Impact of age, sex and ethnicity on intra-cardiac flow components and left ventricular kinetic energy derived from 4D flow CMR

Xiaodan Zhao, Ru-San Tan, Pankaj Garg, Ping Chai, Shuang Leng, Jennifer Bryant, Lynette L. S. Teo, Ching Ching Ong, Rob J. van der Geest, John C. Allen, James W. Yip, Ju Le Tan, Sven Plein, Jos J. W. Westenberg, Liang Zhong

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10 Citations (Scopus)


Background: Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) allows quantification of left ventricular (LV) blood flow. We aimed to 1) establish reference ranges for 4D flow CMR-derived LV relative flow components and kinetic energy parameters indexed to end-diastolic volume (KEi EDV) among healthy Asian subjects, 2) assess effects of age and sex on these parameters, and 3) compare these parameters between Asian and Caucasian subjects. Methods: 74 healthy Asian subjects underwent cine and 4D flow CMR. Relative flow components (direct flow, retained inflow, delayed ejection flow, residual volume) and multiple phasic KEi EDV (LV global, peak systolic, systolic, diastolic, peak E-wave, peak A-wave) were analyzed. Sex- and age-specific reference ranges were reported. Results: Relative flow components and systolic phase KEi EDV did not vary with age. Women had higher retained inflow and peak E-wave KEi EDV, lower residual volume, peak systolic and systolic KEi EDV than men. Peak A-wave KEi EDV increased significantly (r = 0.474) whereas peak E-wave KEi EDV (r = −0.458) and E-wave/A-wave ratio (r = −0.528) decreased with age. A sub-population (n = 44) was compared with 44 sex- and age-matched Caucasian subjects: no significant group differences were observed for all 4D flow CMR parameters. Conclusion: Asian sex- and age-specific 4D flow CMR reference ranges were established. Sex differences in retained inflow, residual volume, peak systolic, systolic KEi EDV and peak E-wave KEi EDV were observed. Ageing influenced diastolic KEi EDV but not systolic phase KEi EDV or relative flow components. All studied parameters were similar between sex- and age-matched Asian and Caucasian subjects, implying generalizability of the ranges.

Original languageEnglish
Pages (from-to)105-112
Number of pages8
JournalInternational Journal of Cardiology
Early online date25 May 2021
Publication statusPublished - 1 Aug 2021


  • 4D flow
  • Flow components
  • Hemodynamics
  • Kinetic energy
  • Normal ranges

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