We used 4D flow MRI before and during acute pharmacological intervention to reduce either afterload or heart rate in young adults born very to extremely premature, finding improved overall cardiac function and shifted intraventricular flow in the RV towards direct flow after RV afterload reduction with sildenafil. We interpret these findings to mean that intrinsic morphologic differences as well as increased RV afterload are stronger drivers of cardiac dysfunction in the preterm heart than decreased filling time. This study design may serve as a blueprint for future studies investigating the effects of acute hemodynamic pharmacological interventions with 4D flow MRI.
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