Table 2 4D flow CMR studies in valvular heart disease
Valve pathology | Study | Nr of patients (n) | Population assessed | Reproducibility assessment | 4D Flow CMR vs. TTE | 4D Flow CMR vs. PCMR | Main findings |
|---|---|---|---|---|---|---|---|
Mitral regurgitation | 2008 Westenberg et al. [69] | Controls n = 10 Patients n = 20 | Ischaemic cardiomyopathy with mitral regurgitation and/or TR | +  | − | +  | PCMR overestimated transmitral flow in healthy volunteers 4D Flow CMR showed strong agreement between MV and TV flow in patients with mitral regurgitation and/or TR |
2009 Roes et al. [25] | Controls n = 22 Patients n = 29 | Ischaemic cardiomyopathy with valvular regurgitation | +  | − | − | Agreement amongst net flow volume for all valves was excellent Good intra- and inter-observer reliability for quantification of RF | |
2009 Marsan et al. [72] | Patients n = 64 | Functional mitral regurgitation | − | + (3D TTE) | − | 2D TTE significantly underestimated mitral regurgitation | |
2011 Brandts et al. [71] | Patients n = 47 | Ischaemic heart failure | − | +  | +  | Higher mitral regurgitant fraction vs. PCMR Strong correlation between 4D Flow CMR and TTE for LV diastolic assessment | |
2018 Gorodisky et al. [74] | Patients n = 27 | Isolated mitral regurgitation of various severity | +  | +  | +  | CMR 4D-PISA was feasible CMR 4D-PISA was smaller than TTE-PISA | |
2018 Feneis et al. [9] | Patients n = 21 | Isolated mitral regurgitation n = 10 Mitral regurgitation + TR n = 5 Isolated TR = 6 | +  | − | +  | Good correlation between PCMR and 4D Flow CMR quantification of regurgitation by direct and indirect methods | |
2019 Kamphuis et al. [70] | Controls = 46 Patients n = 114 | Acquired and congenital pathologies |  +  | − | − | Automated valve tracking is performed more rapidly than manual valve tracking Strong intra- and inter-observer correlation for regurgitant fraction quantification by automated valve tracking | |
2020 Blanken et al. [73] | Patients n = 30 | Various degrees of mitral regurgitation severity |  +  | − | +  | Valve tracking underestimated mitral regurgitation severity in cases of severe mitral regurgitation SFT RV correlated better with indirect quantification of RV by PCMR than RVT | |
2021 Fidock et al. [54] | Patients n = 35 | Primary mitral regurgitation n = 12 Secondary mitral regurgitation n = 10 MVR n = 13 | +  | − | +  | Highest reproducibility was found for MV inflow-AV outflow method of mitral regurgitation quantification Good correlation between all methods in secondary mitral regurgitation and MVR | |
2021 Spampinato et al. [42] | Controls = 6 Patients = 54 | Mitral valve prolapse | +  | +  | +  | Indirect 4D Flow CMR assessment of mitral regurgitation in MVP showed better intra- and inter-technique concordance than direct assessment | |
2021 Juffermans et al. [26] | Patients n = 64 Controls n = 76 | Various pathologies |  +  | − | − | Strong-to-excellent interobserver reliability for forward flow volume and net forward volume for all valves Moderate-to-excellent reliability for assessment of RF for all valves | |
Aortic regurgitation | 2013 Ewe et al. [86] | Patients n = 32 | Various degrees of AR severity | − | + (3D TTE) | − | High concordance between 3D-TTE and 4D Flow CMR |
2016 Chelu et al. [85] | Patients n = 54 | Various pathologies | − | +  | − | AR severity by 4D Flow CMR correlated well with TTE | |
2020 Alvarez et al. [79] | Patients n = 34 | AR > 5% | − | − | +  | AV forward and regurgitant flow by 4D Flow CMR agreed well with PCMR | |
2021 Juffermans et al. [26] | Patients = 64 Controls = 76 | Various pathologies | +  | − | − | Strong-to-excellent interobserver reliability for forward flow volume and net forward volume for all valves Moderate-to-excellent reliability for assessment of RF for all valves | |
Aortic Stenosis | 2013 Dyverfeldt et al. [93] | Controls n = 4 Patients n = 14 | Aortic dilatation present in some cases | − | +  | − | Patients with AS demonstrated much higher peak total TKE in the ascending aorta |
