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Kinetic energy of left ventricular blood flow across heart failure phenotypes and in subclinical diastolic dysfunction

Arvidsson, Per Martin LU ; Nelsson, Anders LU ; Edlund, Jonathan LU orcid ; Smith, J Gustav LU orcid ; Magnusson, Martin LU orcid ; Jin, Ning ; Heiberg, Einar LU ; Carlsson, Marcus LU ; Steding-Ehrenborg, Katarina LU and Arheden, Håkan LU (2022) In Journal of Applied Physiology 133(3). p.697-709
Abstract

BACKGROUND: Kinetic energy (KE) of intracardiac blood flow reflects myocardial work spent on accelerating blood and provides a mechanistic window into diastolic filling dynamics. Diastolic dysfunction may represent an early stage in the development of heart failure (HF). Here we evaluated the hemodynamic effects of impaired diastolic function in subjects with and without HF, testing the hypothesis that left ventricular KE differs between controls, subjects with subclinical diastolic dysfunction (SDD), and HF patients.

METHODS: We studied 77 subjects (16 controls, 20 subjects with SDD, 16 HFpEF, 9 HFmrEF, and 16 HFrEF patients, age- and sex-matched at the group level). Cardiac magnetic resonance at 1.5T included intracardiac 4D... (More)

BACKGROUND: Kinetic energy (KE) of intracardiac blood flow reflects myocardial work spent on accelerating blood and provides a mechanistic window into diastolic filling dynamics. Diastolic dysfunction may represent an early stage in the development of heart failure (HF). Here we evaluated the hemodynamic effects of impaired diastolic function in subjects with and without HF, testing the hypothesis that left ventricular KE differs between controls, subjects with subclinical diastolic dysfunction (SDD), and HF patients.

METHODS: We studied 77 subjects (16 controls, 20 subjects with SDD, 16 HFpEF, 9 HFmrEF, and 16 HFrEF patients, age- and sex-matched at the group level). Cardiac magnetic resonance at 1.5T included intracardiac 4D flow and cine imaging. Left ventricular KE was calculated as 0.5*m*v
2.

RESULTS: Systolic KE was similar between groups (p>0.4), also after indexing to stroke volume (p=0.25), and was primarily driven by ventricular emptying rate (p<0.0001, R
2=0.52). Diastolic KE was higher in heart failure patients than controls (p<0.05) but similar between SDD and HFpEF (p>0.18), correlating with inflow conditions (E-wave velocity, p<0.0001, R
2=0.24) and end-diastolic volume (p=0.0003, R
2=0.17) but not with average e' (p=0.07).

CONCLUSIONS: Diastolic KE differs between controls and heart failure, suggesting more work is spent filling the failing ventricle, while systolic KE does not differentiate between well-matched groups with normal ejection fraction even in the presence of relaxation abnormalities and heart failure. Mechanistically, KE reflects the acceleration imparted on the blood and is driven by variations in ventricular emptying and filling rates, volumes, and heart rate, regardless of underlying pathology.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Applied Physiology
volume
133
issue
3
pages
697 - 709
publisher
American Physiological Society
external identifiers
  • pmid:36037442
  • scopus:85141777364
ISSN
1522-1601
DOI
10.1152/japplphysiol.00257.2022
project
Advanced CMR analysis: from pixels to physiology
language
English
LU publication?
yes
id
0a738f42-a2f6-4771-9f84-c37d4b669918
date added to LUP
2022-09-01 08:05:16
date last changed
2024-11-29 13:12:44
@article{0a738f42-a2f6-4771-9f84-c37d4b669918,
  abstract     = {{<p>BACKGROUND: Kinetic energy (KE) of intracardiac blood flow reflects myocardial work spent on accelerating blood and provides a mechanistic window into diastolic filling dynamics. Diastolic dysfunction may represent an early stage in the development of heart failure (HF). Here we evaluated the hemodynamic effects of impaired diastolic function in subjects with and without HF, testing the hypothesis that left ventricular KE differs between controls, subjects with subclinical diastolic dysfunction (SDD), and HF patients.</p><p>METHODS: We studied 77 subjects (16 controls, 20 subjects with SDD, 16 HFpEF, 9 HFmrEF, and 16 HFrEF patients, age- and sex-matched at the group level). Cardiac magnetic resonance at 1.5T included intracardiac 4D flow and cine imaging. Left ventricular KE was calculated as 0.5*m*v<br>
 2.<br>
 </p><p>RESULTS: Systolic KE was similar between groups (p&gt;0.4), also after indexing to stroke volume (p=0.25), and was primarily driven by ventricular emptying rate (p&lt;0.0001, R<br>
 2=0.52). Diastolic KE was higher in heart failure patients than controls (p&lt;0.05) but similar between SDD and HFpEF (p&gt;0.18), correlating with inflow conditions (E-wave velocity, p&lt;0.0001, R<br>
 2=0.24) and end-diastolic volume (p=0.0003, R<br>
 2=0.17) but not with average e' (p=0.07).<br>
 </p><p>CONCLUSIONS: Diastolic KE differs between controls and heart failure, suggesting more work is spent filling the failing ventricle, while systolic KE does not differentiate between well-matched groups with normal ejection fraction even in the presence of relaxation abnormalities and heart failure. Mechanistically, KE reflects the acceleration imparted on the blood and is driven by variations in ventricular emptying and filling rates, volumes, and heart rate, regardless of underlying pathology.</p>}},
  author       = {{Arvidsson, Per Martin and Nelsson, Anders and Edlund, Jonathan and Smith, J Gustav and Magnusson, Martin and Jin, Ning and Heiberg, Einar and Carlsson, Marcus and Steding-Ehrenborg, Katarina and Arheden, Håkan}},
  issn         = {{1522-1601}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{3}},
  pages        = {{697--709}},
  publisher    = {{American Physiological Society}},
  series       = {{Journal of Applied Physiology}},
  title        = {{Kinetic energy of left ventricular blood flow across heart failure phenotypes and in subclinical diastolic dysfunction}},
  url          = {{http://dx.doi.org/10.1152/japplphysiol.00257.2022}},
  doi          = {{10.1152/japplphysiol.00257.2022}},
  volume       = {{133}},
  year         = {{2022}},
}