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Updated: Feb 24, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
A novel echocardiographic hemodynamic classification of heart failure based on stroke volume index and left atrial
Amr E Abbas1,2, Rami Khoury Abdulla1, Anshul Aggrawal1
1Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
Insights
Ejection fraction alone oversimplifies heart failure (HF). A novel echocardiogram model using stroke volume index and filling pressures reveals distinct hemodynamic profiles in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Ejection fraction (EF) alone may oversimplify heart failure (HF) patient classification.
- A novel echocardiogram-derived hemodynamic model is proposed using stroke volume index (SVI) and E/E' (left atrial pressure correlate).
Purpose of the Study:
- To develop and evaluate a novel echocardiogram-based hemodynamic model for heart failure patients.
- To assess differences in hemodynamic profiles between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
Main Methods:
- Retrospective analysis of 176 HF patients (123 HFrEF, 53 HFpEF).
- Patients were stratified into four hemodynamic groups based on echocardiographic SVI (< or ≥35 mL/m²) and E/E' (≥ or <15).
Main Results:
- HFrEF patients predominantly fell into the low flow, high filling pressure group (Group D).
- HFpEF patients showed a heterogeneous distribution across all four hemodynamic groups.
- No significant difference in mortality or major adverse cardiac events was observed, but HFpEF patients had higher readmission rates.
Conclusions:
- Hemodynamic subgroups identified by this echocardiogram model differ significantly between HFrEF and HFpEF.
- While major adverse cardiovascular events were similar, HFpEF patients experienced increased readmissions.
- Larger studies are warranted to explore the clinical impact of these echo-derived hemodynamic states.
Background And Aim:
Dividing patients with heart failure (HF) based solely on ejection fraction (EF) may over simplify the hemodynamic states of these patients. We describe a novel echo-derived hemodynamic HF model based on flow (stroke volume index [SVI]) and left atrial pressure (E:E') correlates.
Methods:
A retrospective analysis of patients admitted with HF with both reduced (HFrEF) and preserved EF (HFpEF). Patients were subdivided into four hemodynamic groups based on echocardiographic SVI (< or ≥35 mL/m2 ) and E/E' (≥ or <15). Group A: normal flow and normal filling pressure, Group B: normal flow but high filling pressure, Group C: low flow and low filling pressure, and Group D: low flow and high filling pressure.
Results:
A total of 176 patients were enrolled, 123 patients had HFrEF and 53 patients had HFpEF. Baseline characteristics were not statistically significant in both groups. In HFrEF, most patients were in group D compared to a heterogeneous distribution in HFpEF (P<.0001). In HFrEF, there was a trend toward an increase in B-type natriuretic peptide levels with a decrease in SVI and increase in E/E' (P=.05) but not in HFpEF. There was no difference in death, major adverse cardiac events, but a higher readmissions rate in the HFpEF group at 30 days and 18 months.
Conclusions:
Hemodynamic subgroups differ between HFrEF and HFpEF. There is no difference in major adverse cardiovascular events between both groups with increased readmissions in HPpEF patients. Larger studies may help assess the impact of echo-derived hemodynamic state on clinical outcome.
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