What question did this study set out to answer?

This research aims to explore the relationship between hemodynamic metrics from 4D flow CMR and markers of cardiac stress in aortic stenosis patients.

March 16, 2026Open Access

Aortic 4D Flow CMR for the Assessment of Hemodynamics in Aortic Stenosis – Association with Markers of Cardiac Decompensation and Remodeling

Key Result

Peak turbulent kinetic energy and peak systolic velocity derived from 4D flow CMR are significantly associated with indexed LV mass and NT-proBNP in aortic stenosis patients.

Key Points

This research aims to explore the relationship between hemodynamic metrics from 4D flow CMR and markers of cardiac stress in aortic stenosis patients.
Conducted 4D flow CMR on 59 patients with aortic stenosis.
Employed Bayesian multipoint phase-contrast sequence with k-t PCA acceleration.
Analyzed associations between hemodynamic parameters and NT-proBNP, indexed LV mass.
Peak TKE and peak systolic velocity showed significant association with indexed LV mass and NT-proBNP.
Normalized TKE sys was also linked to both markers of cardiac stress.
Mean helicity correlated only with indexed LV mass; other parameters had no significant relationships.

Structured PICO

Do 4D flow CMR-derived hemodynamic metrics associate with markers of LV decompensation and remodeling in patients with aortic stenosis?

Population

59 patients with aortic stenosis (AS), mean age 70 ± 14 years.

Intervention

4D flow cardiovascular magnetic resonance (CMR) using a Bayesian multipoint phase-contrast sequence to quantify hemodynamic metrics (peak TKE, Normalized TKE sys, peak velocity, jet angle, relative flow displacement, mean helicity)

Outcome

Association of 4D flow CMR-derived hemodynamic metrics with NT-proBNP and indexed LV masssurrogate

Flow energetics derived from 4D flow CMR, particularly turbulent kinetic energy and peak systolic velocity, capture the hemodynamic burden on the left ventricle in aortic stenosis better than isolated flow geometry descriptors.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Aortic stenosis (AS) induces complex alterations in ascending aortic flow, including increased turbulent kinetic energy (TKE), altered velocity profiles, and changes in flow organization, which can be quantified using 4D flow cardiovascular magnetic resonance (CMR). The physiological relevance of these flow-derived parameters with respect to left ventricular (LV) adaptation remains incompletely understood. We investigated the associations between 4D flow CMR–derived hemodynamic metrics and established markers of LV decompensation and remodeling in patients with AS. Fifty-nine patients with AS (70 ± 14 yrs.) underwent 4D flow CMR using a Bayesian multipoint phase-contrast sequence with k-t PCA acceleration and three velocity-encoding steps in each direction. Quantified parameters included peak TKE, stroke volume–normalized systolic TKE (Normalized TKE sys ), peak velocity, jet angle, relative flow displacement, and mean helicity. Associations with NT-proBNP and indexed LV mass were analyzed. Peak TKE, Normalized TKE sys , and peak systolic velocity were significantly associated with both indexed LV mass and NT-proBNP, whereas mean helicity was associated with indexed LV mass only. In contrast, jet angle and flow displacement showed no relationship with either marker of LV decompensation and remodeling. During long-term follow-up, no 4D flow CMR parameter was associated with adverse clinical events, likely due to timely valve replacement in most patients. In conclusion, these findings indicate that flow energetics - particularly TKE and peak systolic velocity - most closely capture the hemodynamic burden imposed on the LV supporting their physiological relevance in AS. Isolated descriptors of flow geometry, in contrast, have not shown to reflect maladaptive LV remodeling.