Intra-left ventricular flow dynamics in patients with preserved and impaired left ventricular function: Analysis with 3D cine phase contrast MRI (4D-Flow)

Suwa, Kenichiro; Saitoh, Takeji; Takehara, Yasuo; Sano, Makoto; Saotome, Masao; Urushida, Tsuyoshi; Katoh, Hideki; Satoh, Hiroshi; Sugiyama, Masataka; Wakayama, Teruhiko; Alley, Marcus T.; Sakahara, Harumi; Hayashi, Hideharu

doi:10.1002/jmri.25315

Cited by 28 publications

(26 citation statements)

References 24 publications

(49 reference statements)

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“…Previous studies have demonstrated that structure‐fluid interaction is a determinant factor of diastolic function in human heart . Early diastolic dysfunction is characterized by decreased LV active myocardial relaxation and reduced ability of self‐suction, which will lead to decreased speed of LV early diastolic fast filling and then result in the changes in the ratio of early and late diastolic EL.…”

Section: Discussionmentioning

confidence: 99%

“…In healthy hearts, the viscous EL is proportional to the amount of kinetic energy produced in the blood flow which is in turn proportional to the stroke volume. So the dissipated EL could be considered as an indicator of systolic LV performance . The increased EL during systole indicated that the LV pump function was impaired in patients with slightly impaired LV relaxation.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction

Wang

Chen

et al. 2019

Echocardiography

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Background Intra‐ventricular blood flow dynamics is considered as an important component of left ventricular (LV) function assessment. The purpose of this study was to evaluate the LV diastolic function in chronic kidney disease (CKD) with different degrees of LV diastolic dysfunction (LVDD) by using flow energetic parameters. Methods In this study, a total of 96 cases were recruited, including 58 CKD patients and 38 healthy controls. CKD patients were divided into 2 groups according to LVDD severity, named as DD1 and DD2. Vector flow‐mapping (VFM) analysis was executed to calculate left ventricle average energy loss (EL) during early filling phase (E‐EL_ave), atrial filling phase (A‐EL_ave), diastole phase (D‐EL_ave), and ejection phase (S‐EL_ave). Moreover, the average vortex circulation during early filling phase (E‐cir_ave) and atrial filling phase (A‐cir_ave) was also assessed in the apical three‐chamber view. The rate of average EL during early filling and atrial filling was expressed as E/A‐EL. Result Compared to the control group, A‐EL_ave, S‐EL_ave, and A‐cir_ave in the DD1 group were higher (P < 0.05), and all parameters were obviously higher in the DD2 group (P < 0.05). In the control group and the DD2 subgroup, the E‐EL_ave value was significantly higher than A‐EL_ave value, which was opposite to the DD1 group. As diastolic dysfunction worsened, E‐EL_ave and D‐EL_ave risen gradually (P < 0.05), and A‐EL_ave and S‐EL_ave were slightly elevated with no significance. There were significant correlations between LV diastolic function and flow energetic parameters. Stepwise multiple regression analysis revealed that various LV function parameters could be regarded as independent predictors of average diastolic EL (all P < 0.01). Conclusions For CKD patient with LVDD and LVEF > 50%, effective LV filling and systolic ejection with optimized energy consumption have been impaired. As a new flow‐derived index, EL can quantitatively evaluate LV diastolic function in terms of blood fluid dynamics in CKD with various LVDD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction

Wang

Chen

et al. 2019

Echocardiography

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“…Colour vector analysis was proposed as a novel method of assessing LV diastolic flow in a study of 15 patients with diastolic dysfunction, by observing the termination of organised high velocity flow at the mid-LV [39] . Vortex size and vortex core locations were analysed between heart failure patients, in both preserved and reduced ejection fraction [24] . This study suggests diastolic vortex formation may be crucial for the LV ejection, as well as filling.…”

Section: Discussionmentioning

confidence: 99%

Clinical applications of intra-cardiac four-dimensional flow cardiovascular magnetic resonance: A systematic review

