":0,"name":"Xiqing Niu","email":"","orcid":"","institution":"Hebei Medical University affiliated Cangzhou Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiqing","middleName":"","lastName":"Niu","suffix":""},{"id":269746689,"identity":"3309a0d5-be2b-4632-b4cb-2f70ca20320b","order_by":1,"name":"Yutong Dun","email":"","orcid":"","institution":"Hebei Medical University affiliated Cangzhou Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yutong","middleName":"","lastName":"Dun","suffix":""},{"id":269746690,"identity":"4a2b6867-ad68-4dda-ad43-be63e855fa78","order_by":2,"name":"Guoce Li","email":"","orcid":"","institution":"Cangzhou Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guoce","middleName":"","lastName":"Li","suffix":""},{"id":269746691,"identity":"3ca28205-706c-4c06-a390-5bf407363717","order_by":3,"name":"Houning Zhang","email":"","orcid":"","institution":"North China University of Science and Technology Affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Houning","middleName":"","lastName":"Zhang","suffix":""},{"id":269746692,"identity":"d8861e4c-6b2e-4cc1-90e2-d21c104cec9c","order_by":4,"name":"Bin Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of Hebei North University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Zhang","suffix":""},{"id":269746693,"identity":"b72813bb-2a68-400c-9029-01473d2796f7","order_by":5,"name":"Zhibin Pan","email":"","orcid":"","institution":"Cangzhou Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhibin","middleName":"","lastName":"Pan","suffix":""},{"id":269746694,"identity":"d566a2c7-54da-4a4c-9cab-f0af43f02ced","order_by":6,"name":"Hao Bian","email":"","orcid":"","institution":"Cangzhou Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Bian","suffix":""},{"id":269746695,"identity":"7bb86c69-c72c-4f1d-b32c-9de5f69fcd63","order_by":7,"name":"Liqing Kang","email":"","orcid":"","institution":"Cangzhou Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liqing","middleName":"","lastName":"Kang","suffix":""},{"id":269746696,"identity":"2bdd5168-ac04-4e62-937a-ee77f6d259a8","order_by":8,"name":"Fenghai Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArElEQVRIiWNgGAWjYBACPuYzjA8SDGx4+NkbiNTCxpbDbPChIk1GsucA8VrYBGecOWxjcMOBaC28x5h5287zMNxgYPzwMYcoLXxpj3nbbvMwzm5glpy5jRgt8j3mxiAtzDIH2Jh5idLCxmMmzdt2jodNIoEELZIzzhzg4SFFizEwkJN5JHgONhPnF342HkNgVNrZ2x9vPvjhIzFakABjA2nqR8EoGAWjYBTgBgDXiy5F876nTQAAAABJRU5ErkJggg==","orcid":"","institution":"Cangzhou Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Fenghai","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-01-23 16:44:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3891635/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3891635/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50330899,"identity":"bae3d5e0-03c9-481e-975b-71ac4c43c320","added_by":"auto","created_at":"2024-01-29 21:44:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":607211,"visible":true,"origin":"","legend":"\u003cp\u003ea and b, systolic short-axis blood flow in the LV in the control group and lateral AMI patients. Compared with that in the control group, the blood flow KE near the infarct segment in AMI patients was lower. c and d, LGE and double IR images of AMI patients in the lateral wall, and the arrow indicates the infarction focus. LGE: delayed enhancement, Double IR: fat inhibition black blood sequence\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3891635/v1/c873328a8a47f55842969074.png"},{"id":51867384,"identity":"83e5e943-48a5-4903-acc2-5b213ccfd4cf","added_by":"auto","created_at":"2024-03-01 15:34:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":937467,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3891635/v1/6b753828-9f05-4561-91b7-19858aefdf7c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of left ventricular blood flow kinetic energy in patients with acute myocardial infarction by 4D flow MRI: a preliminary study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAfter acute myocardial infarction (AMI), the myocardial systolic function of the infarct segment is weakened or lost, and left ventricular (LV) contraction becomes asymmetrical. Asymmetric contraction causes the LV wall to experience uneven blood tension, resulting in complex haemodynamic changes that may lead to adverse remodelling and subsequent left heart failure [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The effect of AMI on LV hemodynamic has been confirmed, and the quantification of LV hemodynamic is highly valuable for determining the prognosis of patients with myocardial infarction [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe kinetic energy (KE) of blood flow is an important parameter to evaluate. KE refers to the energy required to accelerate a certain amount of blood from a static state to a certain speed and is the energy accompanying blood flow [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The KE of blood flow includes both in-plane and through-plane components. In-plane KE is the sum of all KE values in the horizontal direction of the short axis from the base to the apex of the LV. In contrast, through-plane KE refers to the component of blood flow perpendicular to the short axis of the heart.