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Echocardiographic grading of diastolic dysfunction was performed according to the multiparametric, threshold-based 2016 ASE\/EACVI approach. Volumetric and echo-equivalent peak velocity grading parameters were evaluated from 4D flow magnitude and velocity data, respectively. Duration of vortical blood flow along the main pulmonary artery (\n                      <jats:italic>t<\/jats:italic>\n                      <jats:sub>vortex<\/jats:sub>\n                      ) was employed as a surrogate grading parameter for echocardiographic tricuspid regurgitant peak velocity (TR). Correlations between grading parameters were analysed; agreement in grading of diastolic dysfunction between methods was assessed using a 5\u2009\u00d7\u20095 contingency table analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study population consisted of 94 participants (mean age, 62\u2009\u00b1\u200912 years, 50 females, 34 with structural heart disease). All volumetric and echo-equivalent 4D flow grading parameters demonstrated strong to very strong correlations with echocardiography (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.75\u20130.92). Volumetric parameters showed significant biases between 4D flow and echocardiography. Employing bias-adjusted 4D flow grading cutoffs for volumetric parameter, echo-equivalent cutoffs for diastolic transmitral and myocardial peak velocities, and\n                      <jats:italic>t<\/jats:italic>\n                      <jats:sub>vortex<\/jats:sub>\n                      \u2009&gt;\u200915% as a surrogate cutoff for TR\u2009&gt;\u20092.8\u2009m\/s, nearly perfect agreement in diastolic dysfunction grading between methods was observed (weighted kappa\u2009=\u20090.84). There was no evidence for over- or underestimation of grades by 4D flow (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.53).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Grading of left ventricular diastolic dysfunction from a single 4D flow measurement is feasible and shows nearly perfect agreement with echocardiography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The lack of comparison studies with echocardiography currently limits cardiac MRI-based grading of diastolic dysfunction. Could 4D flow MRI serve as a viable technique<\/jats:italic>\n                      ?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>A single 4D flow MRI measurement allows multiparametric grading of left ventricular diastolic dysfunction in nearly perfect agreement with echocardiography<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Agreement between 4D flow MRI and echocardiographic grading of left ventricular diastolic dysfunction is comparable to that observed in repeated echocardiographic evaluations, suggesting 4D flow as a viable alternative to echocardiography in selected patients, especially when comprehensive MRI is already performed<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11703-0","type":"journal-article","created":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T04:51:44Z","timestamp":1748148704000},"page":"7118-7132","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["4D flow MRI-based grading of left ventricular diastolic dysfunction: a validation study against echocardiography"],"prefix":"10.1007","volume":"35","author":[{"given":"Clemens","family":"Reiter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewald","family":"Kolesnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Scherr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albrecht","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fuchsj\u00e4ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-2528","authenticated-orcid":false,"given":"Ursula","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,25]]},"reference":[{"key":"11703_CR1","doi-asserted-by":"publisher","unstructured":"Heidenreich PA, Bozkurt B, Aguilar D et al (2022) 2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. 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The study was performed under a Master Research Agreement between the Medical University of Graz, Graz University of Technology, and Siemens Healthcare Diagnostics GmbH. U.R. is a member of the Scientific Editorial Board of European Radiology (section: Physics). As such, they did not participate in the selection or review processes for this article. The remaining authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all patients in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained. Ethical committee: Medical University of Graz, Austria. ClinicalTrials.gov: NCT01728597 and NCT03253835.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The diagnosis and grading of LV diastolic dysfunction based on the 2016 ASE\/EACVI recommendations from 4D flow data with echocardiography as the reference method was not previously investigated. Data of study participants were included in the following previous publications, which focused on methodological aspects of 4D flow data evaluation or the introduction of novel 4D flow metrics:","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}