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Gustav Smith

Associate professor

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

Author

  • Per Martin Arvidsson
  • Anders Nelsson
  • Jonathan Edlund
  • J Gustav Smith
  • Martin Magnusson
  • Ning Jin
  • Einar Heiberg
  • Marcus Carlsson
  • Katarina Steding-Ehrenborg
  • Håkan Arheden

Summary, in English

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.

Department/s

  • Lund Cardiac MR Group
  • Clinical Physiology (Lund)
  • WCMM-Wallenberg Centre for Molecular Medicine
  • Heart Failure and Mechanical Support
  • Cardiovascular Epigenetics
  • Cardiology
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Molecular Epidemiology and Cardiology
  • Cardiovascular Research - Hypertension
  • eSSENCE: The e-Science Collaboration

Publishing year

2022-08-29

Language

English

Pages

697-709

Publication/Series

Journal of Applied Physiology

Volume

133

Issue

3

Document type

Journal article

Publisher

American Physiological Society

Topic

  • Cardiac and Cardiovascular Systems

Status

Published

Project

  • Advanced CMR analysis: from pixels to physiology

Research group

  • Lund Cardiac MR Group
  • Heart Failure and Mechanical Support
  • Cardiovascular Epigenetics
  • Molecular Epidemiology and Cardiology
  • Cardiovascular Research - Hypertension

ISBN/ISSN/Other

  • ISSN: 1522-1601