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Updated: Jul 14, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Isovolumic Contraction Velocity in Heart Failure With Reduced Ejection Fraction and Effect of Sacubitril/Valsartan:
Alaa Mabrouk Salem Omar1, Sean Murphy2, G Michael Felker3
1Department of Cardiovascular Medicine, Mount Sinai Morningside, New York, NY.
Insights
Mitral annular isovolumic contraction velocity (ICV) improved after sacubitril/valsartan treatment in heart failure with reduced ejection fraction (HFrEF). This enhanced systolic function assessment predicts cardiac remodeling and treatment response.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Isovolumic contraction velocity (ICV) may reflect load-independent systolic function.
- Combining ICV with ejection fraction (EF) can enhance the assessment of left ventricular (LV) contractility.
Purpose of the Study:
- To evaluate the change in tissue Doppler-derived mitral annular ICV after initiating sacubitril/valsartan therapy.
- To assess the predictive value of ICV for cardiac remodeling and treatment response in patients with HFrEF.
Main Methods:
- Echocardiograms were performed at baseline, 6, and 12 months in 651 HFrEF participants treated with sacubitril/valsartan.
- Baseline ICV and LV ejection fraction (LVEF) were used to classify patients and predict outcomes.
Main Results:
- Median ICV significantly increased after sacubitril/valsartan therapy (P=0.005).
- Baseline ICV/EF classification identified distinct groups with varying remodeling, health status, and biomarker profiles.
- Treatment led to significant shifts towards better ICV/EF profiles, with a doubling of high ICV/high EF and a substantial reduction in low ICV/low EF.
Conclusions:
- In HFrEF, ICV provides valuable insights into systolic function and independently predicts reverse cardiac remodeling post-sacubitril/valsartan treatment.
- Changes in ICV can be utilized to monitor and assess patient responses to therapy.
Objectives:
To assess tissue Doppler-derived mitral annular isovolumic contraction velocity (ICV) after starting sacubitril/valsartan (sac/val) for the treatment of heart failure with reduced ejection fraction (HFrEF) and left ventricular [LV] EF < 40%).
Background:
ICV may inform load-independent systolic function; combining ICV and LVEF may improve assessment of LV contractility.
Methods:
Among 651 participants with HFrEF treated with sac/val, echocardiograms were performed at baseline, 6 and 12 months. Pretreatment median ICVs and LVEFs were used for classification to predict LV reverse remodeling, health status using the Kansas City Cardiomyopathy Questionnaire, and biomarker concentrations.
Results:
The mean age was 64.6 ± 12.4 years, and 28% were women, baseline LVEF: 28.9% ± 6.9%. Compared to baseline, median ICV increased post sac/val therapy (4.6 [3.5, 6.1] vs 4.9 [3.6, 6.4]; P = 0.005). ICV added value to separate and combined models of biomarkers and clinical and echocardiographic variables for prediction of post-therapy EF recovery. Classification using baseline ICV/EF yielded relatively equal numbers in 4 groups based on low/high ICV or LVEF. Most deleterious results for remodeling, health status and biomarkers were found in patients with low ICV/low EF, whereas patients with high ICV/high EF had the best profiles; other groups were intermediate. Significant shifts toward better ICV/EF profiles were noted post sac/val treatment compared to baseline, with doubling of high ICV/high EF (241 [60%] vs 123 [31%]) and 78% reduction of low ICV/low EF (28 [7%] vs 125 [32%]).
Conclusions:
In HFrEF, ICV adds to the profiling of systolic function and represents an independent predictor of reverse cardiac remodeling after treatment with sac/val. ICV changes may be used for assessment of treatment responses.
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