Introduction
Methods
Study population
Cardiac magnetic resonance protocol
Cardiac magnetic resonance image analysis
Biventricular measurements
4D flow error corrections
Biventricular 4D flow analysis
Statistical analysis
Results
Demographic characteristics and baseline CMR data
All (n = 163) | Men (n = 95) | Women (n = 68) | P1,2 | |
---|---|---|---|---|
Demographics | ||||
Age, years | 43 ± 13 | 44 ± 13 | 42 ± 12 | 0.322 |
Gender, M/F | 95/68 | 95/0 | 0/68 | – |
Weight, kg | 65 ± 12 | 71 ± 10 | 56 ± 9 | < 0.001 |
Height, cm | 167 ± 9 | 172 ± 7 | 160 ± 7 | < 0.001 |
Systolic blood pressure, mmHg | 125 ± 16 | 129 ± 15 | 121 ± 17 | 0.002 |
Diastolic blood pressure, mmHg | 76 ± 12 | 79 ± 11 | 73 ± 12 | 0.003 |
Body surface area, m2 | 1.72 ± 0.19 | 1.83 ± 0.14 | 1.57 ± 0.14 | < 0.001 |
Body mass index, kg/m2 | 23.1 ± 3.4 | 24.0 ± 3.4 | 21.8 ± 3.1 | < 0.001 |
Heart rate, bpm | 73 ± 13 | 73 ± 14 | 73 ± 12 | 0.809 |
Ethnicity | 0.529* | |||
Chinese, n (%) | 143 (87.7%) | 84 (88.4%) | 59 (86.8%) | – |
Malay, n (%) | 7 (4.3%) | 5 (5.3%) | 2 (2.9%) | – |
Other, n (%) | 13 (8%) | 6 (6.3%) | 7 (10.3%) | – |
LV function | ||||
LV mass index, g/m2 | 47 ± 11 | 51 ± 12 | 42 ± 8 | < 0.001 |
LVEDV index, ml/m2 | 71 ± 13 | 75 ± 12 | 65 ± 11 | < 0.001 |
LVESV index, ml/m2 | 27 ± 9 | 29 ± 8 | 23 ± 8 | < 0.001 |
LVSV index, ml/m2 | 44 ± 8 | 46 ± 7 | 42 ± 7 | 0.001 |
LV ejection fraction, % | 63 ± 8 | 62 ± 7 | 65 ± 8 | 0.022 |
RV function | ||||
RVEDV index, ml/m2 | 77 ± 15 | 83 ± 14 | 69 ± 13 | < 0.001 |
RVESV index, ml/m2 | 34 ± 10 | 38 ± 10 | 29 ± 8 | < 0.001 |
RVSV index, ml/m2 | 43 ± 8 | 45 ± 8 | 40 ± 6 | < 0.001 |
RV ejection fraction, % | 56 ± 7 | 55 ± 6 | 59 ± 6 | < 0.001 |
RVEDV/LVEDV ratio | 1.09 ± 0.13 | 1.11 ± 0.12 | 1.07 ± 0.13 | 0.018 |
LV flow componentsa | ||||
Direct flow, % | 34 (29, 38) | 33 (28, 37) | 34 (31, 40) | 0.132 |
Retained inflow, % | 15 (12, 18) | 14 (12, 17) | 16 (14, 19) | 0.041 |
Delayed ejection flow, % | 17 (14, 20) | 16 (13, 19) | 17 (15, 22) | 0.092 |
Residual volume, % | 33 (29, 37) | 35 (30, 39) | 31 (27, 34) | < 0.001 |
LV KEiEDV parametersa | ||||
Global KEiEDV, μJ/ml | 9.1 (7.5, 11.4) | 9.0 (7.5, 11.3) | 9.3 (7.6, 11.5) | 0.894 |
Peak systolic KEiEDV, μJ/ml | 18.3 (15.1, 22.9) | 20.1 (16.0, 24.3) | 16.6 (13.6, 20.4) | 0.002 |
Average systolic KEiEDV, μJ/ml | 10.2 (8.1, 12.6) | 10.8 (8.8, 13.4) | 9.2 (7.6, 11.3) | 0.002 |
Average diastolic KEiEDV, μJ/ml | 8.7 (6.8, 10.7) | 8.3 (6.3, 10.3) | 9.1 (7.3, 11.5) | 0.054 |
Peak E-wave KEiEDV, μJ/ml | 25.2 (19.0, 31.5) | 23.7 (17.8, 30.2) | 27.7 (22.7, 33.0) | 0.010 |
Peak A-wave KEiEDV, μJ/ml | 10.8 (6.8, 15.2) | 11.3 (7.1, 15.9) | 10.2 (6.8, 14.3) | 0.543 |
