Hemodynamic force analysis is not ready for clinical trials on HFpEF

Area of Science:

• Cardiovascular Physiology
• Biomedical Engineering
• Medical Imaging

Background:

• Heart failure with preserved ejection fraction (HFpEF) presents diagnostic challenges.
• Hemodynamic force analysis is a potential novel biomarker for early detection of subclinical systolic dysfunction.

Purpose of the Study:

• To evaluate the efficacy of left ventricular (LV) hemodynamic forces in differentiating healthy individuals from patients with varying degrees of systolic dysfunction.
• To assess the correlation between LV hemodynamic forces and ejection fraction (EF).

Main Methods:

• Cardiac magnetic resonance imaging (CMR) with cine and 4D flow was performed on 34 controls, 16 HFpEF patients, and 25 patients with HFmrEF/HFrEF.
• Global LV hemodynamic forces were computed using the Navier-Stokes equation over the cardiac cycle.
• Forces were analyzed, both normalized and non-normalized to LV volume, across systole, diastole, and the entire heartbeat.

Main Results:

• Volume-normalized hemodynamic forces positively correlated with EF (r²=0.47, p<0.0001).
• Significantly lower systolic and diastolic forces were observed in heart failure with reduced ejection fraction (HFrEF) compared to controls (p<0.0001).
• No significant differences in hemodynamic forces were found between controls and HFpEF patients (p>0.34 for normalized; p>0.24 for non-normalized).

Conclusions:

• Left ventricular hemodynamic force analysis, regardless of volume normalization, is currently insufficient for clinical assessment of HFpEF.
• Further refinement of hemodynamic force analysis is needed before its application in clinical trials for HFpEF detection.