P585Intra left ventricular hemodynamics assessed using 4D flow MRI in the patient with left ventricular thrombus

Abstract Background Early detection of left ventricular mural thrombus (LVT) in patients with reduced ejection fraction (EF) is crucial in prevention of arterial embolism. 3D-cine phase-contrast magnetic resonance imaging (4D flow MRI) can visualize the intra-LV vortex flow in diastole and quantify the maximum flow velocity (Vmax) at the apex. it remains, however, unknown whether 4D flow MRI is useful for detecting LVT. Purpose The purpose of our study is to examine the intra-LV vortex formation and flow velocity in patients with severe LV dysfunction using 4D Flow MRI, and to compare differences in intra-LV flow dynamics between patients with and without LVT. We also examined the diagnostic accuracy to detect LVT by 4D flow MRI. Methods Twenty-nine patients with impaired LV function (LVEF 25.8±7.4%, 62.5±12.3 years old, 24 males, 11 with ischemic cardiomyopathy, 9 with LVT) underwent 4D flow MRI from January 2012 to August 2018 in our institution. Intra-LV vortex size was evaluated as vortex/LV area ratio by streamline imaging (Figure 1). The diagnostic accuracy to predict LVT by vortex size and Vmax at the apex was determined by ROC analysis. Results The vortex was smaller (vortex/LV area ratio; 30.6±7.0% vs. 45.1±9.0%, p<0.05) and Vmax at the apex was lower (0.20±0.04 m/s vs. 0.28±0.09 m/s, p=0.013) in patients with LVT compared to those without LVT. The AUC was 0.789 for Vmax (cut-off value=0.226 m/s, sensitivity=0.889, specificity=0.650) and was 0.900 for vortex/LV area ratio (cut-off value=34.7%, sensitivity=0.889, specificity=0.850). Figure 1 Conclusion The smaller size of intra-LV vortex and the lower flow velocity at the LV apex may have association with LVT formation in patients with reduced EF. 4D flow MRI might be useful to predict LVT formation. Large scale longitudinal study is warranted to evaluate the incidence of LVT in the patients with lower flow velocity. Acknowledgement/Funding None

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ANALYSES OF INTRA-LEFT VENTRICULAR (LV) FLOW DYNAMICS IN PATIENTS WITH NORMAL AND IMPAIRED LV FUNCTION USING PHASE-RESOLVED 3D CINE PHASE-CONTRAST MRI (4D-FLOW MRI)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)61252-3 ◽

2014 ◽

Vol 63 (12) ◽

pp. A1252

Author(s):

Kenichiro Suwa ◽

Takeji Saitoh ◽

Makoto Sano ◽

Mamoru Nobuhara ◽

Masao Saotome ◽

...

Keyword(s):

Phase Contrast ◽

Left Ventricular ◽

Flow Dynamics ◽

Lv Function ◽

4D Flow Mri ◽

4D Flow ◽

Phase Contrast Mri ◽

Flow Mri ◽

Cine Phase Contrast

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Abstract 14534: In vitro Assessment of Transvalvular Peak Velocity Measurement for Various Orifice Shapes: Comparison Between 4D Flow MRI vs. Doppler Echocardiography

Circulation ◽

10.1161/circ.142.suppl_3.14534 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jeesoo Lee ◽

Nadia El hangouche ◽

Liliana Ma ◽

Michael Scott ◽

Michael Markl ◽

...

Keyword(s):

Temporal Resolution ◽

Continuous Wave ◽

Peak Velocity ◽

Left Ventricular ◽

Patient Specific ◽

Maximal Velocity ◽

4D Flow Mri ◽

4D Flow ◽

Flow Phantom ◽

Flow Mri

Introduction: 4D flow MRI can assess transvalvular velocity, but validation against continuous wave (CW) Doppler echo is limited in high-velocity regurgitation and stenosis situations. We sought to compare 4D flow MRI and echo peak velocity using a pulsatile echo-MRI flow phantom. Materials and Methods: An MRI-compatible flow phantom with restrictive orifice situated was driven by a left ventricular assist device at 50 bpm (figure 1A). Three orifice shapes were tested: circular, elliptical and 3D-printed patient-specific mitral regurgitant orifice model of prolapse with areas of 0.5, 0.41 and 0.35 cm 2 , respectively. CW Doppler was acquired with peak velocity extracted from the profile. Retrospectively-gated 4D flow MRI was performed (spatial resolution = 2 mm isotropic, temporal resolution = 36 ms, encoding velocity = 400 cm/s). Maximal velocity magnitude was extracted volumetrically (figure 1B). An echo-mimicking profile was also obtained with a “virtual” ultrasound beam in the 4D flow data to simulate CW Doppler (figure 1C). Bland-Altman analysis was used to assess the agreement of temporal peak velocities. Results: 4D flow MRI demonstrated a centrally directed jet for the circular and elliptical orifices and an oblique jet for the prolapse orifice (figure 1B). Peak velocities were in excellent agreement between 4D flow MRI vs. echo for the circular (peak: 5.13 vs. 5.08 m/s, bias = 0.06 ± 0.66 m/s, figure 1D) and the elliptical orifice (peak: 4.95 vs. 4.79 m/s, bias = 0.07 ± 0.87 m/s, figure 1E). The prolapse orifice velocity was underestimated somewhat by MRI by ~10% (peak: 4.41 vs. 4.90 m/s, bias=0.26±1.18, figure 1F). Conclusion: 4D flow MRI can quantify high velocities like echo for simple geometries while underestimating for more complex geometry, likely due to partial volume effects. Further investigation is warranted to systematically investigate the effects of 4D flow MRI spatial and temporal resolution as well as the jet angle on velocity quantification accuracy.

