Use of 4D Flow MRI to Indirectly Predict Cardiac Adverse Events Through Hemodynamic Alterations Induced by Exercise

Motivation: Cardiovascular-related deaths are increasing in athletes, which necessitates a deeper understanding of hemodynamics. Goal(s): Our goal was to use 4D flow MRI to assess athletes' cardiac and aortic hemodynamics and their links to myocardial fibrosis and cardiac remodeling risks. Approach: Cardiac MRI was performed on 213 athletes and 32 matched controls. Hemodynamic parameters were measured and analyzed against myocardial fibrosis and cardiac remodeling risks. Results: Athletes exhibited increased wall shear stress and energy loss. Hemodynamics differed markedly between groups. Our prediction model reliably displayed the potential of 4D flow in assessing cardiac risks. Impact: Exercise can elevate aortic wall shear stress and energy loss. Four-dimensional flow cardiac MRI may allow predicting myocardial fibrosis or cardiac remodeling risks in athletes, thus informing clinicians of adverse event associations and guiding follow-up adjustments.