Hemodynamic forces derived from cine cardiac magnetic resonance imaging: technical aspects, applications in various clinical scenarios, and in athlete's heart

Recently, intraventricular pressure gradients, or hemodynamic forces (HDF), which are their global measure integrated over the left ventricular volume, have been proposed as a new concept capable of detecting subtle changes in left ventricular function. Thanks to a mathematical model, the analysis of routinely acquired cine cardiac magnetic resonance (CMR) images is now feasible without the need for contrast administration or 4D flow imaging, making it an attractive tool for the early detection and follow-up of left ventricular dysfunction. HDF derived from cine CMR images have been applied in normal subjects and in several pathological conditions, and the results of these studies confirm the feasibility and support the usefulness of this method in clinical practice. This review focuses on the technical aspects of cine CMR-derived HDF, emphasizing the need for precise image acquisition. Furthermore, we review the clinical relevance of HDF in various clinical conditions, illustrating their potential in the detection of cardiac diseases at an early stage, evaluation of medical/interventional treatment, and prediction of future cardiac events. Additionally, we report the results of HDF in athletes, where the HDF analysis is able to discriminate physiological adaptations from pathological cardiac remodeling and to document the effect of intense physical training. Future developments should include consistency of HDF parameters, and at this aim we have suggested a standardized approach for HDF analysis for clear interpretation and clinical use.