\u003c/p\u003e \u003cp\u003eAt present, the conventional imaging techniques for evaluating the characteristics of cardiac blood flow include echocardiography and two-dimensional (2D) phase contrast cardiovascular magnetic resonance. Compared with 2D phase contrast cardiovascular magnetic resonance imaging [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], four-dimensional flow magnetic resonance imaging (4D flow MRI) can detect the velocity along three spatial dimensions in the global cardiac cycle and achieve comprehensive visualization of left ventricular blood flow and quantification of kinetic energy [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The purpose of this study was to preliminarily investigate the changes in regional LV blood flow KE of AMI patients using 4D flow MRI technology.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThirty patients with AMI and twenty age-/sex-matched healthy controls from Cangzhou Central Hospital were retrospectively evaluated between February 2022 and August 2023. The regional ethics committee approved this study (approval number: 2023-222-02), and the requirement for written informed consent was waived.\u003c/p\u003e \u003cp\u003eThe inclusion criteria for patients were as follows: a clinical diagnosis of AMI [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; percutaneous coronary intervention (PCI) performed within 12 hours after the onset of chest pain; CMR imaging completed within one week after treatment; and no contraindications for cardiac MRI. The exclusion criteria for patients were as follows: a previous history of vascular reconstruction surgery (coronary artery bypass grafting or PCI); known cardiomyopathy or valvular heart disease; haemodynamic instability lasting more than 24 hours after PCI; poor-quality CMR images; or incomplete imaging data [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCMR examination\u003c/h2\u003e \u003cp\u003eAll control subjects and patients were scanned in a 3.0T scanner (MR750, GE Healthcare, Signa Discovery) with a 16-channel phased array coil. All the subjects were trained to hold their breath at the end of expiration, and ECG gating and respiratory gating were monitored.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCMR protocol and image acquisition\u003c/h2\u003e \u003cp\u003eThe CMR protocol was as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSurvey images were taken.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe following cines were defined using the survey images:horizontal long-axis, 2-chamber, 4-chamber and the LV volume contiguous short-axis stack.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAll cines were acquired with a balanced steady-state free precession (bSSFP) procedure. The typical parameters for the bSSFP sequence were as follows: flip angle (FA) 60\u0026deg;, echo time (TE) 1.89 milliseconds, repetition time (TR) 3.74 milliseconds, field of view (FOV) 320\u0026ndash;420 mm depending on patient size, slice thickness 8 mm, and 25 phases per cardiac cycle.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLGE imaging was performed 15 min after gadolinium-based contrast agent injection in AMI patients only. LGE imaging was performed with a phase sensitive myocardial delayed enhancement (PSMDE) spoiled gradient recalled echo (FSPGR) sequence. The PSMDE sequence details are as follows: TE/TR, 2.46/5.3 msec; FA, 25\u0026deg;.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFor global heart 4D flow, the field of view (FOV) was planned in the transaxial plane to ensure that the global heart was within the FOV. 4D flow data were acquired with PC VIPR, a 3D radially undersampled, three-directional velocity-encoding technique [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The FOV and number of slices (i.e., the 3D volume) were adjusted according to the subject\u0026rsquo;s size. The scan parameters were as follows: TE, 2.0 ms; TR, 5.3 ms; FA, 14\u0026deg;; VENC, 150 cm/sec.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eImage analysis\u003c/h2\u003e \u003cp\u003eA GE AW4.7 postprocessing workstation was used to measure cardiac function parameters. The indices of left ventricular volume and cardiac function, including the left ventricular end diastolic volume index (LVEDVi), left ventricular end systolic volume index (LVESVi) and left ventricular ejection fraction (LVEF), which were corrected by body surface area, were obtained.\u003c/p\u003e \u003cp\u003eThe parameters of global blood flow KE were analysed using MASS (version 2021-EXP, Medis Medical Imaging). The calculation formula for KE was KE\u0026thinsp;=\u0026thinsp;1/2 ρ\u003csub\u003eblood\u003c/sub\u003e\u0026thinsp;\u0026times;\u0026thinsp;V\u003csub\u003evoxel\u003c/sub\u003e\u0026times; v\u003csup\u003e2\u003c/sup\u003e, where ρ\u003csub\u003eblood\u003c/sub\u003e represents the density of blood (1.06 g/cm3), V\u003csub\u003evoxel\u003c/sub\u003e represents the voxel volume, and v represents the velocity magnitude. At each time point, the KE of each voxel is summed to obtain the total KE of LV blood flow, and the KE value of each voxel in the global cardiac cycle is summed to obtain the time-resolved curve of KE to determine the physiological parameters. All KE parameters were indexed to the LVEDV, and the units were \u0026micro;J/mL (KEi\u003csub\u003eEDV\u003c/sub\u003e) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eKinetic energy analysis of regional blood flow\u003c/h2\u003e \u003cp\u003eMASS automatically quantified the blood flow KE parameters in 16 segments of the heart in all subjects according to American Heart Association standards. In this study, the subjects' hearts were divided into 3 levels (base, mid-ventricle and apex), and each level was divided into 4 segments (anterior wall, posterior wall, septal wall and lateral wall). The differences in regional blood flow KE at different levels and in different segments of the same level of the