Using 5D flow MRI to decode the effects of rhythm on left atrial 3D flow dynamics in patients with atrial fibrillation

Liliana Ma*, Jérôme Yerly, Lorenzo Di Sopra, Davide Piccini, Jeesoo Lee, Amanda DiCarlo, Rod Passman, Philip Greenland, Daniel Kim, Matthias Stuber, Michael Markl

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose: This study used a 5D flow framework to explore the influence of arrhythmia on thrombogenic hemodynamic parameters in patients with atrial fibrillation (AF). Methods: A fully self-gated, 3D radial, highly accelerated free-running 5D flow sequence with interleaved four-point velocity-encoding was acquired using an in vitro arrhythmic flow phantom and in 25 patients with a history of AF (68 ± 8 y, 6 female). Self-gating signals were used to calculate AF burden, bin data, and tag each k-space line with its RRLength. Data were binned as an RR-resolved dataset with four RR-interval bins (RR1-RR4, short-to-long) for compressed sensing reconstruction. AF burden was calculated as interquartile range of all intrascan RR-intervals divided by median RR-interval, and left atrial (LA) stasis as the percent of the cardiac cycle where the velocity was <0.1 m/s. Results: In vitro results demonstrated successful recovery of RR-binned flow curves using RR-resolved 5D flow compared to a real-time PC reference standard. In vivo, 5D flow was acquired in 8:48 minutes. AF burden was significantly correlated with 5D flow-derived peak (PV) and mean (MV) velocity and stasis (|ρ| = 0.54-0.75, P <.001). Sensitivity analyses determined a threshold for low versus high AF burden at 9.7%. High burden patients had increased LA mean stasis (up to +42%, P <.01), and lower MV and PV (−30%, −40.6%, respectively, P <.01). RR4 deviated furthest from respiratory-resolved reconstruction (end-expiration) with increased mean stasis (7.6% ± 14.0%, P =.10) and decreased PV (−12.7 ± 14.2%, P =.09). Conclusions: RR-resolved 5D flow can capture temporal and RR-resolved 3D hemodynamics in <10 minutes and offers a novel approach to investigate arrhythmias.

Original languageEnglish (US)
Pages (from-to)3125-3139
Number of pages15
JournalMagnetic resonance in medicine
Issue number6
StatePublished - Jun 2021


  • 4D flow
  • atrial fibrillation
  • cardiovascular
  • compressed sensing
  • self-gating

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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