4D Flow MRI E/A Reference Values
Explore published E/A ratios by method, age, ventricle and study population. Normal is the default, with separate Overweight and Type 2 diabetes tabs. These are published cohort summaries, not individual diagnostic thresholds.
What are the different E/A ratios?
Velocity E/A compares peak early- and atrial-filling blood speed; Flow E/A compares corresponding peak filling volume flow rates; Kinetic Energy E/A compares the early- and atrial-filling ventricular KE peaks. All are dimensionless, but their measurement definitions differ, so do not pool these ratios as if they were the same biomarker.
The original cohort-specific values, MRI sequence details and literature list remain below the plot. The Alattar and Varga-Szemes method pairs come from the same respective cohorts; Crandon LV and Barker RV share a 53-person cohort.
Normal / Healthy reference
Published healthy E/A values by age.
Hover for the source reference. Click to dim or restore the study.
Values behind the plot
Results and sample sizes are preserved from the original page. Markers indicate reported summary values at study age-band midpoints or published cohort mean ages.
| Reference | Study / chamber | Age | n | E/A | Statistics / method |
|---|
The ratio of cohort E and A medians is not necessarily the median of participant-level E/A ratios. Published ±IQR values from Crandon/Barker are shown without fabricating Q1 and Q3 endpoints.
Sequence parameters
Only studies used in the plot. Voxel sizes refer to the 4D flow sequence. Alattar reports a reconstructed voxel size after zero filling; the acquired voxel size is N/A. Varga-Szemes reports acquired voxel sizes.
| Study | 4D flow scanner / gating | Voxel size | Temporal resolution | Reconstructed cardiac phases |
|---|---|---|---|---|
| Alattar 2022, E/A velocity and flow | 3 T GE; retrospective ECG gating | 1 × 1.48 × 2.38 mm³ (reconstructed; acquired size N/A) | 34 ms | 50 |
| Varga-Szemes 2023, E/A velocity (conventional / compressed sensing) | 3 T Siemens Prisma; retrospective ECG gating | 2.4 × 3.5 × 3.8 / 2.4 × 3.5 × 3.6 mm³ (acquired) | 38.64 / 40.48 ms | 20 / 18–20 |
| Zhao 2023, LV and RV E/A kinetic energy | 3 T Philips, retrospective ECG; 1.5 T Siemens, prospective ECG | 3.0 × 3.0 × 3.0 mm³, both scanners | N/A (Table S1 does not specify a numeric value) | Philips 30; Siemens median 23 (IQR 20–24) |
| Crandon 2018 / Barker 2020, LV and RV E/A kinetic energy | 1.5 T Philips Ingenia; retrospective ECG | Approximately 3 × 3 × 3 mm³ | 40 ms | 30 |
Further reading (not yet plotted)
These studies are relevant but do not yet contribute verified, compatible cohort-level E/A values to the chart. Park et al. (2026) has been moved to the Normal, Overweight and T2D tabs.
- Lee et al., 2025 (SCMR abstract): In 39 healthy adults aged 18–82, valve-tracked mitral E/A flow rate decreased with age, with sex-related differences in E- and A-wave filling rates. The abstract does not provide age-group E/A values for plotting.
- in de Braekt et al., 2026: Repeated whole-heart 4D flow in 21 healthy volunteers assessed scan–rescan reproducibility of mitral E- and A-wave velocities and E/A. Repeated scans represent the same cohort.
- Stipechi et al., 2026: In 60 healthy volunteers, 4D flow mitral velocity and filling rate indices captured age-related LV filling changes; peak early filling rate correlated strongly with age.
- LV early and late filling, 2022: In 50 healthy volunteers, leaflet-tip and annulus-tracking E/A flow ratios aligned closely with echo and showed strong associations with age and LV remodeling.
- Zhao et al., 2021: In 74 healthy Asian volunteers, LV peak KE E/A decreased with age, while age- and sex-matched Asian and Caucasian 4D flow parameters were broadly similar. The study also compared age- and sex-matched Asian and Caucasian groups.
- Viola et al., 2024: In 97 people with chronic ischemic heart disease, a deep learning LV velocity E/A method correlated with echo E/A (R² = 0.72) and ran in about 40 seconds. The automated method showed the strongest echo association among the three approaches.
The Crandon LV and Barker RV results come from the same 53-person cohort. Zhao 2021 partly overlaps Zhao 2023, so these reports are not independent samples for pooling.
What the ratios mean. E/A velocity compares peak early and atrial filling speed at the mitral valve. E/A flow compares the corresponding peak volume flow rates across that plane. E/A kinetic energy compares the ventricular blood-flow energy peaks during E and A filling. E/A vorticity compares integrated LV rotational flow at those peaks, while E/A vortex volume compares the volume occupied by coherent vortical structures. Each is dimensionless, but values from different definitions should be interpreted separately.
References
Numbering matches the plotted studies and data table.
- [1] Zhao X, Tan RS, Garg P, et al. “Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects.” J Cardiovasc Magn Reson. 2023;25:50. View paper ↗
- [2] Crandon S, Westenberg JJM, Swoboda P, et al. “Impact of Age and Diastolic Function on Novel, 4D Flow CMR Biomarkers of Left Ventricular Blood Flow Kinetic Energy.” Sci Rep. 2018. View paper ↗
- [3] Barker N, Zafar H, Fidock B, et al. “Age-associated changes in 4D flow CMR derived Tricuspid Valvular Flow and Right Ventricular Blood Flow Kinetic Energy.” Sci Rep. 2020;10:9908. View paper ↗
- [4] Alattar Y, Soulat G, Gencer U, et al. “Left ventricular diastolic early and late filling quantified from 4D flow magnetic resonance imaging.” Diagn Interv Imaging. 2022;103:345–352. View paper ↗
- [5] Varga-Szemes A, Halfmann M, Schoepf UJ, et al. “Highly Accelerated Compressed-Sensing 4D Flow for Intracardiac Flow Assessment.” J Magn Reson Imaging. 2023;58:496–507. View paper ↗
- [6] Lee et al. “SCMR 2025 conference abstract (linked source; detailed title not independently verified).” J Cardiovasc Magn Reson. 2025; conference abstract. View paper ↗
- [7] in de Braekt T, Roos PR, Houthuizen P, et al. “Reproducibility of 4D Flow MRI-Derived Diastolic Function Testing by Mitral and Pulmonary Venous Flow Indices in Healthy Volunteers.” Applied Sciences. 2026;16(8):3930. View paper ↗
- [8] Park S, Englund EK, Fujiwara T, et al. “Comprehensive CMR evaluation including 4D flow-derived E/A vorticity ratio in overweight adults with and without type 2 diabetes mellitus.” Cardiovasc Diabetol. 2026;25:7. View paper ↗
Study values are descriptive. No pooled estimate or clinical normal range was calculated.