heart cavity in the healthy control group were used as the reference for the AMI group. In the AMI group, the segment with the largest area of myocardial infarction was defined as the infarct segment, and the contralateral myocardium was defined as the noninfarct segment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll analyses were performed using SPSS\u0026reg; Statistics. The normally distributed data are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), and two-independent sample t tests were used. Data with a nonnormal distribution are represented by the interquartile range (IQR), and the Mann‒Whitney U test was used. Categorical data are presented as numbers and proportions. The comparison of different levels and different segments in the control group was performed by one-way ANOVA, and the difference in regional blood flow KE in the AMI group was compared by paired t test or Wilcoxon signed rank sum test. A two-tailed p value of less than 0.05 was considered to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient demographic characteristics\u003c/h2\u003e \u003cp\u003eThere were no significant differences in heart rate (67.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7 beats/min vs. 73.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 beats/min, P\u0026thinsp;=\u0026thinsp;0.057) between the AMI patients and the control group. Healthy controls and the AMI group were matched for age (54\u0026thinsp;\u0026plusmn;\u0026thinsp;9 years vs. 58\u0026thinsp;\u0026plusmn;\u0026thinsp;9 years, P\u0026thinsp;=\u0026thinsp;0.133). The CMR volume parameters of the AMI patients were significantly greater than those of the control group, while the LVEF was significantly lower (48.9%\u0026plusmn;13.0 vs. 67.1%\u0026plusmn;9.4) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of demographic data between controls and AMI patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControls (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAMI patients (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et/χ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male: female) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11:9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18:12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.726\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension (%) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart rate (bpm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEDVi (ml/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.8\u0026thinsp;\u0026plusmn;\u0026thinsp;19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-6.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVESVi (ml/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe values are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). \u003csup\u003ea\u003c/sup\u003e Values are expressed as counts (n). LV measurements are indexed to body surface area. Abbreviations: LVEF, left ventricular ejection fraction. LVEDVi, left ventricular end-diastolic volume (indexed). LVESVi, left ventricular end-systolic volume (indexed).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eKE parameter results\u003c/b\u003e\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eGlobal blood flow KE for the two groups\u003c/h2\u003e \u003cp\u003eThe average LV KEi\u003csub\u003eEDV\u003c/sub\u003e and systolic and diastolic KE in AMI patients were significantly lower than those in the control group (10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3 \u0026micro;J/ml vs. 14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3 \u0026micro;J/ml, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; 14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 \u0026micro;J/ml vs. 18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 \u0026micro;J/ml, P\u0026thinsp;=\u0026thinsp;0.003; and 7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 \u0026micro;J/ml vs. 10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 \u0026micro;J/ml, P\u0026thinsp;=\u0026thinsp;0.003, respectively). No significant difference was found in the minimum or in-plane KE proportion between the AMI patients and the control group (3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 \u0026micro;J/ml vs. 3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 \u0026micro;J/ml, P\u0026thinsp;=\u0026thinsp;0.117; 32.0%\u0026plusmn;11.4 vs. 30.9%\u0026plusmn;12.2, P\u0026thinsp;=\u0026thinsp;0.742) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of LV blood flow KE parameters between controls and AMI patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControls (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAMI patients (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLV KEi\u003csub\u003eEDV\u003c/sub\u003e (\u0026micro;J/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimal KEi\u003csub\u003eEDV\u003c/sub\u003e (\u0026micro;J/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic KEi\u003csub\u003eEDV\u003c/sub\u003e (\u0026micro;J/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic KEi\u003csub\u003eEDV\u003c/sub\u003e (\u0026micro;J/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBlood flow KE at different levels in the control group\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, blood flow KE parameters were different at different levels in the same patient. The average, systolic and diastolic KE in the basal segment (6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 \u0026micro;J/ml, 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 \u0026micro;J/ml, and 