Clinical applications of intra-cardiac four-dimensional flow cardiovascular magnetic resonance: A systematic review

Abstract

BackgroundFour-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology used to visualise and quantify intra-cardiac blood flow. The aim of this systematic review is to assess the literature on the current clinical applications of intra-cardiac 4D flow CMR.MethodsA systematic review was conducted to evaluate the literature on the intra-cardiac clinical applications of 4D flow CMR. Structured searches were carried out on Medline, EMBASE and the Cochrane Library in October 2016. A modified Critical Skills Appraisal Programme (CASP) tool was used to objectively assess and score the included studies. Studies were categorised as ‘highly clinically applicable’ for scores of 67–100%, ‘potentially clinically applicable’ for 34–66% and ‘less clinically applicable’ for 0–33%.ResultsOf the 1608 articles screened, 44 studies met eligibility for systematic review. The included literature consisted of 22 (50%) mechanistic studies, 18 (40.9%) pilot studies and 4 (9.1%) diagnostic studies. Based on the modified CASP tool, 27 (62%) studies were ‘highly clinically applicable’, 9 (20%) were ‘potentially clinically applicable’ and 8 (18%) were ‘less clinically applicable’.ConclusionsThere are many proposed methods for using 4D flow CMR to quantify intra-cardiac flow. The evidence base is mainly mechanistic, featuring single-centred designs. Larger, multi-centre studies are required to validate the proposed techniques and investigate the clinical advantages that 4D flow CMR offers over standard practices.PROSPERO = CRD42016051438.

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

“…Further prospective studies are warranted to investigate and ascertain the phenotype of the patients with breathlessness, raised NTproBNP, and normal TTE. Cardiovascular magnetic resonance imaging has demonstrated some promise to better categorise diastolic function [29][30][31][32][33][34] ; however, this needs further invasive catheter-based validation studies. Third, this study did not record the cause of death.…”

Intracardiac 4D Flow MRI in Congenital Heart Disease: Recommendations on Behalf of the ISMRM Flow & Motion Study Group

“…4D flow magnetic resonance imaging (MRI) [1][2][3][4][5] has been used for the evaluation of various challenging CHD types. Quantitative measures of flow perturbations using 4D flow can aid in surveillance and treatment decision-making, and have been shown to be similar to standard clinical 2D phase-contrast (PC) MRI with acceptable test-retest repeatability.…”

Physicalizing cardiac blood flow data via 3D printing

“…A recent systematic review of over 70 clinical intra-cardiac applications [Crandon et al, 2017] shows that there are many proposed methods that use 4D Flow MRI to quantify and analyze intracardiac flow. Within this literature, the left ventricle has been the most extensively studied chamber of the heart [Crandon et al, 2017].…”

“…A recent systematic review of over 70 clinical intra-cardiac applications [Crandon et al, 2017] shows that there are many proposed methods that use 4D Flow MRI to quantify and analyze intracardiac flow. Within this literature, the left ventricle has been the most extensively studied chamber of the heart [Crandon et al, 2017]. One of the particular applications relevant to our work is the exploration of flow within the left ventricle during diastole [Elbaz et al, 2014, Kumar et al, 2011, Suwa et al, 2016.…”