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The ventricular residence time distribution derived from 4D flow particle tracing: a novel marker of myocardial dysfunction

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Abstract

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.

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Data availability

The anonymized datasets analyzed during the current study are available from the corresponding author, on reasonable request.

Abbreviations

CMR:

Cardiac magnetic resonance imaging

RTD:

Residence time distribution

LV:

Left ventricular

RV:

Right ventricular

EF:

Ejection fraction

GLS:

Global longitudinal strain

4D:

Four dimensional

DCM:

Dilated cardiomyopathy

ECV:

Extracellular volume

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Acknowledgements

We thank the Baker Heart and Diabetes Institute radiology staff for their assistance in this project.

Funding

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.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia

    Benedict T. Costello, Stavroula Papapostolou, James L. Hare, Andre La Gerche & Andrew J. Taylor

  2. Baker Heart and Diabetes Institute, Melbourne, Australia

    Benedict T. Costello, Stavroula Papapostolou, James L. Hare, Andre La Gerche & Andrew J. Taylor

  3. Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia

    Mateen Qadri, Bradley Price, Mark Thompson & Murray Rudman

  4. Department of Cardiovascular Medicine, University of Leuven, Leuven, Belgium

    Andre La Gerche

Authors
  1. Benedict T. Costello
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  2. Mateen Qadri
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  3. Bradley Price
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  4. Stavroula Papapostolou
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  7. Andre La Gerche
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  8. Murray Rudman
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  9. Andrew J. Taylor
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Contributions

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.

Corresponding author

Correspondence to Andrew J. Taylor.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was approved by the Alfred Hospital Ethics Committee (Melbourne, Australia) and carried out under their guidelines.

Informed consent

Prior to inclusion in the study written informed consent was obtained from all participants.

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All authors declare their consent for publication.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10554_2018_1407_MOESM1_ESM.avi

Multimedia: Video file of particle traces with seeding plane at the mitral valve over five cardiac cycles in a participant with a left ventricular ejection fraction of 60%. (AVI 43589 KB)

Supplementary Table 1 (DOCX 12 KB)

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Costello, B.T., Qadri, M., Price, B. et al. The ventricular residence time distribution derived from 4D flow particle tracing: a novel marker of myocardial dysfunction. Int J Cardiovasc Imaging 34, 1927–1935 (2018). https://doi.org/10.1007/s10554-018-1407-0

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  • DOI: https://doi.org/10.1007/s10554-018-1407-0

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