TABLE 2.

Four-dimensional flow CMR studies assessing left ventricular diastolic function using other novel 4D global flow parameters.

Reference	N	Disease/topic	4D diastolic parameters	Comparison vs. conventional diastolic parameters	Relevant findings
Healthy controls
Casas et al. (54)	9 controls	Dobutamine stress	Contraction rate constant, relaxation constant, elastance diastolic time constant	−	Stress resulted in differences in load-independent parameters: contraction rate constant, relaxation constant and elastance diastolic time constant.
Eriksson et al. (44)	12 controls	Relative Pressure	Relative pressure	−	Relative pressure was heterogeneous in the LV, with the main pressure difference along the basal-apical axis.
Cardiovascular disease
Arvidsson et al. (51)	39 HF patients with LBBB 31 controls	HF (mixed etiology) Dyssynchrony	Hemodynamic force, diastolic transverse and longitudinal force ratios	−	Patients with dyssynchrony exhibited increased transverse forces. Diastolic force ratio was able to separate controls from patients.
Elbaz et al. (41)	32 corrected AVSD patients 30 controls	Energy loss	Mean and peak E and A wave EL*, mean and peak E and A wave diastolic KE*	CMR derived E, A velocities and E/A ratio. Direct comparison showed moderate correlation between E/A ratio and Energy Loss E/A ratio	Abnormal diastolic vortex formation was associated with increased viscous energy loss.
Eriksson et al. (50)	18 HF patients	HF (mixed etiology) Dyssynchrony	Hemodynamic force, Sax/Lax-max force ratio	−	LV filling forces more orthogonal to the main LV flow direction in LBBB during early diastole. The greater the conduction abnormality the greater the discordance of LV filling force with predominant LV flow direction.
Eriksson et al. (55)	10 DCM patients 10 controls	HF (DCM)	Hemodynamic force, SAx/LAx force ratio	−	SAx/LAx ratio significantly larger in DCM patients compared to healthy subjects. DCM patients had forces that were more heterogeneous in their direction and magnitude during diastole.
Zajac et al. (42)	9 DCM patients 11 controls	HF (DCM)	LV diastolic TKE, LV peak E and A wave TKE	Echocardiography derived E, A velocities. Direct comparison showed correlation with peak late (A) velocity.	Late diastolic turbulent kinetic energy (TKE) was higher in DCM patients with diastolic dysfunction compared to control.

AVSD, atrioventricular septal defect; DCM, dilated cardiomyopathy; EL, energy loss; HF, heart failure; KE, kinetic energy; LBBB, left bundle branch block; LV, left ventricle; SAx, short axis; LAx, long axis; TKE, turbulent kinetic energy. *Indexed to LVEDV/SV.