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4D flow MRI of the aorta demonstrates age- and gender-related differences in aortic size and blood flow velocity in healthy subjects

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-17-s1-p39 ◽

2015 ◽

Vol 17 (S1) ◽

Cited By ~ 2

Author(s):

Julio Garcia ◽

Kelly B Jarvis ◽

Susanne Schnell ◽

SC Malaisrie ◽

Colleen Clennon ◽

...

Keyword(s):

Blood Flow ◽

Flow Velocity ◽

Blood Flow Velocity ◽

Healthy Subjects ◽

4D Flow Mri ◽

4D Flow ◽

Age And Gender ◽

Flow Mri ◽

And Gender ◽

Aortic Size

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Reduced regional flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI

BMC Medical Imaging ◽

10.1186/s12880-019-0404-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Philip A. Corrado ◽

Jacob A. Macdonald ◽

Christopher J. François ◽

Niti R. Aggarwal ◽

Jonathan W. Weinsaft ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Linear Models ◽

Left Ventricular ◽

Short Axis ◽

Flow Data ◽

4D Flow Mri ◽

4D Flow ◽

Regional Flow ◽

Flow Mri

Abstract Background Acute myocardial infarction (AMI) alters left ventricular (LV) hemodynamics, resulting in decreased global LV ejection fraction and global LV kinetic energy. We hypothesize that anterior AMI effects localized alterations in LV flow and developed a regional approach to analyze these local changes with 4D flow MRI. Methods 4D flow cardiac magnetic resonance (CMR) data was compared between 12 anterior AMI patients (11 males; 66 ± 12yo; prospectively acquired in 2016–2017) and 19 healthy volunteers (10 males; 40 ± 16yo; retrospective from 2010 to 2011 study). The LV cavity was contoured on short axis cine steady-state free procession CMR and partitioned into three regions: base, mid-ventricle, and apex. 4D flow data was registered to the short axis segmentation. Peak systolic and diastolic through-plane flows were compared region-by-region between groups using linear models of flow with age, sex, and heart rate as covariates. Results Peak systolic flow was reduced in anterior AMI subjects compared to controls in the LV mid-ventricle (fitted reduction = 3.9 L/min; P = 0.01) and apex (fitted reduction = 1.4 L/min; P = 0.02). Peak diastolic flow was also lower in anterior AMI subjects compared to controls in the apex (fitted reduction = 2.4 L/min; P = 0.01). Conclusions A regional method to analyze 4D LV flow data was applied in anterior AMI patients and controls. Anterior AMI patients had reduced regional flow relative to controls.

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Scan–rescan reproducibility of diastolic left ventricular kinetic energy, viscous energy loss and vorticity assessment using 4D flow MRI: analysis in healthy subjects

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-017-1291-z ◽

2018 ◽

Vol 34 (6) ◽

pp. 905-920 ◽

Cited By ~ 6

Author(s):

Vivian P. Kamphuis ◽

Jos J. M. Westenberg ◽

Roel L. F. van der Palen ◽

Pieter J. van den Boogaard ◽

Rob J. van der Geest ◽

...

Keyword(s):

Kinetic Energy ◽

Energy Loss ◽

Healthy Subjects ◽

Left Ventricular ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri

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Unilateral branch pulmonary artery stenting in tetralogy of fallot improves ventricular function

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.066 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

MM Bissell ◽

L Mills ◽

DGW Cave ◽

R Foley ◽

JP Greenwood ◽

...