5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 \u0026micro;J/ml, respectively) were significantly greater than those in the middle segment (4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 \u0026micro;J/ml, 5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 \u0026micro;J/ml, and 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 \u0026micro;J/ml, respectively) and apical segment (1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 \u0026micro;J/ml, 2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 \u0026micro;J/ml, and 1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 \u0026micro;J/ml, respectively), and the values in the apical segment were the lowest (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBlood flow KE at different levels of the LV cavity in controls\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMid-ventricle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eApex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage KEi\u003csub\u003eEDV\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003cb\u003ea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003cb\u003eab\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic KEi\u003csub\u003eEDV\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003cb\u003ea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003cb\u003eab\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic KEi\u003csub\u003eEDV\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003cb\u003eab\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e33.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic in-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic in-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e28.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.4\u0026thinsp;\u0026plusmn;\u0026thinsp;18.5\u003cb\u003eab\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e Compared with the basal level, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; \u003csup\u003eb\u003c/sup\u003e compared with the middle level, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; pairwise comparisons were calibrated by Bonferroni multiple correction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBlood flow KE in different segments in the control group\u003c/h2\u003e \u003cp\u003eComparisons of LV blood flow KE parameters in different segments at the same level in the control group are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The systolic KE and systolic in-plane KE were significantly different, while the diastolic KE and diastolic in-plane KE were not significantly different. According to pairwise comparisons of the anterior wall, posterior wall, septal wall and lateral wall, the systolic blood flow KE in the anterior wall and septal wall was significantly greater than that in the corresponding segments. The systolic in-plane KE was not significantly different between the anterior and posterior walls but was significantly different between the septal and lateral walls.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBlood flow KE at different segments of the LV cavity in controls\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSeptal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLateral\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eSystolic KEi\u003csub\u003eEDV\u003c/sub\u003e (\u0026micro;J/ml)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eBase\u003c/p\u003e \u003cp\u003eMid-ventricle\u003c/p\u003e \u003cp\u003eApex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247.5\u0026thinsp;\u0026plusmn;\u0026thinsp;127.0\u003cb\u003eb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.6\u0026thinsp;\u0026plusmn;\u0026thinsp;43.8\u003cb\u003eac\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e292.5\u0026thinsp;\u0026plusmn;\u0026thinsp;203.3\u003cb\u003eb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.8\u0026thinsp;\u0026plusmn;\u0026thinsp;53.2\u003cb\u003eacb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154.8\u0026thinsp;\u0026plusmn;\u0026thinsp;75.5\u003cb\u003eb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.6\u0026thinsp;\u0026plusmn;\u0026thinsp;53.2\u003cb\u003eac\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e147.2\u0026thinsp;\u0026plusmn;\u0026thinsp;78.4\u003cb\u003eb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88.6\u0026thinsp;\u0026plusmn;\u0026thinsp;45.6\u003cb\u003eac\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.8\u0026thinsp;\u0026plusmn;\u0026thinsp;27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.4\u0026thinsp;\u0026plusmn;\u0026thinsp;20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eDiastolic KEi\u003csub\u003eEDV\u003c/sub\u003e (\u0026micro;J/ml)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eBase\u003c/p\u003e \u003cp\u003eMid-ventricle\u003c/p\u003e \u003cp\u003eApex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117.8\u0026thinsp;\u0026plusmn;\u0026thinsp;69.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154.0\u0026thinsp;\u0026plusmn;\u0026thinsp;113.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.6\u0026thinsp;\u0026plusmn;\u0026thinsp;46.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e159.5\u0026thinsp;\u0026plusmn;\u0026thinsp;126.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.4\u0026thinsp;\u0026plusmn;\u0026thinsp;42.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.2\u0026thinsp;\u0026plusmn;\u0026thinsp;43.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.3\u0026thinsp;\u0026plusmn;\u0026thinsp;38.