Crandon

Elbaz

Westenberg

et al. 2017

International Journal of Cardiology

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BackgroundFour-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology used to visualise and quantify intra-cardiac blood flow. The aim of this systematic review is to assess the literature on the current clinical applications of intra-cardiac 4D flow CMR.MethodsA systematic review was conducted to evaluate the literature on the intra-cardiac clinical applications of 4D flow CMR. Structured searches were carried out on Medline, EMBASE and the Cochrane Library in October 2016. A modified Critical Skills Appraisal Programme (CASP) tool was used to objectively assess and score the included studies. Studies were categorised as ‘highly clinically applicable’ for scores of 67–100%, ‘potentially clinically applicable’ for 34–66% and ‘less clinically applicable’ for 0–33%.ResultsOf the 1608 articles screened, 44 studies met eligibility for systematic review. The included literature consisted of 22 (50%) mechanistic studies, 18 (40.9%) pilot studies and 4 (9.1%) diagnostic studies. Based on the modified CASP tool, 27 (62%) studies were ‘highly clinically applicable’, 9 (20%) were ‘potentially clinically applicable’ and 8 (18%) were ‘less clinically applicable’.ConclusionsThere are many proposed methods for using 4D flow CMR to quantify intra-cardiac flow. The evidence base is mainly mechanistic, featuring single-centred designs. Larger, multi-centre studies are required to validate the proposed techniques and investigate the clinical advantages that 4D flow CMR offers over standard practices.PROSPERO = CRD42016051438.

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“…At present, qualitative MV vortex ring analysis is performed using 2D vector field representations 8 and streamlines or pathlines for 3D vortical flow visualization. [9][10][11] Moreover, existing quantitative approaches require manual annotation of vortex regions on a single 2D slice [9][10][11] or involve semi-automated vortex detection in 3D. 12,13 As there is no universal definition of a vortex, 14,15 even in the absence of noise and with infinite temporal and spatial resolution, different vortex criteria have been used to identify MV vortex rings.…”

Section: Introductionmentioning

confidence: 99%

Automated mitral valve vortex ring extraction from 4D‐flow MRI

Kräuter

Reiter

et al. 2020

Magnetic Resonance in Med

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Purpose To present and validate a method for automated extraction and analysis of the temporal evolution of the mitral valve (MV) vortex ring from MR 4D‐flow data. Methods The proposed algorithm uses the divergence‐free part of the velocity vector field for Q criterion‐based identification and tracking of MV vortex ring core and region within the left ventricle (LV). The 4D‐flow data of 20 subjects (10 healthy controls, 10 patients with ischemic heart disease) were used to validate the algorithm against visual analysis as well as to assess the method’s sensitivity to manual LV segmentation. Quantitative MV vortex ring parameters were analyzed with respect to both their differences between healthy subjects and patients and their correlation with transmitral peak velocities. Results The algorithm successfully extracted MV vortex rings throughout the entire cardiac cycle, which agreed substantially with visual analysis (Cohen’s kappa = 0.77). Furthermore, vortex cores and regions were robustly detected even if a static end‐diastolic LV segmentation mask was applied to all frames (Dice coefficients 0.82 ± 0.08 and 0.94 ± 0.02 for core and region, respectively). Early diastolic MV vortex ring vorticity, kinetic energy and circularity index differed significantly between healthy controls and patients. In contrast to vortex shape parameters, vorticity and kinetic energy correlated strongly with transmitral peak velocities. Conclusion An automated method for temporal MV vortex ring extraction demonstrating robustness with respect to LV segmentation strategies is introduced. Quantitative vortex parameter analysis indicates importance of the MV vortex ring for LV diastolic (dys)function.

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Intra-left ventricular flow dynamics in patients with preserved and impaired left ventricular function: Analysis with 3D cine phase contrast MRI (4D-Flow)

Abstract: Vortex formation during the diastolic phase may be critical for both LV filling and ejection. 4D-Flow showed the 3D alterations of intra-LV flow dynamics by LV dilatation and dysfunction in a noninvasive and comprehensive manner. J. Magn. Reson. Imaging 2016;44:1493-1503.

Cited by 28 publications

References 24 publications

Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction

Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction

Clinical applications of intra-cardiac four-dimensional flow cardiovascular magnetic resonance: A systematic review

Automated mitral valve vortex ring extraction from 4D‐flow MRI

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