RV work efficiency is greatly reduced in patients with pulmonary arterial hypertension as evidenced by 4D flow cardiac MRI

Background The dynamic assessment of intracardiac flow remained challenging until the recent development of timeresolved 3D phase-contrast CMR (PC-CMR), which allows for assessment of multi-dimensional whole heart and great vessel flow. Previous studies have used this technique in the ventricles to quantify flow type of the ventricle and the kinetic energy of each flow component. In the great vessels, parameters such as total flow, peak systolic velocity, and wall shear stress have excellent scan-rescan, inter-observer, and intra-observer reproducibility. In disease conditions, pathological vortices have been reported both in the ventricles and great vessels. We propose to use time-resolved 3D PC-CMR to study right ventricular (RV) work in patients with pulmonary arterial hypertension (PAH) as compared to normal subjects.