Abstract
BackgroundFour-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology used to visualise and quantify intra-cardiac blood flow. The aim of this systematic review is to assess the literature on the current clinical applications of intra-cardiac 4D flow CMR. MethodsA systematic review was conducted to evaluate the literature on the intra-cardiac clinical applications of 4D flow CMR. Structured searches were carried out on Medline, EMBASE and the Cochrane Library in October 2016. A modified Critical Skills Appraisal Programme (CASP) tool was used to objectively assess and score the included studies. Studies were categorised as ‘highly clinically applicable’ for scores of 67–100%, ‘potentially clinically applicable’ for 34–66% and ‘less clinically applicable’ for 0–33%. ResultsOf the 1608 articles screened, 44 studies met eligibility for systematic review. The included literature consisted of 22 (50%) mechanistic studies, 18 (40.9%) pilot studies and 4 (9.1%) diagnostic studies. Based on the modified CASP tool, 27 (62%) studies were ‘highly clinically applicable’, 9 (20%) were ‘potentially clinically applicable’ and 8 (18%) were ‘less clinically applicable’. ConclusionsThere are many proposed methods for using 4D flow CMR to quantify intra-cardiac flow. The evidence base is mainly mechanistic, featuring single-centred designs. Larger, multi-centre studies are required to validate the proposed techniques and investigate the clinical advantages that 4D flow CMR offers over standard practices.PROSPERO=CRD42016051438.
Highlights
Cardiovascular disease is the leading cause of mortality worldwide, with an estimated 17.7 million deaths in 2015 alone [1]
Clinical applicability has been divided into the following groups based on the score achieved using the modified Critical Skills Appraisal Programme (CASP) tool: ‘highly’ for 67–100%, ‘potentially’ for 34–67% and ‘less’ for 0–33%
Studies that are relevant to more than one intra-cardiac structure are denoted by an asterisk (*)
Summary
Cardiovascular disease is the leading cause of mortality worldwide, with an estimated 17.7 million deaths in 2015 alone [1]. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is a technique that enables comprehensive haemodynamic flow assessments. The aim of this systematic review is to methodically summarise new mechanistic intra-cardiac findings, along with information regarding the potential clinical applications of these 4D flow CMR techniques. Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is an emerging noninvasive imaging technology used to visualise and quantify intra-cardiac blood flow. The aim of this systematic review is to assess the literature on the current clinical applications of intra-cardiac 4D flow CMR. Methods: A systematic review was conducted to evaluate the literature on the intra-cardiac clinical applications of 4D flow CMR. Multi-centre studies are required to validate the proposed techniques and investigate the clinical advantages that 4D flow CMR offers over standard practices.
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