KEiEDV E/A ratio | 2.39 (1.40, 3.70) | 2.10 (1.25, 3.70) | 2.85 (1.65, 3.71) | 0.060 |
RV flow componentsa | ||||
Direct flow, % | 35 (31, 40) | 34 (30, 38) | 38 (32, 42) | 0.007 |
Retained inflow, % | 17 (14, 20) | 17 (14, 19) | 17 (14, 20) | 0.892 |
Delayed ejection flow, % | 16 (13, 19) | 15 (12, 18) | 17 (13, 20) | 0.043 |
Residual volume, % | 30 (26, 37) | 33 (28, 37) | 27 (24, 35) | 0.001 |
RV KEiEDV parametersa | ||||
Global KEiEDV, μJ/ml | 8.3 (6.8, 10.3) | 7.5 (6.3, 9.8) | 8.9 (7.6, 10.8) | 0.005 |
Peak systolic KEiEDV, μJ/ml | 21.3 (18.0, 27.4) | 21.3 (18.4, 28.7) | 21.2 (17.7, 27.2) | 0.718 |
Average systolic KEiEDV, μJ/ml | 12.0 (9.6, 14.3) | 11.9 (9.1, 14.3) | 12.4 (9.7, 14.4) | 0.744 |
Average diastolic KEiEDV, μJ/ml | 6.1 (4.8, 7.6) | 5.6 (4.3, 7.5) | 6.7 (5.7, 8.4) | < 0.001 |
Peak E-wave KEiEDV, μJ/ml | 12.9 (9.5, 16.3) | 11.9 (8.5, 14.9) | 14.4 (11.3, 17.9) | < 0.001 |
Peak A-wave KEiEDV, μJ/ml | 8.3 (5.7, 11.1) | 8.2 (5.9, 11.2) | 8.3 (5.2, 11.4) | 0.996 |
KEiEDV E/A ratio | 1.41 (0.97, 2.47) | 1.30 (0.93, 2.21) | 1.68 (1.15, 2.64) | 0.028 |
Reference values of LV and RV 4D flow parameters
Sex differences of LV and RV 4D flow parameters
Age differences of LV and RV 4D flow parameters
20–29 (n = 31) | 30–39 (n = 45) | 40–49 (n = 38) | 50–59 (n = 29) | 60–70 (n = 20) | P1 | |
---|---|---|---|---|---|---|
Gender, M/F | 18/13 | 25/20 | 23/15 | 14/15 | 15/5 | 0.447 |
LV ejection fraction, % | 61 ± 7 | 63 ± 7 | 64 ± 9 | 64 ± 8 | 63 ± 7 | 0.419 |
RV ejection fraction, % | 55 ± 6 | 55 ± 7 | 58 ± 8 | 58 ± 6 | 56 ± 5 | 0.164 |
LV flow componentsa | ||||||
Direct flow, % | 37 (33, 41) | 33 (29, 36)* | 33 (28, 39)* | 33 (28, 39)* | 33 (28, 37) | 0.110 |
Retained inflow, % | 14 (11, 17) | 16 (12, 19) | 16 (13, 17) | 16 (14, 19) | 16 (12, 19) | 0.294 |
Delayed ejection flow, % | 16 (13, 19) | 17 (14, 19) | 17 (14, 20) | 16 (13, 22) | 18 (16, 20) | 0.793 |
Residual volume, % | 33 (27, 37) | 33 (30, 37) | 33 (29, 38) | 33 (27, 39) | 32 (27, 38) | 0.951 |
LV KEiEDV parametersa | ||||||
Global KEiEDV, μJ/ml | 9.5 (7.7, 11.2) | 8.8 (7.0, 11.4) | 8.5 (7.9, 11.0) | 8.9 (7.1, 11.6) | 10.2 (7.3, 12.2) | 0.922 |
Peak systolic KEiEDV, μJ/ml | 17.8 (14.5, 22.9) | 18.5 (15.6, 25.4) | 17.0 (14.3, 23.0) | 18.0 (13.3, 22.0) | 18.6 (14.5, 22.8) | 0.951 |
Average systolic KEiEDV, μJ/ml | 10.0 (8.4, 12.6) | 10.1 (7.8, 13.3) | 10.0 (8.3, 12.3) | 9.8 (7.3, 12.6) | 10.7 (9.0, 14.4) | 0.815 |
Average diastolic KEiEDV, μJ/ml | 8.8 (7.3, 11.3) | 8.5 (6.4, 10.5) | 8.2 (6.9, 10.6) | 8.7 (6.2, 10.8) | 9.2 (6.8, 13.1) | 0.874 |
Peak E-wave KEiEDV, μJ/ml | 30.9 (23.8, 37.4) | 27.9 (23.9, 32.3) | 23.5 (19.0, 30.1) | 18.5 (14.5, 29.1)*$ | 20.1 (16.0, 24.3)*$ | < 0.001 |
