title: Vortex-ring mixing as a measure of diastolic function of the human heart: Phantom validation and initial observations in healthy volunteers and patients with heart failure.
abstract: To present and validate a new method for 4D flow quantification of vortex-ring mixing during early, rapid filling of the left ventricle (LV) as a potential index of diastolic dysfunction and heart failure.
  
  
  
  4D flow mixing measurements were validated using planar laser-induced fluorescence (PLIF) in a phantom setup. Controls (n = 23) and heart failure patients (n = 23) were studied using 4D flow at 1.5T (26 subjects) or 3T (20 subjects) to determine vortex volume (VV) and inflowing volume (VVinflow ). The volume mixed into the vortex-ring was quantified as VVmix-in = VV-VVinflow . The mixing ratio was defined as MXR = VVmix-in /VV. Furthermore, we quantified the fraction of the end-systolic volume (ESV) mixed into the vortex-ring (VVmix-in /ESV) and the fraction of the LV volume at diastasis (DV) occupied by the vortex-ring (VV/DV).
  
  
  
  PLIF validation of MXR showed fair agreement (R(2) = 0.45, mean ± SD 1 ± 6%). MXR was higher in patients compared to controls (28 ± 11% vs. 16 ± 10%, P < 0.001), while VVmix-in /ESV and VV/DV were lower in patients (10 ± 6% vs. 18 ± 12%, P < 0.01 and 25 ± 8% vs. 50 ± 6%, P < 0.0001).
  
  
  
  Vortex-ring mixing can be quantified using 4D flow. The differences in mixing parameters observed between controls and patients motivate further investigation as indices of diastolic dysfunction. J. Magn. Reson. Imaging 2016;43:1386-1397.
authors.affiliation: Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.|Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden.
authors.forename: Johannes
authors.initials: J
authors.lastname: Töger
authors.affiliation: Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Kanski
authors.affiliation: Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.
authors.forename: Per M
authors.initials: PM
authors.lastname: Arvidsson
authors.affiliation: Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Carlsson
authors.affiliation: Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Sándor J
authors.initials: SJ
authors.lastname: Kovács
authors.affiliation: Department of Arrhythmias, Lund University Hospital, Lund, Lund University, Lund, Sweden.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Borgquist
authors.affiliation: Department of Energy Sciences, Faculty of Engineering, Lund University, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Revstedt
authors.affiliation: Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden.
authors.forename: Gustaf
authors.initials: G
authors.lastname: Söderlind
authors.affiliation: Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Arheden
authors.affiliation: Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.|Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden.|Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.
authors.forename: Einar
authors.initials: E
authors.lastname: Heiberg
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000295:instrumentation / Q000379:methods*; D008297:Male; D019047:Phantoms, Imaging; D010865:Pilot Projects; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: 4D flow; diastolic dysfunction; heart failure; planar laser-induced fluorescence; validation