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Updated: Oct 5, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Identification of heart failure with preserved ejection fraction helps risk stratification for hypertrophic
Jie Liu1, Dong Wang2, Jieyun Ruan1
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishi Road, Xicheng District, 100037, Beijing, People's Republic of China.
Insights
Heart failure with preserved ejection fraction (HFpEF) is common in hypertrophic cardiomyopathy (HCM). Patients with HFpEF exhibit increased disease severity and a higher risk of death, necessitating tailored treatment strategies.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) represents the predominant form of heart failure (HF).
- Hypertrophic cardiomyopathy (HCM) is a primary cardiac condition.
- Investigating HFpEF within the HCM population is crucial for understanding disease progression and outcomes.
Purpose of the Study:
- To characterize HFpEF in patients diagnosed with HCM.
- To evaluate the prognostic implications of HFpEF in this cohort.
- To determine if HFpEF influences mortality risk in HCM patients.
Main Methods:
- Prospective cohort study including 1178 patients with HCM and available NT-proBNP levels.
- Patients classified as HFpEF (LVEF ≥50%, HF symptoms, NT-proBNP ≥800 pg/mL per AHA criteria) or non-HF.
- Outcomes assessed included all-cause death, cardiovascular death, and sudden cardiac death (SCD).
Main Results:
- 43.5% of HCM patients (513/1178) met criteria for HFpEF.
- HFpEF patients showed significantly greater maximal wall thickness, higher left ventricular outflow tract gradient, and increased atrial fibrillation prevalence.
- HFpEF was associated with a higher incidence and nearly two-fold increased risk of all-cause and cardiovascular death compared to non-HF patients.
Conclusions:
- HFpEF is highly prevalent in HCM patients.
- HFpEF in HCM is linked to increased disease severity and significantly higher mortality.
- Identifying HFpEF using AHA criteria aids risk stratification and may guide more aggressive HF management in HCM.
Background:
Heart failure with preserved ejection fraction (HFpEF) is the dominant form of heart failure (HF). We here aimed to investigate the characteristics and prognosis of HFpEF in patients with hypertrophic cardiomyopathy (HCM).
Methods:
This was a prospective cohort study and patients with HCM with available NT-proBNP results were enrolled. Patients were categorized into HFpEF [defined as LVEF ≥50%, with symptoms or signs of HF, and N-terminal pro-brain natriuretic peptide ≥800 pg/mL according to American Heart Association (AHA) criteria] and without heart failure (non-HF). The outcomes of interest were all-cause death, cardiovascular death, and sudden cardiac death (SCD).
Results:
Of 1178 included patients with HCM, 513 (43.5%) were identified as having HFpEF according to AHA criteria. Compared with non-HF patients, patients with HFpEF had significantly larger maximal wall thickness (P < 0.001), higher maximal left ventricular outflow tract gradient (P < 0.001), higher proportion of atrial fibrillation (P < 0.001), higher incidence of all-cause death (log-rank test, P = 0.002), and cardiovascular death (log-rank test, P = 0.005). Multivariable Cox analysis showed that patients with HFpEF had a nearly two-fold higher risk of all-cause death (adjusted HR = 1.80, 95% CI 1.11-2.90; P = 0.017) and cardiovascular death (adjusted HR =1.82, 95% CI 1.05-3.18; P = 0.033) than non-HF patients.
Conclusions:
Patients with HCM have a high prevalence of HFpEF and those with HFpEF present greater disease severity and higher mortality than non-HF patients, and thus may require an appropriate and more aggressive treatment for HF management. Identification of patients with HFpEF using AHA criteria can provide guidance on patient risk stratification for patients with HCM.
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