scholarly journals Evaluation of intraventricular flow by multimodality imaging: a review and meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ferit Onur Mutluer ◽  
Nikki van der Velde ◽  
Jason Voorneveld ◽  
Johan G. Bosch ◽  
Jolien W. Roos-Hesselink ◽  
...  
Keyword(s):  
Flow Visualization ◽  
Multimodality Imaging ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Normative Values ◽  
Interventional Treatment ◽  
Full Potential ◽  
4D Flow ◽  
4D Flow Cmr ◽  
Intraventricular Flow

Abstract Background The aim of this systematic review was to evaluate current inter-modality agreement of noninvasive clinical intraventricular flow (IVF) assessment with 3 emerging imaging modalities: echocardiographic particle image velocimetry (EPIV), vector flow mapping (VFM), and 4-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). Methods We performed a systematic literature review in the databases EMBASE, Medline OVID and Cochrane Central for identification of studies evaluating left ventricular (LV) flow patterns using one of these flow visualization modalities. Of the 2224 initially retrieved records, 10 EPIV, 23 VFM, and 25 4D flow CMR studies were included in the final analysis. Results Vortex parameters were more extensively studied with EPIV, while LV energetics and LV transport mechanics were mainly studied with 4D flow CMR, and LV energy loss and vortex circulation were implemented by VFM studies. Pooled normative values are provided for these parameters. The meta- analysis for the values of two vortex morphology parameters, vortex length and vortex depth, failed to reveal a significant change between heart failure patients and healthy controls. Conclusion Agreement between the different modalities studying intraventricular flow is low and different methods of measurement and reporting were used among studies. A multimodality framework with a standardized set of flow parameters is necessary for implementation of noninvasive flow visualization in daily clinical practice. The full potential of noninvasive flow visualization in addition to diagnostics could also include guiding medical or interventional treatment.

scholarly journals Stent interventions for pulmonary artery stenosis improve bi-ventricular flow efficiency in a swine model

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Ryan J. Pewowaruk ◽  
Gregory P. Barton ◽  
Cody Johnson ◽  
J. Carter Ralphe ◽  
Christopher J. Francois ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Ventricular Function ◽  
Intervention Group ◽  
Left Ventricular ◽  
Pulmonary Artery Stenosis ◽  
Swine Model ◽  
4D Flow ◽  
4D Flow Cmr ◽  
The Impact

Abstract Background Branch pulmonary artery (PA) stenosis (PAS) commonly occurs in patients with congenital heart disease (CHD). Prior studies have documented technical success and clinical outcomes of PA stent interventions for PAS but the impact of PA stent interventions on ventricular function is unknown. The objective of this study was to utilize 4D flow cardiovascular magnetic resonance (CMR) to better understand the impact of PAS and PA stenting on ventricular contraction and ventricular flow in a swine model of unilateral branch PA stenosis. Methods 18 swine (4 sham, 4 untreated left PAS, 10 PAS stent intervention) underwent right heart catheterization and CMR at 20 weeks age (55 kg). CMR included ventricular strain analysis and 4D flow CMR. Results 4D flow CMR measured inefficient right ventricular (RV) and left ventricular (LV) flow patterns in the PAS group (RV non-dimensional (n.d.) vorticity: sham 82 ± 47, PAS 120 ± 47; LV n.d. vorticity: sham 57 ± 5, PAS 78 ± 15 p < 0.01) despite the PAS group having normal heart rate, ejection fraction and end-diastolic volume. The intervention group demonstrated increased ejection fraction that resulted in more efficient ventricular flow compared to untreated PAS (RV n.d. vorticity: 59 ± 12 p < 0.01; LV n.d. vorticity: 41 ± 7 p < 0.001). Conclusion These results describe previously unknown consequences of PAS on ventricular function in an animal model of unilateral PA stenosis and show that PA stent interventions improve ventricular flow efficiency. This study also highlights the sensitivity of 4D flow CMR biomarkers to detect earlier ventricular dysfunction assisting in identification of patients who may benefit from PAS interventions.

