Validation of time-resolved, automated peak trans-mitral velocity tracking: Two center four-dimensional flow cardiovascular magnetic resonance study

Paul Njoku, Ciaran Grafton-Clarke, Hosamadin Assadi, Rebecca C. Gosling, Gareth T. Archer, Andrew J. Swift, Paul Morris, Abdulaziz Albaraikan, Gareth Williams, Jos J. M. Westenberg, Jean-Paul Aben, Leon Ledoux, Samer Alabed, Marcus Flather, Donnie Cameron, Jordi Broncano Cabrero, Javier Royuela Del Val, Sunil Nair, Alisdair Ryding, Chris SawhPeter P. Swoboda, Eylem Levelt, Amrit Chowdhary, Vassilios Vassiliou, Liang Zhong, Pankaj Garg

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Objective: We aim to validate four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) peak velocity tracking methods for measuring the peak velocity of mitral inflow against Doppler echocardiography. 

Method: Fifty patients were recruited who had 4D flow CMR and Doppler Echocardiography. After transvalvular flow segmentation using established valve tracking methods, peak velocity was automatically derived using three-dimensional streamlines of transvalvular flow. In addition, a static planar method was used at the tip of mitral valve to mimic Doppler technique. 

Results: Peak E-wave mitral inflow velocity was comparable between TTE and the novel 4D flow automated dynamic method (1.02±0.41 m/s vs 1.02±0.36 m/s; P=0.77) however there was a statistically significant difference when compared with the static planar method (0.93±0.37 m/s; P=0.04). Mean A-wave peak velocity was also comparable across TTE and the automated dynamic streamline (0.87±0.39 m/s vs 0.87±0.36 m/s; P=0.99). A significant difference was seen with the static planar method (0.78±0.36 m/s; P=0.04). E/A ratio was comparable between TTE and both the automated dynamic and static planar method (1.22±0.52 vs 1.20±0.34; p=0.76 and 1.36±0.81; p=0.25 respectively). Both novel 4D flow methods showed good correlation with TTE for E-wave (dynamic method; r=0.70; P<0.001 and static planar method; r=0.67; P<0.001) and A-wave velocity measurements (dynamic method; r=0.83; P<0.001 and static method; r=0.71; P<0.001). The automated dynamic method demonstrated excellent intra/inter-observer reproducibility for all parameters. 

Conclusion: Automated dynamic peak velocity tracing method using 4D flow CMR is comparable to Doppler echocardiography for mitral inflow assessment and has excellent reproducibility for clinical use.
Original languageEnglish
Pages (from-to)148-156
Number of pages9
JournalInternational Journal of Cardiology
Early online date15 Jun 2022
Publication statusPublished - 1 Oct 2022


  • 4D flow CMR
  • Mitral valve
  • Peak velocity quantification
  • Validation

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