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86.1\u0026thinsp;\u0026plusmn;\u0026thinsp;36.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;17.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.9\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.4\u0026thinsp;\u0026plusmn;\u0026thinsp;17.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.821\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eSystolic in-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eBase\u003c/p\u003e \u003cp\u003eMid-ventricle\u003c/p\u003e \u003cp\u003eApex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003cb\u003ec\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003cb\u003eb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003cb\u003eac\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.5\u0026thinsp;\u0026plusmn;\u0026thinsp;17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.0\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.2\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7\u003cb\u003ec\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.4\u0026thinsp;\u0026plusmn;\u0026thinsp;19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eDiastolic in-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eBase\u003c/p\u003e \u003cp\u003eMid-ventricle\u003c/p\u003e \u003cp\u003eApex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.1\u0026thinsp;\u0026plusmn;\u0026thinsp;20.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.7\u0026thinsp;\u0026plusmn;\u0026thinsp;18.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e Compared with the anterior segment, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; \u003csup\u003eb\u003c/sup\u003e compared with the posterior segment, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; \u003csup\u003ec\u003c/sup\u003e compared with the septal segment, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; pairwise comparisons were calibrated by Bonferroni multiple correction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRegional blood flow KE in the AMI group\u003c/h2\u003e \u003cp\u003eIn the AMI group, there were 2 cases of anterior wall infarction, 20 cases of posterior wall infarction (14 cases in the basal segment and 6 cases in the middle segment), 5 cases of septal wall infarction, and 3 cases of lateral wall infarction. Because the sample size of patients with anterior and middle posterior wall infarctions was small, this study analysed only the difference in regional KE in patients with posterior basal myocardial infarction. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the systolic and diastolic KE in the infarct segment were significantly lower than those in the noninfarct segment (49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7 \u0026micro;J/ml vs. 126.3\u0026thinsp;\u0026plusmn;\u0026thinsp;50.7 \u0026micro;J/ml, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 25.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1 \u0026micro;J/ml vs. 44.5\u0026thinsp;\u0026plusmn;\u0026thinsp;21.4 \u0026micro;J/ml, P\u0026thinsp;=\u0026thinsp;0.005). However, the proportion of systolic in-plane KE in the infarct segment was greater than that in the noninfarct segment (61.8% \u0026plusmn; 11.5 vs. 42.9% \u0026plusmn; 12.1, P\u0026thinsp;=\u0026thinsp;0.001). There was no significant difference in the proportion of diastolic in-plane KE between the infarct and noninfarct segments (53.6% \u0026plusmn; 19.0 vs. 43.2% \u0026plusmn; 14.4, P\u0026thinsp;=\u0026thinsp;0.203).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePaired t test results of blood flow KE in the basal segment of posterior wall AMI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNoninfarct segment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInfarct segment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic KEi\u003csub\u003eEDV\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126.3\u0026thinsp;\u0026plusmn;\u0026thinsp;50.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.764\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic KEi\u003csub\u003eEDV\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.5\u0026thinsp;\u0026plusmn;\u0026thinsp;21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-6.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.005\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic in-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic in-plane KE (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.6\u0026thinsp;\u0026plusmn;\u0026thinsp;19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eGlobal blood flow KE in the control and AMI groups\u003c/h2\u003e \u003cp\u003eThe KEi\u003csub\u003eEDV\u003c/sub\u003e parameter of LV blood flow was decreased in patients with AMI, which was consistent with the results of Pankaj et al. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and Kanski et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. After MI, the regional contractility of the myocardium is reduced, which reduces the regional pressure on the blood in the cavity and the pressure gradient between the LV and the aorta, thus reducing the total thrust of systolic blood flow, which ultimately manifests as a decrease in systolic KE. Another finding of the study by Pankaj Garg also supports this view: the LV stroke volume was related to the KEi\u003csub\u003eEDV\u003c/sub\u003e only at the end of systole in the infarction group but not in the control group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eBlood flow KE at different levels in the control group\u003c/h2\u003e \u003cp\u003eSeveral studies have reported the application of MRI in detecting LV blood flow KE in healthy individuals. However, the current studies on blood flow KE parameters in healthy people have focused mainly on evaluating flow in the global heart chamber, while few studies have evaluated regional KE. In our study of 20 healthy subjects, the KE values at different levels were different: the basal segment had the largest values, while the apex had the smallest values, which may be related to the proximity of the base flow to the left ventricular outflow tract (LVOT). The jet through the aortic valve improved the KE of the basal segment flow. Previous studies have shown that the blood in the LV contains different components during the cardiac cycle; the residual volume refers to the volume that stays at the apex for more than one cardiac cycle, and the KE of the residual volume is small. Philip's research also revealed that the volume through the apex is significantly reduced [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eBlood flow KE in different segments of the control group\u003c/h2\u003e \u003cp\u003eIn this study, analysis of the blood flow KE in different segments at the same level in the control group showed no statistically significant differences in the diastolic KE, systolic in-plane KE or diastolic in-plane KE between the anterior and posterior walls of the heart cavity. The difference in blood flow KE between the septal and lateral walls was statistically significant only for diastolic KE and diastolic in-plane KE. Therefore, we preliminarily concluded that the blood flow KE parameters between the anterior and posterior walls were similar and that the flow status was more consistent. To compare the regional blood flow in the myocardial infarction group, we focused on analysing the anterior and posterior wall blood flow.\u003c/p\u003e \u003cp\u003eLV flow has a complex motion and haemodynamic characteristics [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The statistically significant difference in systolic KE between the anterior and posterior walls in the control group may be related to the presence of an asymmetric vortex in the heart cavity during systole. Goyal studied the characteristics of the LV systolic vortex in healthy dogs and reported that the systolic vortex in the posterior basal region was more obvious than in the anterior region, which could explain the significant difference in systolic KE between the anterior and posterior walls of the heart cavity in our study [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRegional blood flow KE in the AMI group\u003c/h2\u003e \u003cp\u003eThe blood flow KE in the infarct segment was lower than that in the noninfarct segment in AMI patients, and the proportion of in-plane KE was increased, which was consistent with Garg's findings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In addition, Arka Das et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] reported that patients with adverse ventricular remodelling had increased in-plane KE. The increase in the in-plane KE may be related to pathological blood flow. After MI, LV function is damaged, and the cardiac cavity begins to expand. However, progressive LV impairment and dilatation also cause increased sphericity, which in turn changes flow conditions inside the cavity to a \u0026lsquo;meta-stable\u0026rsquo; state with a large, swirling vortex that encompasses the majority of the LV [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This vortex flow includes transverse thrusts, which increase the proportion of in-plane KE. In addition, our study revealed that there was no significant difference in diastolic in-plane KE between infarct and noninfarct segments. This finding is consistent with the findings of Arka, which may also be related to changes in diastolic blood flow. Suwa et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] reported that patients with impaired LV function had a greater diastolic vortex than did those with normal LV function [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe purpose of this study was to analyse the changes in KE parameters of regional blood flow in the cardiac cavity of MI patients and to determine whether in-plane KE is highly important in blood flow near the cardiac cavity of the regionally infarcted myocardium. A pathological increase in in-plane KE may exert heterogeneous haemodynamic force on the LV wall, which leads to further expansion of the endocardium and increased endothelial dysfunction [\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This pathological process may be related to the formation of ventricular aneurysms. Ventricular aneurysm [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] is a common complication of AMI. After infarction, necrotic myocardial cells are gradually replaced by fibrous scar tissue, and the infarcted myocardium becomes thinner and bulges outwards, possibly leading to abnormal movement during contraction. To date, there is a lack of research on the relationship between haemodynamic parameters and ventricular aneurysm formation in MI patients. Prospective studies are needed in the future, which may provide haemodynamic insights into the pathophysiology of remodelling after myocardial infarction.