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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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Right atrial-right ventricular coupling in heart failure with preserved ejection fraction
Maximilian von Roeder1, Johannes Tammo Kowallick2,3, Karl-Philipp Rommel1
1Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Struempellstrasse 39, 04289, Leipzig, Germany.
Summary
In heart failure with preserved ejection fraction (HFpEF), impaired right ventricular (RV) early filling is compensated by increased right atrial (RA) booster pump function. This RA-RV interaction is linked to reduced exercise tolerance in HFpEF patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Right ventricular (RV) function is crucial for prognosis in heart failure with preserved ejection fraction (HFpEF).
- Limited data exist on the detailed interaction between the RV and right atrium (RA) in HFpEF.
- This study investigates RV-RA interaction using advanced imaging and invasive methods.
Purpose of the Study:
- To characterize the interaction between the RV and RA in patients with HFpEF.
- To assess the impact of RV-RA dysfunction on exercise capacity in HFpEF.
- To elucidate the role of RA mechanics in RV diastolic function.
Main Methods:
- Cardiac magnetic resonance imaging (CMR) with myocardial feature-tracking was performed in 24 HFpEF patients and 12 controls.
- Invasive pressure-volume-loop analysis was used to evaluate RV systolic and diastolic properties.
- RV early filling was quantified from CMR-derived RV volume-time curves, and RA conduit and booster pump functions were assessed.
Main Results:
- RV systolic function was preserved but RV early filling was significantly decreased in HFpEF patients.
- RA conduit function was reduced, while RA booster pump function was increased, indicating compensatory mechanisms.
- Decreased RV early filling was the strongest predictor of reduced exercise tolerance (VO2max), independent of RV stiffness and relaxation.
Conclusions:
- Compensated HFpEF is characterized by impaired RV early filling and preserved RV systolic function.
- Increased RA booster pump function compensates for impaired RV filling, highlighting altered RA-RV coupling.
- RA dysfunction appears to contribute independently to pathophysiology and impaired exercise tolerance in HFpEF.
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