4D Flow Assessment of Vorticity in Right Ventricular Diastolic Dysfunction

Diastolic dysfunction, a leading cause of heart failure in the US, is a complex pathology which manifests morphological and hemodynamic changes in the heart and circulatory system. Recent advances in time-resolved phase-contrast cardiac magnetic resonance imaging (4D Flow) have allowed for characterization of blood flow in the right ventricle (RV) and right atrium (RA), including calculation of vorticity and qualitative visual assessment of coherent flow patterns. We hypothesize that right ventricular diastolic dysfunction (RVDD) is associated with changes in vorticity and right heart blood flow. This paper presents background on RVDD, and 4D Flow tools and techniques used for quantitative and qualitative analysis of cardiac flows in the normal and disease states. In this study, 20 patients with RVDD and 14 controls underwent cardiac 4D Flow and echocardiography. A method for determining the time-step for peak early diastole using 4D Flow data is described. Spatially integrated early diastolic vorticity was extracted from the RV, RA, and combined RV/RA regions of each subject using a range of vorticity thresholding and scaling methods. Statistically significant differences in vorticity were found in the RA and combined RA/RV in RVDD subjects compared to controls when vorticity vectors were both thresholded and scaled by cardiac index.