Automated 4D flow cardiac MRI pipeline to derive peak mitral inflow diastolic velocities using short-axis cine stack: Two centre validation study against echocardiographic pulse-wave doppler

Assadi, Hosamadin ORCID:, Li, Rui, Grafton-Clarke, Ciaran ORCID:, Uthayachandran, Bhalraam, Alabed, Samer, Maiter, Ahmed, Archer, Gareth T., Swoboda, Peter P., Sawh, Chris, Ryding, Alisdair, Nelthorpe, Faye, Kasmai, Bahman, Ricci, Fabrizio, van der Geest, Rob J., Flather, Marcus, Vassiliou, Vassilios S. ORCID:, Swift, Andrew J. and Garg, Pankaj ORCID: (2023) Automated 4D flow cardiac MRI pipeline to derive peak mitral inflow diastolic velocities using short-axis cine stack: Two centre validation study against echocardiographic pulse-wave doppler. BMC Cardiovascular Disorders, 23. ISSN 1471-2261

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Background: Measurement of peak velocities is important in the evaluation of heart failure. This study compared the performance of automated 4D flow cardiac MRI (CMR) with traditional transthoracic Doppler echocardiography (TTE) for the measurement of mitral inflow peak diastolic velocities. Methods: Patients with Doppler echocardiography and 4D flow cardiac magnetic resonance data were included retrospectively. An established automated technique was used to segment the left ventricular transvalvular flow using short-axis cine stack of images. Peak mitral E-wave and peak mitral A-wave velocities were automatically derived using in-plane velocity maps of transvalvular flow. Additionally, we checked the agreement between peak mitral E-wave velocity derived by 4D flow CMR and Doppler echocardiography in patients with sinus rhythm and atrial fibrillation (AF) separately. Results: Forty-eight patients were included (median age 69 years, IQR 63 to 76; 46% female). Data were split into three groups according to heart rhythm. The median peak E-wave mitral inflow velocity by automated 4D flow CMR was comparable with Doppler echocardiography in all patients (0.90 ± 0.43 m/s vs 0.94 ± 0.48 m/s, P = 0.132), sinus rhythm-only group (0.88 ± 0.35 m/s vs 0.86 ± 0.38 m/s, P = 0.54) and in AF-only group (1.33 ± 0.56 m/s vs 1.18 ± 0.47 m/s, P = 0.06). Peak A-wave mitral inflow velocity results had no significant difference between Doppler TTE and automated 4D flow CMR (0.81 ± 0.44 m/s vs 0.81 ± 0.53 m/s, P = 0.09) in all patients and sinus rhythm-only groups. Automated 4D flow CMR showed a significant correlation with TTE for measurement of peak E-wave in all patients group (r=0.73, P<0.001) and peak A-wave velocities (r=0.88, P<0.001). Moreover, there was a significant correlation between automated 4D flow CMR and TTE for peak-E wave velocity in sinus rhythm-only patients (r=0.68, P<0.001) and AF-only patients (r=0.81, P=0.014). Excellent intra-and inter-observer variability was demonstrated for both parameters. Conclusion: Automated dynamic peak mitral inflow diastolic velocity tracing using 4D flow CMR is comparable to Doppler echocardiography and has excellent repeatability for clinical use. However, 4D flow CMR can potentially underestimate peak velocity in patients with AF.

Item Type: Article
Additional Information: Funding: PG and AJS are funded by Wellcome Trust Clinical Research Career Development Fellowships (220703/Z/20/Z & 205188/Z/16/Z). For the purpose of Open Access, these authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, data collection and analysis, publishing decisions, or manuscript preparation.
Uncontrolled Keywords: 4d flow cmr,artificial intelligence,peak velocity,mitral valve,doppler echocardiography,cardiology and cardiovascular medicine,1*,hosamadin assadi ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 18 Jan 2023 11:31
Last Modified: 30 Jan 2023 09:30
DOI: 10.1186/s12872-023-03052-x

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