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Updated: Jun 11, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
A scenario for heart failure during the filling phase
Gianni Pedrizzetti1, Ryusuke Numata2, Dario Collia3
1Department of Engineering and Architecture, University of Trieste, Trieste, Italy. giannip@dia.units.it.
Insights
In hypertrophic cardiomyopathy, stiffening of the left ventricle (LV) impairs left atrial (LA) function, leading to diastolic heart failure. Unbalanced forces cause LA dilation, clarifying a key mechanism of this cardiac disease.
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.
Abstract:
Heart failure (HF) is a life-threating cardiac disease that develops progressively for the reduced ability of the left ventricle (LV) to pump blood into the circulation during systole. HF can also develop in patients with a preserved systolic function, typically in presence of hypertrophic cardiomyopathy (HCM). This type of HF is sometimes termed as diastolic HF, but its biomechanical origin is still unclear. This study employs a physics-based analysis of both the LV and left atrium (LA) in selected HCM patients and matched healthy subjects using 3D echocardiography and demonstrates that alteration on the LV side (stiffening) reduces the elastic recovery of the LA. Moreover, the analysis of the forces exchanged between the two chambers demonstrates that they result unbalanced, keeping the LA in a sustained stretched condition that leads to dilation. This scenario clarifies the diastolic root of the dysfunction that may likely be the cause of the spiraling of events progressing toward failure of both LA emptying and LV filling. This deeply interdisciplinary study provides a physics-based basis for both physics/engineering modeling of heart function and to cardiologists for the design of clinical studies.
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