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eFirst, this was a single-centre study with a small sample size; future studies should involve multiple centres and larger sample sizes to more accurately evaluate the changes in regional blood flow KE in infarct segments. Second, this study lacked comparisons with echocardiography data on diastolic function parameters such as E/A and E/e', and the value of KE parameters in evaluating diastolic function still needs to be further explored. Therefore, additional studies combined with ultrasound functional parameters are needed in the future to comprehensively evaluate cardiac haemodynamic changes in AMI patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides a methodological reference for the regional analysis of LV flow parameters via 4D flow MRI. Differences in the KE parameters at different levels and in different segments of the same level in the LV cavity were found in healthy people. In AMI patients, the average KE in the infarct segment decreased, while the proportion of in-plane KE increased. This was a preliminary study analysing regional LV blood flow KE, and further exploration is needed to determine whether regional LV blood flow KE has predictive value for AMI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis study was supported by the Medical Science Research Project of Hebei Province in China in 2024 (Approval number: 20241752), and chaired by Fenghai Liu.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis study was a retrospective study and was approved by the ethics committee of our hospital and exempted from\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003einformed consent.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent to publish\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 1a, 1b, 1c and 1d.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor\u0026rsquo;s contribution\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by\u003c/em\u003e \u003cem\u003eXiqing Niu, Yutong Dun, Guoce Li, Houning Zhang, Bin Zhang, Zhibin Pan, Hao Bian, Liqing Kang\u003c/em\u003e\u003cem\u003e. The first draft of the manuscript was written by \u003c/em\u003e\u003cem\u003eXiqing Niu\u003c/em\u003e\u003cem\u003e and all authors commented on previous versions of the manuscript. The manuscript was reviewed by Fenghai Liu. All authors read and approved the final manuscript. \u003cbr /\u003e \u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePankaj G, Crandon S, Swoboda PP et al (2018) Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance. 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J Nucl Cardiol 30:2809\u0026ndash;2812. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12350-023-03223-5\u003c/span\u003e\u003cspan address=\"10.1007/s12350-023-03223-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"4D flow MRI, Myocardial infarction, Kinetic energy, In-plane kinetic energy, MASS","lastPublishedDoi":"10.21203/rs.3.rs-3891635/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3891635/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo evaluate the intracavity left ventricular (LV) blood flow kinetic energy (KE) parameters using four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) in patients with acute myocardial infarction (AMI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThirty AMI patients and twenty controls were examined via CMR, which included cine imaging, late gadolinium enhancement (LGE) and global heart 4D flow imaging. The KE parameters were correlated with the left ventricular end-diastolic volume (LVEDV) to obtain average, minimal, systolic, and diastolic KE as well as the proportion of LV in-plane KE (%). These parameters were compared between the AMI patients and controls and between the two subgroups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAnalysis of the LV blood flow KE parameters at different levels of the LV cavity and in different segments of the same level showed that the basal level had the highest blood flow KE while the apical level had the lowest in the control group. There were significant differences in diastolic, systolic and diastolic in-plane KE between the anterior wall and posterior wall (p\u0026gt;0.05). Compared with those in the control group, the average (10.7±3.3 μJ/mL vs. 14.7±3.6 μJ/mL, p\u0026lt;0.001), systolic (14.6±5.1 μJ/mL vs. 18.9±3.9 μJ/mL, p=0.003) and diastolic KE (7.9±2.5 μJ/mLvs. 10.6±3.8 μJ/mL, p=0.018) were significantly lower in the AMI group. The average KE in the infarct segment was lower than that in the noninfarct segment in the AMI group, while the proportion of systolic in-plane KE increased significantly (49.5±18.7 μJ/mL vs. 126.3±50.7 μJ/mL, p\u0026lt;0.001; 61.8%±11.5 vs. 42.9%±14.4, p=0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe 4D flow MRI technique can be used to quantitatively evaluate LV regional haemodynamic parameters. There were differences in the KE parameters of LV blood flow at different levels and in different segments of the same level in healthy people. In AMI patients, the average KE of the infarct segment decreased, while the proportion of systolic in-plane KE significantly increased.\u003c/p\u003e","manuscriptTitle":"Evaluation of left ventricular blood flow kinetic energy in patients with acute myocardial infarction by 4D flow MRI: a preliminary study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-29 21:44:19","doi":"10.21203/rs.3.rs-3891635/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af7c4d94-9a38-49cf-bfaa-1020ded4c177","owner":[],"postedDate":"January 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-01T15:33:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-29 21:44:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3891635","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3891635","identity":"rs-3891635","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}