A Systematic Review of Right Ventricular Diastolic Assessment by 4D Flow CMR

Barker, Natasha; Fidock, Benjamin; Johns, Chris; Kaur, Harjinder; Archer, Gareth; Rajaram, Smitha; Hill, Catherine; Thomas, Steven; Karunasaagarar, Kavitasagary; Capener, David; Mohammad, Atif; Rothman, Alexander; Kiely, David G.; Swift, Andrew J.; Wild, Jim M.; Garg, Pankaj

doi:10.1155/2019/6074984

Cited by 20 publications

(18 citation statements)

References 32 publications

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“…Also, in patients with PH who have poor acoustic windows for echocardiography, 4D flow can provide reliable quantification of tricuspid regurgitation [82,83]. 4D flow could also provide clinically relevant RV diastolic assessment in PH [84,85]. To summarise, 4D flow MRI can provide several complementary diagnostic information in the assessment of patients presenting with suspected PH.…”

Section: D Flowmentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

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Purpose of Review This article reviews advances over the past 3 years in cardiac magnetic resonance (CMR) imaging in pulmonary hypertension (PH). We aim to bring the reader up-to-date with CMR applications in diagnosis, prognosis, 4D flow, strain analysis, T1 mapping, machine learning and ongoing research. Recent Findings CMR volumetric and functional metrics are now established as valuable prognostic markers in PH. This imaging modality is increasingly used to assess treatment response and improves risk stratification when incorporated into PH risk scores. Emerging techniques such as myocardial T1 mapping may play a role in the follow-up of selected patients. Myocardial strain may be used as an early marker for right and left ventricular dysfunction and a predictor for mortality. Machine learning has offered a glimpse into future possibilities. Ongoing research of new PH therapies is increasingly using CMR as a clinical endpoint. Summary The last 3 years have seen several large studies establishing CMR as a valuable diagnostic and prognostic tool in patients with PH, with CMR increasingly considered as an endpoint in clinical trials of PH therapies. Machine learning approaches to improve automation and accuracy of CMR metrics and identify imaging features of PH is an area of active research interest with promising clinical utility.

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Section: D Flowmentioning

confidence: 99%

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Alabed

Garg

Johns

et al. 2020

Curr Cardiovasc Imaging Rep

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“…First, we did not collect echocardiographic images in these participants, precluding comparison with more traditional measures of diastolic function. However, MRI is the reference standard imaging modality for cardiac structure and function, and 4D flow MRI is emerging as a powerful complementary tool for uncovering subtle dysfunction (19,46,47). A second limitation was that two different MR scanners were used, which may have had a slight impact on 4D flow measurements through differential gradient performance.…”

Section: Discussionmentioning

confidence: 99%

Altered Right Ventricular Filling at Four-dimensional Flow MRI in Young Adults Born Prematurely

Corrado

Barton

Macdonald

et al. 2021

Radiology: Cardiothoracic Imaging

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To use four-dimensional (4D) flow MRI to measure intraventricular flow in young adults who were born prematurely to investigate mechanisms that may account for increased heart failure risk in this population. Materials and Methods:In this secondary analysis of a prospective study, a total of 56 young adults participated in an observational cardiac 4D flow MRI study from 2016 to 2020. There were 35 participants who had been born moderately to extremely prematurely (birth weight ,1500 g or gestational age 32 weeks; 23 women; mean age, 26 years 6 4) and 21 term-born participants (11 women; mean age, 25 years 6 3). Participants underwent cardiac MRI, including cine cardiac structure and function assessment, as well as 4D flow MRI. In each ventricle, normalized kinetic energy (KE/end diastolic volume) and flow through the atrioventricular valve were computed and compared between term-born and preterm participants at systolic and diastolic (early diastolic filling rate [E wave] and late diastolic filling [atrial contraction] rate [A wave]) time points by using Wilcoxon rank-sum tests.Results: Preterm-born participants had lower right ventricular (RV) E wave/A wave (E/A) KE ratios (2.4 6 1.7 vs 3.5 6 1.4; P , .01) and lower E/A peak filling rate ratios (computed from RV volume-time curves; 2.3 6 1.3 vs 3.5 6 2.5; P = .03). Additionally, viscous energy dissipation was increased during systole (5.7 µW/mL 6 3.0 vs 4.2 µW/mL 6 1.6; P = .03), increased during late diastole (3.9 µW/mL 6 4.0 vs 2.2 µW/mL 6 1.6; P = .03), and summed over the cardiac cycle (2.4 µJ/mL 6 1.0 vs 1.9 µJ/mL 6 0.6; P = .02) in preterm relative to term participants. Conclusion:These results suggest that RV diastolic filling is altered in young adults who were born moderately to severely prematurely.

