Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Sep 18;25(1):50.
doi: 10.1186/s12968-023-00960-x.

Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects

Xiaodan Zhao  1 , Ru-San Tan  1   2   3 , Pankaj Garg  4 , Ping Chai  5   6 , Shuang Leng  1   2 , Jennifer Ann Bryant  1   2   3 , Lynette L S Teo  5   6 , Tee Joo Yeo  5   6 , Marielle V Fortier  2   7   8 , Ting Ting Low  5 , Ching Ching Ong  5   6 , Shuo Zhang  9 , Rob J Van der Geest  10 , John C Allen  2 , Teng Hong Tan  2   7 , James W Yip  5   6 , Ju Le Tan  1   2   3 , Marina Hughes  4 , Sven Plein  11 , Jos J M Westenberg  10 , Liang Zhong  12   13
Affiliations
Observational Study

Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects

Xiaodan Zhao et al. J Cardiovasc Magn Reson. .

Abstract

Background: Advances in four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) have allowed quantification of left ventricular (LV) and right ventricular (RV) blood flow. We aimed to (1) investigate age and sex differences of 4D flow CMR-derived LV and RV relative flow components and kinetic energy (KE) parameters indexed to end-diastolic volume (KEiEDV) in healthy subjects; and (2) assess the effects of age and sex on these parameters.

Methods: We performed 4D flow analysis in 163 healthy participants (42% female; mean age 43 ± 13 years) of a prospective registry study (NCT03217240) who were free of cardiovascular diseases. Relative flow components (direct flow, retained inflow, delayed ejection flow, residual volume) and multiple phasic KEiEDV (global, peak systolic, average systolic, average diastolic, peak E-wave, peak A-wave) for both LV and RV were analysed.

Results: Compared with men, women had lower median LV and RV residual volume, and LV peak and average systolic KEiEDV, and higher median values of RV direct flow, RV global KEiEDV, RV average diastolic KEiEDV, and RV peak E-wave KEiEDV. ANOVA analysis found there were no differences in flow components, peak and average systolic, average diastolic and global KEiEDV for both LV and RV across age groups. Peak A-wave KEiEDV increased significantly (r = 0.458 for LV and 0.341 for RV), whereas peak E-wave KEiEDV (r = - 0.355 for LV and - 0.318 for RV), and KEiEDV E/A ratio (r = - 0.475 for LV and - 0.504 for RV) decreased significantly, with age.

Conclusion: These data using state-of-the-art 4D flow CMR show that biventricular flow components and kinetic energy parameters vary significantly by age and sex. Age and sex trends should be considered in the interpretation of quantitative measures of biventricular flow. Clinical trial registration https://www.

Clinicaltrials: gov . Unique identifier: NCT03217240.

Keywords: 4D flow; Flow components; Hemodynamics; Kinetic energy; Reference values.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Right ventricular (RV) kinetic energy (KE) curve normalized to RV end-diastolic volume (EDV) in A a 29-year-old normal subject, B a 36-year-old normal subject, C a 49-year-old normal subject, D a 55-year-old normal subject and E a 64-year-old normal subject. KEiEDV KE normalized to RVEDV
Fig. 2
Fig. 2
Comparisons between female and male for (A) left ventricular (LV) flow components; B LV peak systolic and average systolic KEiEDV; C right ventricular (RV) flow components; and D RV global, average diastolic, and peak E-wave KEiEDV. KEiEDV Kinetic energy normalized to end-diastolic volume (EDV). *denotes P < 0.0125 for (A, C) and P < 0.007 for (B, D) based on Bonferroni significance levels from Table 1
Fig. 3
Fig. 3
Scatter plots of peak E-wave (first row), peak A-wave KEiEDV (middle row) and KEiEDV E/A ratio (last row) according to age and sex for LV (left panel) and RV (right panel). All figures show regression line, correlation coefficient R, fitted curve (solid line), prediction interval (shaded area) and confidence interval (dot lines). LV left ventricle, RV right ventricle, KEiEDV kinetic energy normalized to RV end-diastolic volume
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Crandon S, Elbaz MSM, Westenberg JJM, van der Geest RJ, Plein S, Garg P. Clinical applications of intra-cardiac four-dimensional flow cardiovascular magnetic resonance: a systematic review. Int J Cardiol. 2017;249:486–493. doi: 10.1016/j.ijcard.2017.07.023. - DOI - PMC - PubMed
    1. Demirkiran A, van Ooij P, Westenberg JJM, Hofman MBM, van Assen HC, Schoonmade LJ, et al. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Eur Heart J Cardiovasc Imaging. 2022;23:154–165. doi: 10.1093/ehjci/jeab112. - DOI - PMC - PubMed
    1. Azarine A, Garçon P, Stansal A, Canepa N, Angelopoulos G, Silvera S, et al. Four-dimensional flow MRI: principles and cardiovascular applications. Radiographics. 2019;39:632–648. doi: 10.1148/rg.2019180091. - DOI - PubMed
    1. Fredriksson AG, Zajac J, Eriksson J, Dyverfeldt P, Bolger AF, Ebbers T, et al. 4-D blood flow in the human right ventricle. Am J Physiol Heart Circ Physiol. 2011;301:H2344–H2350. doi: 10.1152/ajpheart.00622.2011. - DOI - PubMed
    1. Carlsson M, Heiberg E, Toger J, Arheden H. Quantification of left and right ventricular kinetic energy using four-dimensional intracardiac magnetic resonance imaging flow measurements. Am J Physiol Heart Circ Physiol. 2012;302:H893–900. doi: 10.1152/ajpheart.00942.2011. - DOI - PubMed

Publication types

Associated data