The effects of aging on left ventricular diastolic function evaluated with 4D flow MRI: a novel approach using mitral velocity and propagation velocity measurements

Objective.Assessing diastolic function (DF) using 4D-flow MRI may offer valuable physiological insights during left ventricular (LV) filling. We aimed to test DF parameters typically obtained with transthoracic echocardiography (TTE) but derived from 4D-flow MRI, including inflow velocity, flow filling rate, and propagation velocity (VP), by characterizing LV diastolic filling associated with aging.Approach.Sixty healthy volunteers (34 women, 26 men; mean age, 52 ± 18 years; range: 20-80 years) underwent cardiac 4D-flow MRI and TTE as part of cardiac aging studies. Early (E) and atrial (A) mitral inflow peak velocities were obtained at the leaflet tips with and without normal projection (EandALT_PROJ,EandALT_NON-PROJ). Peak early and atrial filling rates (PEFR, PAFR) were derived from flow curves.VPwas calculated mimicking TTE approach (VP_SLOPE) and by taking the slope of a plane fitting the velocity curves on a 3D streamline within the LV (VP_PLANE). Associations between age, velocity-derived indices related to DF and LV geometry were assessed.Main results.All 4D-flow velocity parameters were associated with age (p< 0.001).E/ALT_NON-PROJandE/ALT_PROJratios correlated with TTE (r= 0.69 andr= 0.67 respectively,p< 0.001). PEFR showed a stronger inverse association with age (r= -0.75,p< 0.001) than TTE peak velocities (r= -0.19,p= 0.149).VP_PLANEcorrelated better with age (r= -0.47,p< 0.001) thanVP_SLOPE(r= -0.26,p< 0.05) and with indicators of DF such asE/E'TTE, PEFR/PAFR ratio and PEFR normalized to filling volume.Significance.Indices derived from 4D-flow MRI were sensitive to age-related variations in LV filling dynamics, indicating potential for validation in pathological cohorts with confirmed diastolic dysfunction.