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“…Four-dimensional (4D) flow is a promising but time-consuming technique that may take advantage of the thusly spared time [ 27 , 28 ]. Depending on the sequence design, this technique may provide both qualitative and quantitative assessments of flow patterns and ventricular volumes [ 29 ]. As extended examination durations are an obstacle for the routine use of 4D flow, compressed-sensing 4D flow prototypes are also being developed [ 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Volume and Function Assessment in Congenital Heart Disease Using CMR Compressed-Sensing Real-Time Cine Imaging

Longère

Pagniez

Coisne

et al. 2021

JCM

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Background and objective: To evaluate the reliability of compressed-sensing (CS) real-time single-breath-hold cine imaging for quantification of right ventricular (RV) function and volumes in congenital heart disease (CHD) patients in comparison with the standard multi-breath-hold technique. Methods: Sixty-one consecutive CHD patients (mean age = 22.2 ± 9.0 (SD) years) were prospectively evaluated during either the initial work-up or after repair. For each patient, two series of cine images were acquired: first, the reference segmented multi-breath-hold steady-state free-precession sequence (SSFPref), including a short-axis stack, one four-chamber slice, and one long-axis slice; then, an additional real-time compressed-sensing single-breath-hold sequence (CSrt) providing the same slices. Two radiologists independently assessed the image quality and RV volumes for both techniques, which were compared using the Wilcoxon test and paired Student’s t test, Bland–Altman, and linear regression analyses. The visualization of wall-motion disorders and tricuspid-regurgitation-related signal voids were also analyzed. Results: The mean acquisition time for CSrt was 22.4 ± 6.2 (SD) s (95% CI: 20.8–23.9 s) versus 442.2 ± 89.9 (SD) s (95% CI: 419.2–465.2 s) for SSFPref (p < 0.001). The image quality of CSrt was diagnostic in all examinations and was mostly rated as good (n = 49/61; 80.3%). There was a high correlation between SSFPref and CSrt images regarding RV ejection fraction (49.8 ± 7.8 (SD)% (95% CI: 47.8–51.8%) versus 48.7 ± 8.6 (SD)% (95% CI: 46.5–50.9%), respectively; r = 0.94) and RV end-diastolic volume (192.9 ± 60.1 (SD) mL (95% CI: 177.5–208.3 mL) versus 194.9 ± 62.1 (SD) mL (95% CI: 179.0–210.8 mL), respectively; r = 0.98). In CSrt images, tricuspid-regurgitation and wall-motion disorder visualization was good (area under receiver operating characteristic curve (AUC) = 0.87) and excellent (AUC = 1), respectively. Conclusions: Compressed-sensing real-time cine imaging enables, in one breath hold, an accurate assessment of RV function and volumes in CHD patients in comparison with standard SSFPref, allowing a substantial improvement in time efficiency.

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A Systematic Review of Right Ventricular Diastolic Assessment by 4D Flow CMR

Cited by 20 publications

References 32 publications

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Cardiac Magnetic Resonance in Pulmonary Hypertension—an Update

Altered Right Ventricular Filling at Four-dimensional Flow MRI in Young Adults Born Prematurely

Right Ventricular Volume and Function Assessment in Congenital Heart Disease Using CMR Compressed-Sensing Real-Time Cine Imaging

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