Cardiac magnetic resonance (CMR) four-dimensional (4D) flow is a novel method for flow quantification potentially helpful in management of mitral valve regurgitation (MVR). In this systematic review, we aimed to depict the clinical role of intraventricular 4D-flow in MVR. The reproducibility, technical aspects, and comparison against conventional techniques were evaluated. Published studies on SCOPUS, MEDLINE, and EMBASE were included using search terms on 4D-flow CMR in MVR. Out of 420 screened articles, 18 studies fulfilled our inclusion criteria. All studies (n = 18, 100%) assessed MVR using 4D-flow intraventricular annular inflow (4D-flowAIM) method, which calculates the regurgitation by subtracting the aortic forward flow from the mitral forward flow. Thereof, 4D-flow jet quantification (4D-flowjet) was assessed in 5 (28%), standard 2D phase-contrast (2D-PC) flow imaging in 8 (44%) and the volumetric method (the deviation of left ventricle stroke volume and right ventricular stroke volume) in 2 (11%) studies. Inter-method correlations among the 4 MVR quantification methods were heterogeneous across studies, ranging from moderate to excellent correlations. Two studies compared 4D-flowAIM to echocardiography with moderate correlation. In 12 (63%) studies the reproducibility of 4D-flow techniques in quantifying MVR was studied. Thereof, 9 (75%) studies investigated the reproducibility of the 4D-flowAIM method and the majority (n = 7, 78%) reported good to excellent intra- and inter-reader reproducibility. Intraventricular 4D-flowAIM provides high reproducibility with heterogeneous correlations to conventional quantification methods. Due to the absence of a gold standard and unknown accuracies, future longitudinal outcome studies are needed to assess the clinical value of 4D-flow in the clinical setting of MVR.
Funding Acknowledgements Type of funding sources: None. Background Reduced left ventricular systolic function is a well established predictor for outcome in Patients with myocarditis. However, the predictive role of diastolic function in patients with suspected myocarditis and preserved ejection fraction is unknown. Purpose Assess the predicative value of diastolic left ventricular function in patients with suspected myocarditis. Methods Late and early radial, circumferential and longitudinal diastolic strain rate was assessed as using CMR feature tracking in patients with clinically suspected myocarditis being referred for cardiac magnetic resonance imaging (CMR). The primary endpoint was defined as a composite of first major adverse cardiovascular events (MACE) including all-cause mortality, sustained ventricular tachycardia and hospitalization for heart failure. Results 755 consecutive patients with suspected myocarditis and referred for CMR (277, 37% female; mean age 48 ± 16years) were included. Of those late gadolinium enhancement (LGE) was present in 417 (55.2%). 416 had a preserved ejection fraction >50% (55.1%). Mace was documented in 123 patients (16.3%) during a median observational time of 3.77 years. After adjustment for LVEF, LGE extend, age, and gender early circumferential strain rate (HR=0.35 95% CI 0.16–0.77, p = 0.009), early longitudinal diastolic strain rate (HR=0.40 95% CI 0.17–0.96, p = 0.042) and late diastolic strain rate (HR=0.23 95% CI 0.07–0.74, p = 0.013) remained independent predictors of MACE. Conclusion CMR feature tracking diastolic strain rate is independently associated with outcome, beyond LVEF and LGE in patients with myocarditis, and might therefore contribute to improved risk stratification in this sclinical setting.
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