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Updated: Jun 10, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a
Anand Prasad1, Jeffrey L Hastings, Shigeki Shibata
1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Tex 75231, USA.
Insights
Heart failure with preserved ejection fraction (HFPEF) in seniors shows impaired relaxation and reduced distensibility, not always increased stiffness. Early diagnosis is key for managing this growing condition.
Area of Science:
- Cardiology
- Geriatrics
- Physiology
Background:
- Congestive heart failure with preserved left ventricular ejection fraction (HFPEF) is increasingly prevalent in older adults.
- The specific pathophysiologic abnormalities in ventricular function and structure in HFPEF are not fully understood.
- This study investigated diastolic function in HFPEF patients compared to healthy controls.
Purpose of the Study:
- To test the hypothesis that HFPEF patients exhibit impaired LV diastolic function, including increased diastolic stiffness and slowed relaxation.
- To compare diastolic properties between HFPEF patients and age-matched healthy individuals.
Main Methods:
- Recruited 11 HFPEF patients and 13 healthy controls (mean age 70-73 years).
- Performed pulmonary artery catheterization to measure cardiac output, pressures, and volumes under varying preload conditions.
- Utilized Doppler echocardiography to assess diastolic function parameters like tissue Doppler velocities and isovolumic relaxation time.
Main Results:
- HFPEF patients had similar left ventricular (LV) contractile function and static compliance compared to controls.
- Patients with HFPEF demonstrated reduced LV chamber distensibility and elevated filling pressures.
- Myocardial relaxation was significantly slower in HFPEF patients, as indicated by tissue Doppler imaging.
Conclusions:
- Increased end-diastolic static ventricular stiffness was not universally observed in this HFPEF cohort.
- HFPEF patients consistently showed elevated filling pressures, reduced distensibility, and increased diastolic wall stress.
- Left ventricular relaxation, assessed by Doppler variables, was consistently impaired in patients with HFPEF.
Background:
Congestive heart failure in the setting of a preserved left ventricular (LV) ejection fraction is increasing in prevalence among the senior population. The underlying pathophysiologic abnormalities in ventricular function and structure remain unclear for this disorder. We hypothesized that patients with heart failure with preserved ejection fraction (HFPEF) would have marked abnormalities in LV diastolic function with increased static diastolic stiffness and slowed myocardial relaxation compared with age-matched healthy controls.
Methods And Results:
Eleven highly screened patients (4 men, 7 women) aged 73±7 years with HFPEF were recruited to participate in this study. Thirteen sedentary healthy controls (7 men, 6 women) aged 70±4 years also were recruited. All subjects underwent pulmonary artery catheterization with measurement of cardiac output, end-diastolic volumes, and pulmonary capillary wedge pressures at baseline; cardiac unloading (lower-body negative pressure or upright tilt); and cardiac loading (rapid saline infusion). The data were used to define the Frank-Starling and LV end-diastolic pressure-volume relationships. Doppler echocardiographic data (tissue Doppler velocities, isovolumic relaxation time, propagation velocity of early mitral inflow , E/A-wave ratio) were obtained at each level of cardiac preload. Compared with healthy controls, patients with HFPEF had similar LV contractile function and static LV compliance but reduced LV chamber distensibility with elevated filling pressures and slower myocardial relaxation as assessed by tissue Doppler imaging.
Conclusions:
In this small, highly screened patient population with hemodynamically confirmed HFPEF, increased end-diastolic static ventricular stiffness relative to age-matched controls was not a universal finding. Nevertheless, patients with HFPEF, even when well compensated, had elevated filling pressures, reduced distensibility, and increased diastolic wall stress compared with controls. In contrast, LV relaxation as assessed by tissue Doppler variables appeared consistently impaired in patients with HFPEF.
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