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Atrioventricular Area Difference Assessed by Exercise Cardiovascular Magnetic Resonance Shows Impaired Diastolic Filling in Heart Failure Patients

Edlund, Jonathan LU orcid ; Östenson, Björn LU orcid ; Åkesson, Julius LU ; Heiberg, Einar LU orcid ; Arheden, Håkan LU and Steding-Ehrenborg, Katarina LU (2026) In Journal of Applied Physiology
Abstract

Heart failure (HF) is a complex clinical syndrome characterized by exercise intolerance. However, most diagnostic assessments are performed at rest, when many patients are asymptomatic. To better understand the underlying pathophysiology, examination during exercise is needed. Hydraulic force, a newly identified mechanism of diastolic filling, is proportional to the difference in short-axis areas between the left ventricle and atrium, known as the atrioventricular area difference (AVAD). While hydraulic force has been shown to augment diastolic filling during exercise in healthy individuals, its role in HF during exercise remains unexplored. This study aimed to investigate whether hydraulic forces impair or augment diastolic filling in... (More)

Heart failure (HF) is a complex clinical syndrome characterized by exercise intolerance. However, most diagnostic assessments are performed at rest, when many patients are asymptomatic. To better understand the underlying pathophysiology, examination during exercise is needed. Hydraulic force, a newly identified mechanism of diastolic filling, is proportional to the difference in short-axis areas between the left ventricle and atrium, known as the atrioventricular area difference (AVAD). While hydraulic force has been shown to augment diastolic filling during exercise in healthy individuals, its role in HF during exercise remains unexplored. This study aimed to investigate whether hydraulic forces impair or augment diastolic filling in HF patients during exercise, using AVAD measurements from exercise cardiovascular magnetic resonance (CMR) imaging. We examined 13 healthy volunteers and 22 HF patients at rest and during exercise using a CMR-compatible ergometer. AVAD was measured at end-systole (ES) and end-diastole (ED). In HF patients, AVAD at ED decreased during exercise (from 17±5 cm2 to 15±6 cm2, p = 0.006), whereas it increased in healthy volunteers (from 16±3 cm2 to 17±3 cm2, p = 0.014). AVAD at ES decreased in both HF (from -2±5 cm2 to -8±5 cm2, p < 0.001) and healthy volunteers (from -3±2 cm2 to -5±3 cm2, p = 0.011). In conclusion, the results suggest impaired diastolic function during exercise in HF through reduced hydraulic force compared to rest. These findings provide new mechanistic insights and may partly explain the hallmark symptom of exercise intolerance in heart failure.

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; ; ; ; and
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Contribution to journal
publication status
epub
subject
in
Journal of Applied Physiology
publisher
American Physiological Society
external identifiers
  • pmid:41592758
ISSN
1522-1601
DOI
10.1152/japplphysiol.00858.2025
language
English
LU publication?
yes
id
d2bb5eb3-e361-43d9-b905-2ae3d9346d1c
date added to LUP
2026-01-29 09:49:49
date last changed
2026-01-29 09:59:59
@article{d2bb5eb3-e361-43d9-b905-2ae3d9346d1c,
  abstract     = {{<p>Heart failure (HF) is a complex clinical syndrome characterized by exercise intolerance. However, most diagnostic assessments are performed at rest, when many patients are asymptomatic. To better understand the underlying pathophysiology, examination during exercise is needed. Hydraulic force, a newly identified mechanism of diastolic filling, is proportional to the difference in short-axis areas between the left ventricle and atrium, known as the atrioventricular area difference (AVAD). While hydraulic force has been shown to augment diastolic filling during exercise in healthy individuals, its role in HF during exercise remains unexplored. This study aimed to investigate whether hydraulic forces impair or augment diastolic filling in HF patients during exercise, using AVAD measurements from exercise cardiovascular magnetic resonance (CMR) imaging. We examined 13 healthy volunteers and 22 HF patients at rest and during exercise using a CMR-compatible ergometer. AVAD was measured at end-systole (ES) and end-diastole (ED). In HF patients, AVAD at ED decreased during exercise (from 17±5 cm2 to 15±6 cm2, p = 0.006), whereas it increased in healthy volunteers (from 16±3 cm2 to 17±3 cm2, p = 0.014). AVAD at ES decreased in both HF (from -2±5 cm2 to -8±5 cm2, p &lt; 0.001) and healthy volunteers (from -3±2 cm2 to -5±3 cm2, p = 0.011). In conclusion, the results suggest impaired diastolic function during exercise in HF through reduced hydraulic force compared to rest. These findings provide new mechanistic insights and may partly explain the hallmark symptom of exercise intolerance in heart failure.</p>}},
  author       = {{Edlund, Jonathan and Östenson, Björn and Åkesson, Julius and Heiberg, Einar and Arheden, Håkan and Steding-Ehrenborg, Katarina}},
  issn         = {{1522-1601}},
  language     = {{eng}},
  month        = {{01}},
  publisher    = {{American Physiological Society}},
  series       = {{Journal of Applied Physiology}},
  title        = {{Atrioventricular Area Difference Assessed by Exercise Cardiovascular Magnetic Resonance Shows Impaired Diastolic Filling in Heart Failure Patients}},
  url          = {{http://dx.doi.org/10.1152/japplphysiol.00858.2025}},
  doi          = {{10.1152/japplphysiol.00858.2025}},
  year         = {{2026}},
}