Keyword(s):

Kinetic Energy ◽

Ejection Fraction ◽

Pulmonary Artery ◽

Longitudinal Strain ◽

Left Ventricular ◽

Energy Curve ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Background Pulmonary artery stenosis (PAS) occurs commonly in patients with tetralogy of fallot (ToF). Cardiac function and especially left ventricular longitudinal strain has been identified as an important prognostic factor for long term survival in ToF. The clinical relevance of unilateral PAS to long-term bi-ventricular function is poorly understood. Purpose We sought to evaluate the effect of resolving unilateral pulmonary artery obstruction on right and left ventricular performance. Methods We prospectively included 40 patients with TOF between 2016 and 2020, 20 who underwent unilateral PAS stenting and as comparison 20 who underwent surgical pulmonary valve replacement (PVR). MRI data was acquired during routine clinical care before and around 6-12 months after the procedure. 4 PAS patients attended additional research scans acquiring ventricular 4D flow MRI data. 4D flow MRI data was compared to the average kinetic energy curve of 10 age-matched healthy volunteers. Results Of the 20 patients undergoing PAS, 2 also underwent percutaneous PVR and were excluded from the comparison analysis. All patients in the PAs group showed an improvement in branch PA flow differential post procedure. Patients undergoing PAS were younger than those undergoing PVR (median 12 vs 19 years, p < 0.001). Other baseline anatomical and functional parameters including right ventricular (RV) volume indexed to body surface are (RVEDV/BSA) were comparable (pre PAS median 151 [122,170] vs pre PVR 162 [140,191]; p = 0.217). While in the PVR group the right ventricular volumes reduced in both end-diastole and end-systole, in the PAS group RV function improved due to reduced end-systolic volume with largely stable end-diastolic volumes. Changes in the left ventricle (LV) were even more interesting. In the PVR group ejection fraction improved due to an increase in end-diastolic volume with no improvement in ventricular longitudinal strain. In contrast, in the PAS group LV ejection fraction improved by a reduction in end-systolic volume and the PAS group showed a small but significant improvement in LV longitudinal strain. In addition, ¾ patients undergoing 4D flow MRI assessment showed LV kinetic energy curve more similar to the healthy volunteer averaged LV kinetic energy curve after PAS. The 4th patient already had a near normal LV kinetic energy curve prior to PAS. Conclusion Unilateral PAS does not alter RV end-diastolic volumes but improves RV function. LV ejection fraction improvement is similar to that seen after PVR, but importantly PAS also improved LV longitudinal strain. This suggests that PAS might positively influence long term morbidity and mortality risk in ToF patients, but a larger multi-centre long term follow-up study is needed to confirm this.

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4D flow MRI, cardiac function, and T1 -mapping: Association of valve-mediated changes in aortic hemodynamics with left ventricular remodeling

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.25916 ◽

2017 ◽

Vol 48 (1) ◽

pp. 121-131 ◽

Cited By ~ 11

Author(s):

Julia Geiger ◽

Amir A. Rahsepar ◽

Kenichiro Suwa ◽

Alex Powell ◽

Ahmadreza Ghasemiesfe ◽

...

Keyword(s):

Cardiac Function ◽

T1 Mapping ◽

Ventricular Remodeling ◽

Left Ventricular Remodeling ◽

Left Ventricular ◽

4D Flow Mri ◽

4D Flow ◽

Flow Mri ◽

Aortic Hemodynamics

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Reduced flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI

10.21203/rs.2.10741/v2 ◽

2019 ◽

Author(s):

Philip A Corrado ◽

Jacob A. Macdonald ◽

Christopher J. Francois ◽

Niti R. Aggarwal ◽

Jonathan W. Weinsaft ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Linear Models ◽

Left Ventricular ◽

Short Axis ◽

Flow Data ◽

4D Flow Mri ◽

4D Flow ◽

Regional Flow ◽

Flow Mri

Abstract Background: Acute myocardial infarction (AMI) alters left ventricular (LV) hemodynamics, resulting in decreased global LV ejection fraction and global LV kinetic energy. We hypothesize that anterior AMI effects localized alterations in LV flow and developed a regional approach to analyze these local changes with 4D flow MRI. Methods: 4D flow cardiac magnetic resonance (CMR) data was compared between 12 anterior AMI patients (11 males; 66±12yo; prospectively acquired in 2016-2017) and 19 healthy volunteers (10 males; 40±16yo; retrospective from 2010-2011 study). The LV cavity was contoured on short axis cine steady-state free procession CMR and partitioned into three regions: base, mid-ventricle, and apex. 4D flow data was registered to the short axis segmentation. Peak systolic and diastolic through-plane flows were compared region-by-region between groups using linear models of flow with age, sex, and heart rate as covariates. Results: Peak systolic flow was reduced in anterior AMI subjects compared to controls in the LV mid-ventricle (fitted reduction = 3.9 L/min; P=0.01) and apex (fitted reduction = 1.4 L/min; P=0.02). Peak diastolic flow was also lower in anterior AMI subjects compared to controls in the apex (fitted reduction = 2.4 L/min; P=0.01). Conclusions: A regional method to analyze 4D LV flow data was applied in anterior AMI patients and controls. Anterior AMI patients had reduced regional flow relative to controls.

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