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Four-dimensional flow magnetic resonance imaging in evaluating ventricular hemodynamic characteristics of ventricular premature contractions in children and its predictive value for load degree
FENG Kai  YANG Linlin  DANG Yuxue  XIN Yang  ZHONG Qingjun  WANG Ying  HOU Yang  MA Yue 

DOI:10.12015/issn.1674-8034.2025.11.006.


[Abstract] Objective Four-dimensional flow cardiac magnetic resonance imaging (4D Flow CMR) was used to analyze the left ventricular blood flow and kinetic energy characteristics in children with premature ventricular complexes (PVCs). This study aimed to evaluate the relationship between left ventricular hemodynamic changes, left ventricular function, and PVCs burden, as well as to explore the predictive value of 4D Flow indices for the degree of premature ventricular complex burden in children with PVCs.Materials and Methods Children with PVCs who underwent 4D Flow CMR scanning at Shengjing Hospital Affiliated to China Medical University from January 2024 to January 2025 were enrolled. The case group was divided into two subgroups based on the degree of premature ventricular complex burden detected by 24-hour Holter monitoring: the low-burden group (PVCs-M group, premature ventricular complex burden ≤1‰) and the high-burden group (PVCs-S group, premature ventricular complex burden >1‰). Additionally, children without cardiopulmonary diseases who underwent CMR examination were included as the control group. All children underwent CMR scanning after 24-hour Holter monitoring. The balanced steady-state free precession (bSSFP) sequence was used to acquire cardiac cine sequences, and functional parameters such as left/right ventricular stroke volume index (L/RVSVi) and left ventricular ejection fraction (LVEF) were measured. A three-dimensional retrospective ECG-triggered navigator-gated 4D Flow sequence was employed for whole-heart blood flow scanning, and left ventricular blood flow components and kinetic energy (KE) were determined using post-processing software. Differences in routine CMR indicators and hemodynamic indicators were compared between the case group and the control group, as well as between the subgroups within the case group. Binary logistic regression was used to screen and identify predictive indicators for evaluating the burden degree, and receiver operating characteristic curve analysis was applied to assess the predictive efficacy of various CMR indicators.Results A total of 49 subjects were enrolled in this study, including 14 in the control group and 35 in the case group. The case group was further divided into the PVCs-M group (16 subjects) and the PVCs-S group (19 subjects). There were no statistically significant differences in age, gender, or heart rate between the control group and the case group. In terms of conventional CMR indicators, no statistically significant differences were observed between the case group and the control group. However, within the case group, the RVEDVi of the PVCs-S group was lower than that of the PVCs-M group [(77.82 ± 17.73) mL/m2 vs. (65.97 ± 13.23) mL/m2, P = 0.030]. For 4D Flow indicators, the direct flow in the case group was lower than that in the control group (31.70% ± 11.69% vs. 38.49% ± 6.13%, P = 0.045), while the time deviation was increased [25.80 (0,34.40) ms vs. 0 (0,0) ms, P = 0.001]. Meanwhile, compared with the PVCs-M group, the PVCs-S group showed an increase in residual volume [20.31% (19.08%, 30.20%) vs. 16.65% (13.71%, 23.21%), P = 0.016], and decreases in direct flow and systolic KEiEDV [28.16% ± 8.60% vs. 35.90% ± 13.66%, P = 0.049; 5.59 (4.47,6.41) μJ/mL vs. 7.76 (7.09,8.33) μJ/mL, P = 0.003]. Binary multivariate Logistic regression analysis was performed on the indicators with P < 0.05 between subgroups in the case group. The results showed that RVEDVi, residual volume, and systolic KEiEDV were independently associated with the burden of premature ventricular contractions (PVCs) in children. A combined prediction model for PVC burden was constructed using these indicators individually and in combination. The combined prediction model was found to have higher predictive power than individual indicators (AUC = 0.924, P < 0.001).Conclusions 4D Flow CMR can measure abnormal changes in left ventricular blood flow components and kinetic energy characteristics in children with PVCs under free breathing, and these changes are closely related to left cardiac function. Among 4D Flow CMR indicators, systolic KEiEDV, RVEDVi, and residual volume are independently associated with the burden of premature ventricular contractions (PVCs) in children. The prediction model using the three indicators in combination has high predictive value for PVC burden, and is expected to be used for clinical risk stratification and prognosis prediction in children with PVCs.
[Keywords] premature ventricular complexes；children；cardiac magnetic resonance imaging；4D Flow；hemodynamics

FENG Kai1   YANG Linlin2   DANG Yuxue1   XIN Yang3   ZHONG Qingjun1   WANG Ying1   HOU Yang1   MA Yue1*  

1 Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China

2 Imaging Center, Guangdong Second Provincial General Hospital, Guangzhou 510317, China

3 Department of Radiology, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen 518035, China

Corresponding author: MA Y, E-mail: mmaayyuueezzz@163.com

Conflicts of interest   None.

Received  2025-08-27
Accepted  2025-10-29
DOI: 10.12015/issn.1674-8034.2025.11.006
DOI:10.12015/issn.1674-8034.2025.11.006.

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