The ventricular residence time distribution derived from 4D flow particle tracing: a novel marker of myocardial dysfunction
4D flow cardiac magnetic resonance (CMR) imaging allows visualisation of blood flow in the cardiac chambers and great vessels. Post processing of the flow data allows determination of the residence time distribution (RTD), a novel means of assessing ventricular function, potentially providing additional information beyond ejection fraction. We evaluated the RTD measurement of efficiency of left and right ventricular (LV and RV) blood flow. 16 volunteers and 16 patients with systolic dysfunction (LVEF < 50%) underwent CMR studies including 4D flow. The RTDs were created computationally by seeding virtual ‘particles’ at the inlet plane in customised post-processing software, moving these particles with the measured blood velocity, recording and counting how many exited per unit of time. The efficiency of ventricular flow was determined from the RTDs based on the time constant (RTDc = − 1/B) of the exponential decay. The RTDc was compared to ejection fraction, T1 mapping and global longitudinal strain (GLS). There was a significant difference between groups in LV RTDc (healthy volunteers 1.2 ± 0.13 vs systolic dysfunction 2.2 ± 0.80, p < 0.001, C-statistic = 1.0) and RV RTDc (1.5 ± 0.15 vs 2.0 ± 0.57, p = 0.013, C-statistic = 0.799). The LV RTDc correlated significantly with LVEF (R = − 0.84, P < 0.001) and the RV RTDc had significant correlation with RVEF (R = − 0.402, p = 0.008). The correlation between LV RTDc and LVEF was similar to GLS and LVEF (0.926, p < 0.001). The ventricular residence time correlates with ejection fraction and can distinguish normal from abnormal systolic function. Further assessment of this method of assessment of chamber function is warranted.
Keywords4D flow Cardiac magnetic resonance Dilated cardiomyopathy
Cardiac magnetic resonance imaging
Residence time distribution
Global longitudinal strain
We thank the Baker Heart and Diabetes Institute radiology staff for their assistance in this project.
BC: conception, design and analysis and interpretation of data, and drafting of the manuscript; MQ: development of MATLAB code, analysis of data and revision of the manuscript; BP: development of MATLAB code; MT: development of code and revision of manuscript: JH: conception and design and revision of the manuscript; ALG: analysis and interpretation of data, revision of manuscript; MR: development of MATLAB code, analysis of data, revision of manuscript; AJT: conception, design and analysis and interpretation of data, revision of the manuscript and final approval.
The study was funded by a research grant from Monash Institute of Medical Engineering (MIME) and by a National Health and Medical Research Council of Australia grant.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
The study was approved by the Alfred Hospital Ethics Committee (Melbourne, Australia) and carried out under their guidelines.
Prior to inclusion in the study written informed consent was obtained from all participants.
Consent for publication
All authors declare their consent for publication.
- 4.Fogler HS (2016) Elements of chemical reaction engineering. Prentice HallGoogle Scholar
- 11.Thomas L, Hoy M, Byth K, Schiller N (2007) The left atrial function index: a rhythm independent marker of atrial function. Eur J Echocardiogr 2008:356–362Google Scholar
- 15.Stoll V, Hess AT, Eriksson J et al (2016) The kinetic energies of left ventricular 4D flow components correlate with established markers of prognosis and represent novel imaging biomarkers in both ischaemic and dilated cardiomyopathy. J Cardiovasc Magn Reson 18:O68CrossRefPubMedCentralGoogle Scholar
- 17.Elbaz MSM, Calkoen EE, Westenberg JJM, Lelieveldt BPF, Roest AAW, van der Geest RJ (2014) Vortex flow during early and late left ventricular filling in normal subjects: quantitative characterization using retrospectively-gated 4D flow cardiovascular magnetic resonance and three-dimensional vortex core analysis. J Cardiovasc Magn Reson 16:45CrossRefGoogle Scholar