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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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Increased Myocardial Stiffness in Patients With High-Risk Left Ventricular Hypertrophy: The Hallmark of Stage-B Heart
Michinari Hieda1,2, Satyam Sarma1,2, Christopher M Hearon1,2
1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.).
Circulation
|December 24, 2019
Summary
Middle-aged individuals with left ventricular hypertrophy (LVH) and elevated cardiac biomarkers show increased left ventricular myocardial stiffness. This finding suggests a transitional state towards heart failure with preserved ejection fraction (HFpEF).
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Biomedical Engineering
Background:
- Middle-aged individuals with left ventricular hypertrophy (LVH) and elevated cardiac biomarkers face a high risk of developing heart failure with preserved ejection fraction (HFpEF).
- The underlying pathophysiological mechanisms for this elevated risk remain unclear.
- This study investigates whether increased left ventricular (LV) myocardial stiffness contributes to this high-risk state.
Purpose of the Study:
- To test the hypothesis that patients with LVH and elevated cardiac biomarkers exhibit increased LV myocardial stiffness compared to healthy controls.
- To identify myocardial stiffness as a potential marker for future HFpEF development.
Main Methods:
- Recruited 46 patients with LVH and elevated cardiac biomarkers, and 61 healthy controls.
- Utilized right heart catheterization and 3D echocardiography to assess LV pressure-volume relationships.
- Manipulated preload using lower body negative pressure and saline infusion.
Main Results:
- Patients with LVH demonstrated significantly lower LV distensibility compared to controls.
- LV myocardial stiffness was found to be nearly 30% greater in the LVH group (stiffness constant: 0.053±0.027) versus controls (0.042±0.020, P=0.028).
- Significant differences in body size, blood pressure, and pulmonary capillary wedge pressure were observed between groups.
Conclusions:
- Elevated LV myocardial stiffness in patients with LVH and biomarkers suggests a transitional stage towards HFpEF.
- This increased stiffness may represent an early marker for HFpEF.
- Further research is needed to explore interventions, like exercise training, to improve LV compliance and potentially prevent HFpEF manifestation.
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