Intraventricular Stasis in Non Ischemic Dilated Myocardiopathy

Quantification of Intraventricular Stasis and Thromboembolic Risk With New Imaging Methods in Patients With Non Ischemic Dilated Myocardiopathy

This study is designed to quantify the ventricular stasis in patients with non-ischemic dilated cardiomyopathy by post-processing of 2D color Doppler echocardiography images in order to establish the relationship between quantitative variables of intraventricular stasis and the prevalence of silent embolic events and/or intraventricular mural thrombosis determined by magnetic resonance.

In patients with left ventricular dysfunction, intraventricular mural thrombosis is a recognized risk factor for cardioembolic events. The flow stasis accompanying ventricular remodeling and myocardial dysfunction could favor the formation of small intracavitary thrombi between LV trabeculae, small enough not be detected by conventional imaging techniques. Computational post-processing techniques allow a robust and complete characterization of numerous aspects of fluid dynamics within the heart using the flow field obtained by Echo or MRI imaging, and it is possible to quantify the stasis and washing of blood in the left ventricular cavity.

A cross-sectional study in 80 patients with non-ischemic DCM in sinus rhythm is proposed in which an echocardiogram, cardiac and cerebral MRI will be performed. Our objective is to quantify the ventricular stasis by post-processing of 2D color Doppler echocardiography images in order to establish the relationship between quantifiable intraventricular stasis variables and the prevalence of silent and embolic events and intracavitary thrombosis determined by magnetic resonance (MRI).

Inclusion Criteria:

• Diagnosis of nonischemic dilated cardiomyopathy.
• Sinus rhythm.
• LV ejection fraction (EF) less than 45%.
• Signature of informed consent for the study.

Exclusion Criteria:

• Implantable defibrillation or stimulation devices not compatible with MRI.
• Hemodynamically significant primary valvular disease or cardiac valve prosthesis.
• Claustrophobia.
• Documented history of paroxysmal or persistent atrial fibrillation (AF).
• Previous carotid disease diagnosed with stenosis greater than 50%.
• Complete oral anticoagulation prior to inclusion in the study or indication of anticoagulation.
• Known prothrombotic states (active oncological pathology, alteration of the coagulation cascade).