Vortex ring formation in the left ventricle of the heart: analysis by 4D flow MRI and Lagrangian coherent structures

Recent studies suggest that vortex ring formation during left ventricular (LV) rapid filling is an optimized mechanism for blood transport, and that the volume of the vortex ring is an important measure. However, due to lack of quantitative methods, the volume of the vortex ring has not previously been studied. Lagrangian Coherent Structures (LCS) is a new flow analysis method, which enables in vivo quantification of vortex ring volume. Therefore, we aimed to investigate if vortex ring volume in the human LV can be reliably quantified using LCS and magnetic resonance velocity mapping (4D PC-MR). Flow velocities were measured using 4D PC-MR in 9 healthy volunteers and 4 patients with dilated ischemic cardiomyopathy. LV LCS were computed from flow velocities and manually delineated in all subjects. Vortex volume in the healthy volunteers was 51 ± 6% of the LV volume, and 21 ± 5% in the patients. Interobserver variability was -1 ± 13% and interstudy variability was -2 ± 12%. Compared to idealized flow experiments, the vortex rings showed additional complexity and asymmetry, related to endocardial trabeculation and papillary muscles. In conclusion, LCS and 4D PC-MR enables measurement of vortex ring volume during rapid filling of the LV.