Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation

Mills, Mark T; Grafton-Clarke, Ciaran; Williams, Gareth; Gosling, Rebecca; Baraikan, Abdulaziz Al; Kyriacou, Andreas; Morris, Paul D; Gunn, Julian; Swoboda, Peter; Levelt, Eylem; Tsampasian, Vasiliki; Geest, Rob J. van der; Swift, Andrew J.; Greenwood, John P.; Plein, Sven; Vassiliou, Vassilios; Garg, Pankaj

doi:10.12688/wellcomeopenres.16655.1

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…Additionally, 11 studies (61%) compared patients with underlying cardiac disease and MVR to healthy volunteers for internal validity assessments. Across studies, underlying cardiac diseases such as mitral valve prolapse (MVP) [ 16 ], atrial fibrillation (AF) [ 17 ], and HCM [ 18 ] were included.…”

Section: Resultsmentioning

confidence: 99%

“…Across studies, underlying cardiac diseases such as mitral valve prolapse (MVP) [ 16 ], atrial fibrillation (AF) [ 17 ], and HCM [ 18 ] were included.…”

Section: Resultsmentioning

confidence: 99%

“…All studies administrated contrast agents before the 4D-flow acquisition, without specification of the exact timing, and used ECG triggering and respiratory gating. For flow analysis, retrospective valve tracking using post-processing software such as MASS (n = 6) (Leiden University Medical Center, The Netherlands) [ 9 – 11 , 17 , 20 , 21 ] and cvi42 (n = 2) (Circle Cardiovascular Imaging, Calgary, Canada) [ 8 , 18 ] was common. All studies visually assessed the quality of images and performed pre-processing for de-noising and anti-aliasing.…”

Section: Resultsmentioning

confidence: 99%

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Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Safarkhanlo

Jung

Bernhard

et al. 2023

Int J Cardiovasc Imaging

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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.

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Section: Resultsmentioning

confidence: 99%

“…Across studies, underlying cardiac diseases such as mitral valve prolapse (MVP) [ 16 ], atrial fibrillation (AF) [ 17 ], and HCM [ 18 ] were included.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Safarkhanlo

Jung

Bernhard

et al. 2023

Int J Cardiovasc Imaging

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“…Eight patients with AF were included and compared with ten healthy controls in sinus rhythm 17 . Baseline demographics are detailed in Table 1.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation

et al. 2021

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Background: Four-dimensional (4D) flow cardiovascular magnetic resonance imaging (MRI) is an emerging technique used for intra-cardiac blood flow assessment. The role of 4D flow cardiovascular MRI in the assessment of trans-valvular flow in patients with atrial fibrillation (AF) has not previously been assessed. The purpose of this study was to assess the feasibility, image quality, and internal validity of 4D flow cardiovascular MRI in the quantification of trans-valvular flow in patients with AF. Methods: Patients with AF and healthy controls in sinus rhythm underwent cardiovascular MRI, including 4D flow studies. Quality assurance checks were done on the raw data and streamlines. Consistency was investigated by trans-valvular flow assessment between the mitral valve (MV) and the aortic valve (AV). Results: Eight patients with AF (88% male, mean age 62±13 years, mean heart rate (HR) 83±16 beats per minute (bpm)) were included and compared with ten healthy controls (70% male, mean age 41±20 years, mean HR 68.5±9 bpm). All scans were of either good quality with minimal blurring artefacts, or excellent quality with no artefacts. No significant bias was observed between the AV and MV stroke volumes in either healthy controls (–4.8, 95% CI –15.64 to 6.04; P=0.34) or in patients with AF (1.64, 95% CI –4.7 to 7.94; P=0.56). A significant correlation was demonstrated between MV and AV stroke volumes in both healthy controls (r=0.87, 95% CI 0.52 to 0.97; P=0.001) and in AF patients (r=0.82, 95% CI 0.26 to 0.97; P=0.01). Conclusions: In patients with AF, 4D flow cardiovascular MRI is feasible with good image quality, allowing for quantification of trans-valvular flow.

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4D Flow Cardiac MR in Primary Mitral Regurgitation

Gorecka,

Cole,

Bissell

et al. 2024

Magnetic Resonance Imaging

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BackgroundFour‐dimensional‐flow cardiac MR (4DF‐MR) offers advantages in primary mitral regurgitation. The relationship between 4DF‐MR‐derived mitral regurgitant volume (MR‐Rvol) and the post‐operative left ventricular (LV) reverse remodeling has not yet been established.PurposeTo ascertain if the 4DF‐MR‐derived MR‐Rvol correlates with the LV reverse remodeling in primary mitral regurgitation.Study TypeProspective, single‐center, two arm, interventional vs. nonintervention observational study.PopulationForty‐four patients (male N = 30; median age 68 [59–75]) with at least moderate primary mitral regurgitation; either awaiting mitral valve surgery (repair [MVr], replacement [MVR]) or undergoing “watchful waiting” (WW).Field Strength/Sequence5 T/Balanced steady‐state free precession (bSSFP) sequence/Phase contrast imaging/Multishot echo‐planar imaging pulse sequence (five shots).AssessmentPatients underwent transthoracic echocardiography (TTE), phase‐contrast MR (PMRI), 4DF‐MR and 6‐minute walk test (6MWT) at baseline, and a follow‐up PMRI and 6MWT at 6 months. MR‐Rvol was quantified by PMRI, 4DF‐MR, and TTE by one observer. The pre‐operative MR‐Rvol was correlated with the post‐operative decrease in the LV end‐diastolic volume index (LVEDVi).Statistical TestsIncluded Student t‐test/Mann–Whitney test/Fisher's exact test, Bland–Altman plots, linear regression analysis and receiver operating characteristic curves. Statistical significance was defined as P < 0.05.ResultsWhile Bland–Altman plots demonstrated similar bias between all the modalities, the limits of agreement were narrower between 4DF‐MR and PMRI (bias 15; limits of agreement −36 mL to 65 mL), than between 4DF‐MR and TTE (bias −8; limits of agreement −106 mL to 90 mL) and PMRI and TTE (bias −23; limits of agreement −105 mL to 59 mL). Linear regression analysis demonstrated a significant association between the MR‐Rvol and the post‐operative decrease in the LVEDVi, when the MR‐Rvol was quantified by PMRI and 4DF‐MR, but not by TTE (P = 0.73). 4DF‐MR demonstrated the best diagnostic performance for reduction in the post‐operative LVEDVi with the largest area under the curve (4DF‐MR 0.83; vs. PMRI 0.78; and TTE 0.51; P = 0.89).Data ConclusionThis study demonstrates the potential clinical utility of 4DF‐MR in the assessment of primary mitral regurgitation.Evidence Level2Technical EfficacyStage 5

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Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation

Cited by 8 publications

References 29 publications

Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications

Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation

4D Flow Cardiac MR in Primary Mitral Regurgitation

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