P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ribeyrolles ◽  
J L Monin ◽  
A Rohnean ◽  
C Diakov ◽  
C Caussin ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Stroke Volume ◽  
Left Ventricular ◽  
Left Ventricular Stroke Volume ◽  
4D Flow ◽  
Mitral Flow ◽  
4D Flow Cmr ◽  
Mr Quantification ◽  
Cine Cmr

Abstract Background Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification. Purpose Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach. Methods We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR. Results 33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]). Conclusion 4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.

scholarly journals Mechanical dyssynchrony alters left ventricular flow energetics in failing hearts with LBBB: a 4D flow CMR pilot study

2017 ◽  
Vol 34 (4) ◽  
pp. 587-596 ◽  
Author(s):  
Jakub Zajac ◽  
Jonatan Eriksson ◽  
Urban Alehagen ◽  
Tino Ebbers ◽  
Ann F. Bolger ◽  
...  
Keyword(s):  
Pilot Study ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
4D Flow ◽  
4D Flow Cmr

scholarly journals Bias associated with left ventricular quantification by multimodality imaging: a systematic review and meta-analysis

Open Heart ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. e000388 ◽  
Author(s):  
Marzia Rigolli ◽  
Sulakchanan Anandabaskaran ◽  
Jonathan P Christiansen ◽  
Gillian A Whalley
Keyword(s):  
Systematic Review ◽  
Multimodality Imaging ◽  
Meta Analysis ◽  
Left Ventricular

scholarly journals Quantification of regurgitation in mitral valve prolapse with four-dimensional flow cardiovascular magnetic resonance

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Ricardo A. Spampinato ◽  
Cosima Jahnke ◽  
Gerard Crelier ◽  
Frank Lindemann ◽  
Florian Fahr ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
4D Flow ◽  
Proximal Isovelocity Surface Area ◽  
4D Flow Cmr ◽  
Severity Grading

Abstract Background Four-dimensional cardiovascular magnetic resonance (CMR) flow assessment (4D flow) allows to derive volumetric quantitative parameters in mitral regurgitation (MR) using retrospective valve tracking. However, prior studies have been conducted in functional MR or in patients with congenital heart disease, thus, data regarding the usefulness of 4D flow CMR in case of a valve pathology like mitral valve prolapse (MVP) are scarce. This study aimed to evaluate the clinical utility of cine-guided valve segmentation of 4D flow CMR in assessment of MR in MVP when compared to standardized routine CMR and transthoracic echocardiography (TTE). Methods Six healthy subjects and 54 patients (55 ± 16 years; 47 men) with MVP were studied. TTE severity grading used a multiparametric approach resulting in mild/mild-moderate (n = 12), moderate-severe (n = 12), and severe MR (n = 30). Regurgitant volume (RVol) and regurgitant fraction (RF) were also derived using standard volumetric CMR and 4D flow CMR datasets with direct measurement of regurgitant flow (4DFdirect) and indirect calculation using the formula: mitral valve forward flow - left ventricular outflow tract stroke volume (4DFindirect). Results There was moderate to strong correlation between methods (r = 0.59–0.84, p < 0.001), but TTE proximal isovelocity surface area (PISA) method showed higher RVol as compared with CMR techniques (PISA vs. CMR, mean difference of 15.8 ml [95% CI 9.9–21.6]; PISA vs. 4DFindirect, 17.2 ml [8.4–25.9]; PISA vs. 4DFdirect, 27.9 ml [19.1–36.8]; p < 0.001). Only indirect CMR methods (CMR vs. 4DFindirect) showed moderate to substantial agreement (Lin’s coefficient 0.92–0.97) without significant bias (mean bias 1.05 ± 26 ml [− 50 to 52], p = 0.757). Intra- and inter-observer reliability were good to excellent for all methods (ICC 0.87–0.99), but with numerically lower coefficient of variation for indirect CMR methods (2.5 to 12%). Conclusions In the assessment of patients with MR and MVP, cine-guided valve segmentation 4D flow CMR is feasible and comparable to standard CMR, but with lower RVol when TTE is used as reference. 4DFindirect quantification has higher intra- and inter-technique agreement than 4DFdirect quantification and might be used as an adjunctive technique for cross-checking MR quantification in MVP.

scholarly journals Reproducibility of left ventricular blood flow kinetic energy measured by four-dimensional flow CMR

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ciaran Grafton-Clarke ◽  
Saul Crandon ◽  
Jos J. M. Westenberg ◽  
Peter P. Swoboda ◽  
John P. Greenwood ◽  
...  
Keyword(s):  
Blood Flow ◽  
Kinetic Energy ◽  
Healthy Volunteers ◽  
Statistical Power ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
4D Flow ◽  
Energy Data ◽  
Dimensional Flow ◽  
4D Flow Cmr

