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Updated: Mar 13, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Ventricular-vascular dynamics in pediatric patients with heart failure and preserved ejection fraction
Satoshi Masutani1, Seiko Kuwata1, Clara Kurishima1
1Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Insights
Pediatric heart failure with preserved ejection fraction (HFpEF) involves increased ventricular-arterial stiffness and impaired reserve function. These findings correlate with an imbalanced coronary supply and demand in children with HFpEF.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) in children is not well understood.
- Ventricular-vascular dynamics in pediatric HFpEF require further investigation.
Purpose of the Study:
- To test the hypothesis that pediatric HFpEF patients exhibit ventricular systolic, diastolic, and arterial stiffening at rest.
- To assess impaired reserve function and coronary supply/demand imbalance in pediatric HFpEF.
Main Methods:
- Studied ventricular pressure-area relationships in 22 pediatric HFpEF patients and 22 controls.
- Assessed ventricular reserve and coronary supply/demand balance using dobutamine infusion, abdominal compression, and subendocardial viability ratio (SEVR).
Main Results:
- HFpEF patients showed higher end-systolic elastance (Ees), arterial elastance (Ea), and ventricular diastolic stiffness.
- Pediatric HFpEF patients had impaired beta-adrenergic reserve, reduced ventricular-arterial coupling, and lower SEVR compared to controls.
- Diastolic reserve was limited in HFpEF patients, evidenced by increased end-diastolic pressure (EDP) with preload augmentation.
Conclusions:
- Pediatric HFpEF is characterized by elevated ventricular-arterial stiffness and diminished systolic and diastolic reserve.
- Impaired coronary supply/demand balance is closely linked to the pathophysiology of pediatric HFpEF.
- Findings highlight the importance of assessing ventricular-arterial coupling and coronary hemodynamics in pediatric HFpEF management.
Objective:
The details of the ventricular-vascular dynamics of heart failure with preserved ejection fraction (HFpEF) in children remain poorly understood. We tested the hypothesis that pediatric HFpEF patients have ventricular systolic, diastolic, and arterial stiffening at rest as well as impaired reserve function associated with coronary supply/demand imbalance.
Methods:
We studied the ventricular pressure-area relationship in 22 pediatric HFpEF patients and 22 control subjects before and after dobutamine infusion and during abdominal compression. Coronary supply/demand balance was assessed by subendocardial viability ratio (SEVR) calculated from the aortic pressure waveform.
Results:
Compared with controls, the HFpEF patients had significantly higher end-systolic (Ees) and arterial (Ea) elastance. Increased ventricular diastolic stiffness also occurred in the HFpEF patients, resulting in modest elevation of end-diastolic pressure (EDP) at rest (13.6±4.3 vs. 7.3±2.3mmHg, P<0.0001). The difference in EDP became more evident with a preload increase through abdominal compression, indicating a limited diastolic reserve in HFpEF patients (EDP changes; 11.3±6.2 for HFpEF vs. 3.4±0.6mmHg for controls, P=0.016). The HFpEF patients exhibited impaired beta-adrenergic reserve in ventricular contractility and ventricular-arterial coupling in response to dobutamine infusion. SEVR was significantly lower in the HFpEF (0.64±0.11) than in the control (0.79±0.07, P<0.0001) and was significantly correlated with LV diastolic stiffness and dobutamine-induced changes in ventricular contractility.
Conclusions:
HFpEF in children involves higher ventricular-arterial stiffness at rest as well as impaired systolic and diastolic reserve, which closely correlate with impaired coronary supply/demand balance.
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