A scenario for heart failure during the filling phase

Area of Science:

• Cardiovascular Physiology
• Biomedical Engineering
• Cardiac Mechanics

Background:

• Heart failure (HF) with preserved ejection fraction, often seen in hypertrophic cardiomyopathy (HCM), has unclear biomechanical origins.
• Diastolic dysfunction in HF is a significant clinical challenge, particularly in HCM patients.

Purpose of the Study:

• To investigate the biomechanical interplay between the left ventricle (LV) and left atrium (LA) in HCM.
• To elucidate the underlying physics-based mechanisms of diastolic dysfunction in HCM.

Main Methods:

• Physics-based analysis of LV and LA function in HCM patients and healthy controls.
• Utilized 3D echocardiography for detailed cardiac chamber assessment.
• Quantified forces exchanged between the LV and LA.

Main Results:

• LV stiffening in HCM reduces the elastic recovery of the LA.
• Unbalanced forces between LV and LA result in sustained LA stretching and dilation.
• This mechanism clarifies the diastolic dysfunction leading to impaired LA emptying and LV filling.

Conclusions:

• LV stiffening is a primary driver of diastolic dysfunction in HCM via LA alterations.
• The findings provide a physics-based understanding of diastolic HF in HCM.
• This study offers insights for cardiac modeling and clinical study design.