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Exploring Novel Aspects of Cardiac Mechanics Using Exercise CMR

Edlund, Jonathan LU orcid (2025) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Heart failure is a global health concern whose burden is increasing as our population ages. Early diagnosis and accurate prognosis are critical for improving outcomes, highlighting the need for novel methods that can better identify and elucidate the pathophysiology of heart failure. The cardinal symptom of heart failure is exercise intolerance, yet most cardiac imaging is performed at rest, potentially overlooking abnormalities that manifest only during exertion. This thesis aimed to advance the noninvasive assessment of cardiac function at rest and during exercise by exploring novel cardiac mechanics using cardiovascular magnetic resonance (CMR).

Four studies were conducted. Study I validated a method that greatly accelerates... (More)
Heart failure is a global health concern whose burden is increasing as our population ages. Early diagnosis and accurate prognosis are critical for improving outcomes, highlighting the need for novel methods that can better identify and elucidate the pathophysiology of heart failure. The cardinal symptom of heart failure is exercise intolerance, yet most cardiac imaging is performed at rest, potentially overlooking abnormalities that manifest only during exertion. This thesis aimed to advance the noninvasive assessment of cardiac function at rest and during exercise by exploring novel cardiac mechanics using cardiovascular magnetic resonance (CMR).

Four studies were conducted. Study I validated a method that greatly accelerates the analysis of noninvasive, CMR-derived pressure-volume (PV) loops. This method was then applied across healthy volunteers, individuals with subclinical diastolic dysfunction, and heart failure subtypes, and it showed results comparable to those obtained using invasive methods. Study II developed an algorithm that enables analysis of free-breathing, non-ECG-gated, real-time CMR images acquired during exercise. This was validated against conventional gated cine imaging for left ventricular mass and volumes at rest and during exercise.

Using these tools, Study III assessed hydraulic forces, a novel mechanism of diastolic function, by measuring the atrioventricular area difference (AVAD) in athletes and sedentary controls using exercise CMR. End-diastolic AVAD increased from rest to moderate exercise in both groups, indicating that the net hydraulic force augments diastolic filling during exertion. In contrast, Study IV showed that in heart failure, end-diastolic AVAD decreased with exercise, suggesting a diminished hydraulic contribution to filling.

Collectively, these findings further our understanding of the role of diastolic hydraulic forces during exercise in both the healthy and the failing heart and advance the methods for CMR-derived, noninvasive PV loop analysis as well as exercise CMR. (Less)
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author
supervisor
opponent
  • Professor, M.D. Baggish, Aaron, University of Lausanne, Vaud, Switzerland
organization
publishing date
type
Thesis
publication status
published
subject
keywords
cardiovascular magnetic resonance imaging, heart failure, pressure-volume loops, exercise imaging, exercise physiology, hydraulic forces, atrioventricular area difference
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2025:128
pages
132 pages
publisher
Lund University, Faculty of Medicine
defense location
Föreläsningssal 1, Centralblocket, Entrégatan 7, Skånes Universitetssjukhus i Lund
defense date
2025-11-28 09:00:00
ISSN
1652-8220
ISBN
1652-8220
language
English
LU publication?
yes
id
ddafe3f3-64dc-4b88-92a8-64e5b4b96f4e
date added to LUP
2025-11-03 10:17:50
date last changed
2025-11-06 12:09:17
@phdthesis{ddafe3f3-64dc-4b88-92a8-64e5b4b96f4e,
  abstract     = {{Heart failure is a global health concern whose burden is increasing as our population ages. Early diagnosis and accurate prognosis are critical for improving outcomes, highlighting the need for novel methods that can better identify and elucidate the pathophysiology of heart failure. The cardinal symptom of heart failure is exercise intolerance, yet most cardiac imaging is performed at rest, potentially overlooking abnormalities that manifest only during exertion. This thesis aimed to advance the noninvasive assessment of cardiac function at rest and during exercise by exploring novel cardiac mechanics using cardiovascular magnetic resonance (CMR).<br/><br/>Four studies were conducted. Study I validated a method that greatly accelerates the analysis of noninvasive, CMR-derived pressure-volume (PV) loops. This method was then applied across healthy volunteers, individuals with subclinical diastolic dysfunction, and heart failure subtypes, and it showed results comparable to those obtained using invasive methods. Study II developed an algorithm that enables analysis of free-breathing, non-ECG-gated, real-time CMR images acquired during exercise. This was validated against conventional gated cine imaging for left ventricular mass and volumes at rest and during exercise.<br/><br/>Using these tools, Study III assessed hydraulic forces, a novel mechanism of diastolic function, by measuring the atrioventricular area difference (AVAD) in athletes and sedentary controls using exercise CMR. End-diastolic AVAD increased from rest to moderate exercise in both groups, indicating that the net hydraulic force augments diastolic filling during exertion. In contrast, Study IV showed that in heart failure, end-diastolic AVAD decreased with exercise, suggesting a diminished hydraulic contribution to filling.<br/><br/>Collectively, these findings further our understanding of the role of diastolic hydraulic forces during exercise in both the healthy and the failing heart and advance the methods for CMR-derived, noninvasive PV loop analysis as well as exercise CMR.}},
  author       = {{Edlund, Jonathan}},
  isbn         = {{1652-8220}},
  issn         = {{1652-8220}},
  keywords     = {{cardiovascular magnetic resonance imaging; heart failure; pressure-volume loops; exercise imaging; exercise physiology; hydraulic forces; atrioventricular area difference}},
  language     = {{eng}},
  number       = {{2025:128}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Exploring Novel Aspects of Cardiac Mechanics Using Exercise CMR}},
  url          = {{https://lup.lub.lu.se/search/files/232047614/Avhandling_Jonathan_Edlund_LUCRIS.pdf}},
  year         = {{2025}},
}