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Background Atrial fibrillation (AF) is associated with increased risk of stroke due to development of left atrial (LA) thrombus [1]. Studies utilizing transesophageal echocardiography (TEE) have shown that decreased peak emptying flow velocity in the LA appendage (LAA) in patients with AF is a risk factor for stroke [2,3]. As a non-invasive alternative, 4D flow MRI can measure 3D blood flow velocities with full coverage of the LA [4]. However, 4D flow data are acquired over multiple heart beats and beat-to-beat flow variations in AF patients with cardiac arrhythmia cannot be captured. A recent simulation study showed that ECG gated multi-beat flow MRI in patients with cardiac arrhythmia could reproduce persistent average LA and left ventricular mean velocities within 7.0-7.4% compared to real time TEE [5]. These findings suggest that 4D flow MRI can reliably assess persistent atrial flow and stasis patterns that are consistently present over multiple heart beats. However, a systematic comparison of LA flow dynamics based 4D flow MRI and real time TEE (reference standard) in-vivo is lacking. Our aim was thus to test the hypothesis that 4D flow MRI derived metrics of LA flow (velocities, stasis) are associated with LAA peak velocities obtained by TEE in the same patient.

LA velocities and stasis assessed by 4D flow MRI are closely associated with LAA peak velocities by Doppler TEE in patients with atrial fibrillation