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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction.
Sathish K Parasuraman1, Brodie L Loudon1, Crystal Lowery1
11 Norwich Medical School University of East Anglia Norwich United Kingdom.
Journal of the American Heart Association
|March 30, 2019
Summary
Exercise-induced pulmonary hypertension in heart failure with preserved ejection fraction (HFpEF) causes significant diastolic ventricular interaction. This interaction restricts left ventricular filling and worsens the Frank-Starling response during exercise.
Area of Science:
- Cardiology
- Pulmonary Hypertension
- Heart Failure
Background:
- Exercise-induced pulmonary hypertension is prevalent in heart failure with preserved ejection fraction (HFpEF).
- This condition may lead to pericardial constraint and diastolic ventricular interaction during exercise in HFpEF patients.
Purpose of the Study:
- To investigate the presence and impact of pericardial constraint and diastolic ventricular interaction during exercise in HFpEF patients.
- To compare these effects between HFpEF patients, hypertensive controls, and healthy controls.
Main Methods:
- Contrast stress echocardiography was used in 30 HFpEF patients, 17 hypertensive controls, and 17 healthy controls.
- Cardiac volumes and interventricular septum normalized radius of curvature (NRC) were measured at rest and peak exercise.
- Septal flattening (increased end-diastolic NRC) and its correlation with cardiac function parameters were analyzed.
Main Results:
- HFpEF patients showed significant septal flattening (increased end-diastolic NRC) at peak exercise, confirming pulmonary hypertension.
- This septal flattening correlated with end-systolic NRC and was significantly greater than in control groups.
- Increased end-diastolic NRC in HFpEF patients negatively correlated with changes in left ventricular end-diastolic volume and stroke volume, indicating restricted filling.
Conclusions:
- Exercise-induced pulmonary hypertension leads to significant diastolic ventricular interaction in some HFpEF patients.
- This interaction restricts right ventricular filling, exacerbating the impaired Frank-Starling response in HFpEF.
- Findings highlight a mechanism contributing to exercise intolerance in HFpEF.
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