Assessment of biventricular hemodynamics and energy dynamics using lumen-tracking 4D flow MRI without contrast medium

Background: Biventricular physiological interaction remains a challenging problem in cardiology. We developed a four-dimensional (4D) flow magnetic resonance imaging (MRI) scan and clinically available analysis protocol based on beat tracking of the cardiovascular lumen without contrast medium, which enabled measurement of the biventricular hemodynamics and energetic performance by calculating flow energy loss (EL) and kinetic energy (KE). The aim of this study was to observe the flow patterns and energy dynamics to reveal the physiology of the right and left ventricular systems. Methods: 4D flow MRI studies were performed in 19 healthy volunteers including 11 male and 8 female. The right and left ventricular systems were segmented to visualize the flow patterns and to quantify the hemodynamics and energy dynamics. Results: A large vortex was observed in the left ventricle (LV), along the longitudinal axis, during end diastole and early systole. At early systole, the vortex appeared to facilitate smooth ejection with little EL. In contrast, in the right ventricle (RV), there were vortices near the free wall in both the short and long axes during the diastolic filling phase. Mean EL index during a single cardiac cycle in the right and left heart systems was 0.63 +/- 0.16 (0.42-0.99) mW/m(2), and 1.02 +/- 0.26 (0.58-1.58) mW/m(2), respectively. EL is inevitable loss caused by the vortex flow to facilitate smooth right and left ventricular function and left-sided EL tended to correlate positively with heart rate and right ventricular stroke volume. Kinetic energy at the aortic valve was influenced by LV end-diastolic volume/stroke volume. No gender difference was observed. Conclusions: The RV appears to function as a regulator of the energy dynamics of the LV system. (C) 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Automated summary

Using 4D flow MRI technology, differences in flow patterns and energy dynamics between the left and right ventricular systems were observed in 19 healthy volunteers. The left ventricle exhibited a large vortex while the right ventricle had smaller vortices, leading to differences in energy loss indices between the two ventricles.