Peak A-wave KEiEDV, μJ/ml | 9.0 (6.5, 11.4) | 8.0 (5.6, 13.4) | 10.6 (6.8, 15.3) | 13.4 (10.3, 18.6)*$ | 18.0 (12.9, 25.3)*$# | < 0.001 |
KEiEDV E/A ratio | 3.49 (2.81, 4.63) | 3.44 (2.26, 5.23) | 2.10 (1.53, 3.26)*$ | 1.43 (0.90, 2.27)*$# | 1.16 (0.81, 1.47)*$# | < 0.001 |
RV flow componentsa | ||||||
Direct flow, % | 34 (29, 39) | 35 (30, 40) | 36 (31, 41) | 37 (33, 40) | 37 (32, 40) | 0.504 |
Retained inflow, % | 16 (14, 18) | 17 (14, 18) | 16 (14, 19) | 17 (13, 22) | 18 (15, 22) | 0.625 |
Delayed ejection flow, % | 17 (13, 19) | 16 (13, 19) | 16 (12, 19) | 14 (11, 20) | 17 (11, 19) | 0.511 |
Residual volume, % | 29 (27, 38) | 33 (28, 37) | 30 (25, 35) | 30 (24, 38) | 26 (25, 36) | 0.322 |
RV KEiEDV parametersa | ||||||
Global KEiEDV, μJ/ml | 9.0 (7.0, 11.3) | 8.3 (6.9, 10.2) | 8.5 (7.3, 9.6) | 7.7 (6.6, 10.9) | 7.3 (5.6, 9.2) | 0.268 |
Peak systolic KEiEDV, μJ/ml | 23.1 (19.4, 30.9) | 21.3 (18.3, 27.3) | 21.7 (18.4, 28.0) | 20.5 (16.3, 26.1) | 19.3 (16.6, 27.0) | 0.305 |
Average systolic KEiEDV, μJ/ml | 12.7 (11.3, 16.9) | 11.9 (9.7, 13.9) | 12.3 (10.0, 14.4) | 11.7 (8.8, 13.4) | 11.0 (8.5, 12.3) | 0.181 |
Average diastolic KEiEDV, μJ/ml | 6.6 (5.2, 8.6) | 6.0 (4.9, 7.7) | 6.1 (5.3, 7.5) | 6.2 (4.6, 8.3) | 5.1 (3.9, 8.0) | 0.467 |
Peak E-wave KEiEDV, μJ/ml | 14.8 (11.6, 21.0) | 13.8 (12.1, 16.5) | 12.7 (9.7, 16.0) | 11.3 (8.0, 14.6) | 9.3 (7.0, 12.7)*$# | 0.001 |
Peak A-wave KEiEDV, μJ/ml | 6.9 (4.8, 8.7) | 7.2 (4.5, 9.4) | 8.7 (7.0, 11.2) | 10.3 (8.1, 14.8)*$ | 9.7 (7.8, 12.7)* | < 0.001 |
KEiEDV E/A ratio | 1.95 (1.59, 3.05) | 2.13 (1.36, 3.02) | 1.32 (1.06, 2.15)* | 0.94 (0.73, 1.35)*$# | 1.03 (0.68, 1.25)*$# | < 0.001 |
Association of function and 4D flow parameters with age
Left ventricle | Right ventricle | |||
---|---|---|---|---|
Correlation coefficient | P value | Correlation coefficient | P value | |
Function | ||||
End-diastolic volume index | − 0.270 | 0.001 | − 0.275 | < 0.001 |
End-systolic volume index | − 0.227 | 0.004 | − 0.251 | < 0.001 |
Stroke volume index | − 0.200 | 0.011 | − 0.216 | 0.006 |
Ejection fraction | 0.099 | 0.210 | 0.132 | 0.094 |
4D flow components | ||||
Direct flow | − 0.117 | 0.139 | 0.131 | 0.094 |
Retained inflow | 0.064 | 0.415 | 0.109 | 0.165 |
Delayed ejection flow | 0.080 | 0.310 | − 0.153 | 0.051 |
Residual volume | 0.014 | 0.862 | − 0.118 | 0.134 |
4D KEiEDV parameters | ||||
Global KEiEDV | 0.062 | 0.435 | − 0.095 | 0.228 |
Peak systolic KEiEDV | 0.036 | 0.649 | − 0.167 | 0.033 |
Average systolic KEiEDV | 0.106 | 0.176 | − 0.158 | 0.044 |
Average diastolic KEiEDV | 0.022 | 0.785 | − 0.042 | 0.592 |
Peak E-wave KEiEDV | − 0.355 | < 0.001 | − 0.318 | < 0.001 |
Peak A-wave KEiEDV | 0.458 | < 0.001 | 0.341 | < 0.001 |
KEiEDV E/A ratio | − 0.475 | < 0.001 | − 0.504 | < 0.001 |