Abstract Objectives Four-dimensional flow CMR allows for a comprehensive assessment of the blood flow kinetic energy of the ventricles of the heart. In comparison to standard two-dimensional image acquisition, 4D flow CMR is felt to offer superior reproducibility, which is important when repeated examinations may be required. The objective was to evaluate the inter-observer and intra-observer reproducibility of blood flow kinetic energy assessment using 4D flow of the left ventricle in 20 healthy volunteers across two centres in the United Kingdom and the Netherlands. Data description This dataset contains 4D flow CMR blood flow kinetic energy data for 20 healthy volunteers with no known cardiovascular disease. Presented is kinetic energy data for the entire cardiac cycle (global), the systolic and diastolic components, in addition to blood flow kinetic energy for both early and late diastolic filling. This data is available for reuse and would be valuable in supporting other research, such as allowing for larger sample sizes with more statistical power for further analysis of these variables.

scholarly journals Left ventricular four-dimensional blood flow energetics and vorticity in chronic myocardial infarction patients with/without left ventricular thrombus

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Demirkiran ◽  
M ECJ Hassell ◽  
P Garg ◽  
M SM Elbaz ◽  
R Delewi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vortex Ring ◽  
Left Ventricular ◽  
Residual Flow ◽  
4D Flow ◽  
Direct Flow ◽  
4D Flow Cmr ◽  
Ventricular Thrombus ◽  
The Mean ◽  
Flow Components

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation [FS/10/62/28409] and Dutch ZonMw [104003001]. Background Left ventricular thrombus (LVT) formation is a frequent and serious complication of myocardial infarction (MI). How global LV flow characteristics are related to this phenomenon is yet uncertain. In this study, we investigated LV flow differences using 4D flow cardiovascular magnetic resonance (CMR) between chronic MI patients with LVT [MI-LVT(+)] and without LVT [MI-LVT(-)], and healthy controls. Methods In this prospective cohort study, the 4D flow CMR data were acquired in 19 chronic MI patients (MI-LVT(+), n= 9 and MI-LVT(-), n= 10) and 9 age-matched controls. All included subjects were in sinus rhythm. The following LV flow parameters were obtained: LV flow components (direct, retained, delayed, residual), mean and peak KE values (indexed to instantaneous LV volume), mean and peak vorticity values, and diastolic vortex ring properties (position, orientation, shape). Results The MI patients demonstrated a significantly larger amount of delayed and residual flow, and a smaller amount of direct flow compared to controls (p = 0.02, p = 0.03, and p &lt; 0.001, respectively). The MI-LVT(+) patients demonstrated numerically increased residual flow and reduced retained and direct flow in comparison to MI-LVT(-) patients. Systolic mean and peak LV blood flow KE values were significantly lower in MI patients compared to controls (p = 0.04, p = 0.03, respectively). Overall, the mean and peak LV vorticity values were significantly lower in MI patients compared to controls. The mean vorticity at the basal level was significantly higher in MI-LVT(+) than in MI-LVT(-) patients (p &lt; 0.01). The vortex ring core during E-wave in MI-LVT(-) group was located closer to the mitral annulus and in a less tilted orientation to the LV compared to MI-LVT(+) group (p = 0.05, p &lt; 0.01, respectively). Conclusion Chronic MI patients with LVT express a different distribution of LV flow components, irregular vorticity vector fields, and altered diastolic vortex ring geometric properties as assessed by 4D flow CMR. Larger prospective studies are warranted to further evaluate these initial observations.

scholarly journals Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Ribeyrolles ◽  
J L Monin ◽  
A Rohnean ◽  
C Diakov ◽  
C Caussin ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Transthoracic Echocardiography ◽  
Validation Cohort ◽  
Left Ventricular ◽  
Observer Agreement ◽  
4D Flow ◽  
Funding Sources ◽  
4D Flow Cmr ◽  
Optimal Thresholds ◽  
Initial Cohort

Abstract Background Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR. Purpose To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR. Methods We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016–2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR. Results We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95% CI, 0.8–1) and 20% and 37% for RF (κ=0.90; 95% CI, 0.7–0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95% CI, 0.61–0.94). Conclusion We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification. FUNDunding Acknowledgement Type of funding sources: None. Quantification of MR using 4D Flow CMR

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