Abstract
BackgroundTo assess age-related changes of blood flow and geometry of the caval veins and right atrium (RA) using 4D flow cardiovascular magnetic resonance (CMR) data obtained in a population-based study.MethodsAn age-stratified sample (n = 126) of the population of the city of Freiburg, Germany, underwent transthoracic echocardiography and electrocardiogram-triggered and navigator-gated 4D flow CMR at 3 Tesla covering the caval veins and right heart. Study participants were divided into three age groups (1:20–39; 2:40–59; and 3:60–80 years of age). Analysis planes were placed in the superior and inferior caval vein. Subsequently, RA morphology and three-dimensional blood inflow pattern was assessed.ResultsBlood flow of the RA showed a clockwise rotating helix without signs of turbulence in younger subjects. By contrast, such rotation was absent in 12 subjects of group 3 and turbulences were significantly more frequent (p < 0.001). We observed an age-related shift of the caval vein axis. While the outlets of the superior and inferior caval veins were facing each other in group 1, lateralization occurred in older subjects (p < 0.001). A convergence of axes was observed from lateral view with facing axes in older subjects (p = 0.004). Finally, mean and peak systolic blood flow in the caval veins decreased with age (group 3 < 2 < 1).ConclusionsWe have provided reference values of 4D CMR blood flow for different age groups and demonstrated the significant impact of age on hemodynamics of the RA inflow tract. This effect of aging should be taken into account when assessing pathologic conditions of the heart in the future.
Highlights
To assess age-related changes of blood flow and geometry of the caval veins and right atrium (RA) using 4D flow cardiovascular magnetic resonance (CMR) data obtained in a population-based study
Application of flow-sensitive 3D phase-contrast CMR (4D flow CMR) allows in-vivo visualization of blood flow from the caval veins through the right atrium (RA) into the right ventricular (RV) [9]. 4D flow CMR was already used to highlight the role of vortex formation in healthy individuals as a driving force of RA filling [10]
In conclusion, we have shown that 4D flow CMR can be used to visualize and assess flow in the caval veins and in the RA inflow tract
Summary
To assess age-related changes of blood flow and geometry of the caval veins and right atrium (RA) using 4D flow cardiovascular magnetic resonance (CMR) data obtained in a population-based study. While 3D-TTE can overcome some of these restraints, its applicability is often limited by suboptimal acoustic windows This limitation can be overcome by using 3D imaging techniques such as 3D cardiovascular magnetic resonance (CMR) which can improve assessment of morphological features [8]. Despite its inherent potential to comprehensively assess right heart filling and associated pathologic conditions, most applications of cardiac 4D flow CMR, have focused on the left heart [12, 13] or the pulmonary arteries [11, 14]
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