Dynamic vortical flow profile quantitatively characterizes mitral valvular-left ventricular hemodynamic coupling: In vivo analysis by dynamic 3D enstrophy mapping from 4D Flow MRI

Vortical blood flow in the human left ventricular (LV) inflow initiates from the mitral valve (MV) and evolves within the LV during diastolic E-filling. Hence, vortical flow links MV and LV hemodynamics. This study sought to elucidate and quantitatively characterize the in vivo 3D dynamics of LV vortical flow over E-filling and relation to MV-LV hemodynamic coupling using 4D Flow MRI flow field. 34 healthy volunteers and 5 example patients underwent 4D Flow MRI. Vortical blood flow evolution was mapped in the LV over E-wave using enstrophy density. A new dimensionless profile PMV-LV was derived as a function of both MV vortex formation time (VFT) and LV volumetric enstrophy density. Results reveal that 3D vortical flow evolution in the healthy LV follows a bi-phasic behavior with a vortical growth phase followed by a vortical decay phase. In healthy LVs studied, the PMV-LV profile showed that the vortical growth and decay phases are characterized by a vortical growth time T_growth= 1.23+/-0.25, growth rate {\alpha}=0.80+/-0.17, decay time T_decay= 0.96+/-0.39 and decay rate \b{eta}=-1.02+/-0.49. Distinctly altered parameters were found in the pilot patients studied. The derived PMV-LV profile quantitatively characterizes MV-LV hemodynamic coupling by vortical flow dynamics. Results herein unravel new insights into cardiac physiology and could enable a novel standardized methodology to study MV-LV hemodynamic coupling and association to cardiac function in health and disease.