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Updated: Jul 18, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Contribution of systolic and diastolic abnormalities to heart failure with a normal and a reduced ejection fraction
Hidekatsu Fukuta1, William C Little
1Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA.
Insights
Heart failure (HF) involves diastolic dysfunction regardless of ejection fraction (EF). Some patients with normal EF exhibit contractile issues, differing from reduced EF HF in remodeling.
Area of Science:
- Cardiology
- Heart Failure Pathophysiology
Background:
- Heart failure (HF) traditionally classified as reduced ejection fraction (EF) or normal EF.
- Both HF types share reduced exercise tolerance and neurohumoral activation.
- Normal EF in HF suggests compensated pump function but may mask underlying issues.
Purpose of the Study:
- To investigate contractile dysfunction in HF with normal EF.
- To compare cardiac remodeling between HF with reduced EF and HF with normal EF.
- To identify factors contributing to differential remodeling in HF.
Main Methods:
- Analysis of left ventricular (LV) filling dynamics and relaxation.
- Assessment of longitudinal systolic velocity in HF patients.
- Comparison of ventricular dimensions and myocyte characteristics based on EF.
Main Results:
- HF with normal EF can present with reduced longitudinal systolic velocity, indicating contractile dysfunction.
- Diastolic filling abnormalities are present in all HF patients, irrespective of EF.
- HF with reduced EF shows ventricular dilatation and elongated myocytes, unlike HF with normal EF.
Conclusions:
- Diastolic abnormalities are a common feature of HF, regardless of EF.
- Contractile dysfunction can exist in HF with normal EF despite preserved systolic pump performance.
- Differences in remodeling between HF with normal and reduced EF warrant further investigation into factors like aging, sex, and diabetes.
Abstract:
Heart failure (HF) has traditionally been divided into HF with a reduced ejection fraction (EF; systolic HF) and HF with a normal EF (diastolic HF). Both groups have reductions in exercise tolerance, neurohumoral activation, and abnormal left ventricular (LV) filling dynamics and impaired relaxation. Although the normal EF indicates that pump performance is adequately compensated, some of the patients with HF and a normal EF have reduced longitudinal systolic velocity indicating cardiac muscular contractile dysfunction. Regardless of EF, the severity of HF and its prognosis and degree of exercise intolerance are closely related to the degree of diastolic filling abnormalities. Patients with HF and a reduced EF have ventricular dilatation and elongated myocytes, whereas patients with HF and a normal EF do not. Thus, patients with HF have diastolic abnormalities regardless of EF and many patients with HF and a normal EF have contractile abnormalities despite preserved systolic pump performance. Heart failure with a normal EF and a reduced EF differs in the systolic LV pump performance and the type of remodeling. The mechanism of the differing remodeling responses is not known, but aging, sex differences, and diabetes may contribute.
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