Related Experiment Video
Updated: May 10, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Prevalence, clinical characteristics, and outcomes associated with eccentric versus concentric left ventricular
Daniel H Katz1, Lauren Beussink, Andrew J Sauer
1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Eccentric hypertrophy (EH) in heart failure with preserved ejection fraction (HFpEF) patients presents unique characteristics, including reduced contractility and increased compliance. Despite these differences, EH and concentric hypertrophy (CH) share similar adverse outcomes in HFpEF.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) commonly involves concentric remodeling or hypertrophy.
- Eccentric hypertrophy (EH), though less common, also occurs in HFpEF but remains poorly characterized.
- Understanding distinct left ventricular (LV) structural patterns is crucial for HFpEF management.
Purpose of the Study:
- To delineate the clinical, hemodynamic, and prognostic features of eccentric hypertrophy (EH) in patients with HFpEF.
- To compare EH with other LV geometric patterns, particularly concentric hypertrophy (CH).
- To identify potential therapeutic implications for EH in HFpEF.
Main Methods:
- Prospective study of 402 HFpEF patients categorized into four LV structure groups: normal geometry, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).
- Comprehensive assessment including clinical data, laboratory tests, echocardiography, and invasive hemodynamics.
- Statistical analysis to compare characteristics and outcomes among the groups, with covariate adjustment.
Main Results:
- Eccentric hypertrophy (EH) was identified in 12% (48/402) of HFpEF patients.
- Compared to CH, EH patients exhibited lower systolic blood pressure and less renal impairment, despite similar hypertension rates.
- EH was associated with reduced LV contractility (lower LVEF, SBP/ESV ratio) and increased LV compliance (higher LVEDV at 20 mmHg EDP) versus CH.
- Despite distinct functional differences, EH and CH demonstrated similar elevated cardiac filling pressures and comparable adverse clinical outcomes.
Conclusions:
- Eccentric hypertrophy (EH) represents a distinct pathophysiological phenotype within HFpEF.
- The functional profile of EH in HFpEF resembles that of heart failure with reduced ejection fraction (HFrEF).
- Patients with EH in HFpEF may potentially benefit from therapies currently used for HFrEF.
Abstract:
Although concentric remodeling (CR) and concentric hypertrophy (CH) are common forms of left ventricular (LV) remodeling in heart failure with preserved ejection fraction (HFpEF), eccentric hypertrophy (EH) can also occur in these patients. However, clinical characteristics and outcomes of EH have not been well described in HFpEF. We prospectively studied 402 patients with HFpEF, divided into 4 groups based on LV structure: normal geometry (no LV hypertrophy [LVH] and relative wall thickness [RWT] ≤0.42); CR (no LVH and RWT >0.42); CH (LVH and RWT >0.42); and EH (LVH and RWT ≤0.42). We compared clinical, laboratory, echocardiographic, invasive hemodynamic, and outcome data among groups. Of 402 patients, 48 (12%) had EH. Compared with CH, patients with EH had lower systolic blood pressure and less renal impairment despite similar rates of hypertension. After adjustment for covariates, EH was associated with reduced LV contractility compared with CH: lower LVEF (β coefficient = -3.2; 95% confidence interval [CI] -5.4 to -1.1%) and ratio of systolic blood pressure to end-systolic volume (β coefficient = -1.0; 95% CI -1.5 to -0.5 mm Hg/ml). EH was also associated with increased LV compliance compared with CH (LV end-diastolic volume at an idealized LV end-diastolic pressure of 20 mm Hg β coefficient = 14.2; 95% CI 9.4 to 19.1 ml). Despite these differences, EH and CH had similarly elevated cardiac filling pressures and equivalent adverse outcomes. In conclusion, the presence of EH denotes a distinct subset of HFpEF that is pathophysiologically similar to HF with reduced EF (HFrEF) and may benefit from HFrEF therapy.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Heart Failure II: Pathophysiology
01:17Pathophysiology of Heart Failure
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:26Heart Failure III: Clinical Manifestations