2014 Garcia et al. [90] | Controls n = 10 Patients n = 40 | Tricuspid and bicuspid AS | +  | − | +  | EOA measurement by 4D Flow CMR jet shear layer detection method was feasible 3D projection of vena contracta by 4D Flow CMR enabled more accurate localisation of the measurement plane | |
2016 Negahdar et al. [92] | Controls n = 5 Patients n = 4 |  ≤ moderate AS | − |  +  | − | Spiral 4D Flow readout resulted in shorter TE and shorter scan time | |
2020 Archer et al. [91] | Patients n = 18 | SAVR n = 10 TAVR n = 8 | − |  +  | − | Invasive peak pressure gradient and4D Flow CMR derived peak pressure gradient correlated well Prognostic advantage of 4D Flow CMR derived gradient vs. TTE | |
2020 Callahan et al. [37] | Controls n = 6 Patients n = 8 | Severe aortic stenosis | − | − | − | Combination of dual-VENC 4D Flow acquisition and spiral read-out offers increased velocity resolution and reduced scan time | |
Bicuspid aortic valve | 2018 Bissell et al. [34] | Controls n = 30 Patients n = 60 | Native BAV n = 30 Prior AVR n = 30 | − | − | − | Normalisation of wall shear stress and rotational flow in patients with mechanical AVR or Ross procedure, but not those with bioprosthetic AV |
2019 Elbaz et al. [98] | Controls n = 34 Patients n = 57 | BAV; stenotic and regurgitant valves |  +  | − | − | Kinetic energy, viscous energy loss rate and vorticity were reproducible in BAV patients Patients with severe AS showed highest levels of VELR and vorticity | |
2019 Dux-Santoy et al. [96] | Controls n = 24 Patients n = 132 | BAV n = 111; non-severe disease TAV with dilated arch n = 21 | − | − | − | In-plane rotational flow, right/noncoronary BAV and systolic flow reversal ratio were predictors of aortic dilatation | |
2020 Fatehi Hassanabad et al. [99] | Controls n = 11 Patients n = 32 | BAV; stenotic and regurgitant valves |  +  | − |  +  | Larger pressure drop was observed in patients with > than moderate BAV stenosis | |
Tricuspid regurgitation | 2008 Westenberg et al. [69] | Controls n = 10 Patients n = 20 | Ischaemic cardiomyopathy with mitral regurgitation and/or TR |  +  | − |  +  | PCMR overestimated transtricuspid flow 4D Flow CMR showed strong agreement between MV and TV flow in patients with mitral regurgiatiton and/or TR |
2009 Roes et al. [25] | Controls n = 22 Patients n = 29 | Ischaemic cardiomyopathy with valvular regurgitation |  +  | − | − | Agreement amongst net flow volume for all valves was excellent Good intra- and interobserver reliability for quantification of RF | |
2018 Feneis et al. [9] | Patients n = 21 | Isolated TR n = 6 Mitral regurgitation + TR n = 5 Isolated mitral regurgitaiton n = 10 |  +  | − |  +  | Good correlation between PCMR and 4D Flow CMR quantification of regurgitation by direct and indirect methods | |
2018 Driessen et al. [100] | Controls n = 21 Patients n = 67 | RV pressure overload | +  | +  | +  | Excellent concordance of effective TV flow vs. PCMR derived effective PV flow 4D Flow reclassified TR severity to a different grade vs. TTE grades | |
2021 Juffermans et al. [26] | Patients = 64 Controls = 76 | Various pathologies | +  | − | − | Strong-to-excellent interobserver reliability for forward flow volume and net forward volume for all valves Moderate-to-excellent reliability for assessment of RF for all valves | |
Pulmonary regurgitation | 2016 Chelu et al. [101] | Patients n = 52 | Heterogenous group | +  | − | +  | Peak systolic PV velocity may be underestimated; this can be minimised by measuring the velocity where it appears to be the highest |
2019 Rizk et al. [103] | Controls n = 11 Patients n = 49 | Tetralogy of Fallot n = 30 BAV n = 19 | +  | − | − | Severity of PR was proportional to peak diastolic WSS | |
2020 Jacobs et al. [102] | Patients n = 34 | Paediatric patients with repaired Tetralogy of Fallot | +  | − | +  | Pulmonary flow and aortic flow were most consistent at valve level RV ejection fraction was more reproducible by 4D Flow CMR vs. standard CMR RV volumes were mildly overestimated by 4D Flow CMR | |
2021 Juffermans et al. [26] | Patients = 64 Controls = 76 | Various pathologies | +  | − | − | Strong-to-excellent interobserver reliability for forward flow volume and net forward volume for all valves Moderate-to-excellent reliability for assessment of RF for all valves |