Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects
Xiaodan Zhao, Ru‐San Tan, Pankaj Garg, Ping Chai, Shuang Leng, Jennifer Bryant, Lynette Teo, Tee Joo Yeo, Marielle V. Fortier, Ting Ting Low, Ching Ching Ong, Shuo Zhang, Rob J. van der Geest, John Carson Allen, Teng Hong Tan, James Yip, Ju Le Tan, Marina Hughes, Sven Plein, Jos J.M. Westenberg, Liang Zhong
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 (KEi EDV ) 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 KEi EDV (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 KEi EDV , and higher median values of RV direct flow, RV global KEi EDV , RV average diastolic KEi EDV , and RV peak E-wave KEi EDV . ANOVA analysis found there were no differences in flow components, peak and average systolic, average diastolic and global KEi EDV for both LV and RV across age groups. Peak A-wave KEi EDV increased significantly (r = 0.458 for LV and 0.341 for RV), whereas peak E-wave KEi EDV (r = − 0.355 for LV and − 0.318 for RV), and KEi EDV 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.