Sub-analysis with patients stratified according to Late Gadolinium Enhancement test.

<p>Sub-analysis with patients stratified according to Late Gadolinium Enhancement test.</p

The 4D flow components as proportions of total LV EDV (percent ± SD) in the three sub-groups stratified by LVEDVI.

<p>Non-ejecting volume is comprised of the Retained inflow (yellow) and Residual volume (red) flow components (yellow + red = orange). * P<0.05 vs Control group; † P<0.05 vs Lower LVEDVI group.</p

Correlation plots.

<p>A. Direct flow (DF) volume ratio (in relation to LVEDV) versus LVEDV index (LVEDVI). B. DF Kinetic energy (KE) ratio at ED versus LVEDVI. C. Non-ejecting (NE) volume ratio versus LVEDVI. D. NE KE ratio at ED versus LVEDVI.</p

4D flow components.

<p>A. Schematic of the routes of the four LV flow components; direct flow (green), retained inflow (yellow), delayed ejection flow (blue), and residual volume (red). A semitransparent grayscale three-chamber image provides morphological orientation. Circles indicate the approximate location of the center of mass of each component at the time of end-diastole. B. Particle trace pathlines indicate routes of direct flow (green) and retained inflow (yellow). Red dots indicate the positions of the residual volume pathlines at end-diastole. Non-ejected flow comprises the retained inflow and the residual volume. Ao, aorta; LA, left atrium; LV, left ventricle.</p

Correlation between 4D flow measures and LV volumes.

<p>Correlation between 4D flow measures and LV volumes.</p

Altered Diastolic Flow Patterns and Kinetic Energy in Subtle Left Ventricular Remodeling and Dysfunction Detected by 4D Flow MRI.

4D flow magnetic resonance imaging (MRI) allows quantitative assessment of left ventricular (LV) function according to characteristics of the dynamic flow in the chamber. Marked abnormalities in flow components' volume and kinetic energy (KE) have previously been demonstrated in moderately dilated and depressed LV's compared to healthy subjects. We hypothesized that these 4D flow-based measures would detect even subtle LV dysfunction and remodeling.We acquired 4D flow and morphological MRI data from 26 patients with chronic ischemic heart disease with New York Heart Association (NYHA) class I and II and with no to mild LV systolic dysfunction and remodeling, and from 10 healthy controls. A previously validated method was used to separate the LV end-diastolic volume (LVEDV) into functional components: direct flow, which passes directly to ejection, and non-ejecting flow, which remains in the LV for at least 1 cycle. The direct flow and non-ejecting flow proportions of end-diastolic volume and KE were assessed. The proportions of direct flow volume and KE fell with increasing LVEDV-index (LVEDVI) and LVESV-index (LVESVI) (direct flow volume r = -0.64 and r = -0.74, both P74 ml/m2 compared to patients with LVEDVI <74 ml/m2 and controls (both P<0.05).Direct flow volume and KE proportions diminish with increased LV volumes, while non-ejecting flow proportions increase. A decrease in direct flow volume and KE at end-diastole proposes that alterations in these novel 4D flow-specific markers may detect LV dysfunction even in subtle or subclinical LV remodeling