Related Experiment Video
Updated: May 2, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Stroke volume paradox in heart failure: mathematical validation
Srilakshmi M Adhyapak1, V Rao Parachuri
1Department of Cardiology, St. John's Medical College Hospital, Bangalore, India.
Insights
In ischemic cardiomyopathy, stroke volume initially increases with ventricular size but decreases beyond a certain point. Post-surgery, reduced stroke volume doesn't indicate worsened heart function.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Cardiac Mechanics
Background:
- Ischemic cardiomyopathy can present with enlarged ventricles and paradoxically preserved stroke volume.
- Surgical ventricular restoration (SVR) improves clinical status, ventricular volumes, and ejection fraction.
- However, SVR can lead to a decrease in stroke volume, raising questions about cardiac function.
Purpose of the Study:
- To investigate the relationship between end-diastolic volume and stroke volume before and after SVR.
- To determine if a decrease in stroke volume post-SVR reflects impaired cardiac function.
Main Methods:
- Studied 101 patients with postinfarction left ventricular aneurysms using echocardiography and contrast ventriculography.
- 57 patients were reassessed 1.7-2.2 years post-SVR.
- Analyzed changes in end-diastolic volume index (EDVI) and stroke volume index (SVI).
Main Results:
- SVR decreased EDVI by 40.2 mL and SVI by 10.0 mL, while increasing ejection fraction by 6.7%.
- A linear relationship existed between SVI and EDVI for EDVI < 150 mL (r=0.64, p<0.001).
- The change in EDVI and SVI showed a significant linear relationship (r=0.72, p<0.001) persisting post-surgery.
Conclusions:
- Stroke volume increases with end-diastolic volume up to a threshold, after which it declines.
- Decreased stroke volume following SVR is a consequence of optimizing ventricular size, not impaired cardiac function.
Background:
In some patients with ischemic cardiomyopathy, despite large increases in ventricular size with decreased cardiac output, the paradox of preserved stroke volume has been observed. Following surgical ventricular restoration, despite marked improvements clinically and in ventricular volumes and ejection fraction, a decrease in stroke volume was observed.
Methods:
101 consecutive patients with postinfarction left ventricular aneurysms were studied by 2-dimensional echocardiography and contrast ventriculography at baseline, and 57 of these patients at 1.7 to 2.2 years (mean 1.95 ± 0.44 years) after surgical ventricular restoration.
Results:
Surgical ventricular restoration resulted in a decrease in end-diastolic volume index of 40.2 mL (95% confidence interval: 33.6-46.7) and stroke volume index of 10.0 mL (95% confidence interval: 6.6-13.5), and an increase in ejection fraction of 6.7% (95% confidence interval: 5.5-7.9). The stroke volume index had a significant linear relationship with the end-diastolic volume index at rest in patients with end-diastolic volume index < 150 mL (r = 0.64, p < 0.001). In patients with end-diastolic volume index >150 mL, this linear relationship was not seen. The change in end-diastolic volume index and stroke volume index had a significant linear relationship (r = 0.72, p < 0.001) that persisted at 1.95 years after surgery.
Conclusions:
In ischemic cardiomyopathy, stroke volume increases linearly with increases in end-diastolic volume up to a certain magnitude of end-diastolic volume, beyond which it decreases. Hence, following surgical ventricular restoration, decreases in stroke volume are not a reflection of impaired cardiac function.
More Related Videos
Related Concept Videos
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
01:11Cardiac Output and Stroke Volume
In an average resting adult male, the typical cardiac...
01:29Heart Failure II: Pathophysiology
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart...