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Gustav Smith

Associate professor

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Hydraulic force is a novel mechanism of diastolic function which may contribute to decreased diastolic filling in HFpEF and facilitate filling in HFrEF


  • Katarina Steding-Ehrenborg
  • Erik Hedström
  • Marcus Carlsson
  • Elira Maksuti
  • Michael Broomé
  • Martin Ugander
  • Martin Magnusson
  • J Gustav Smith
  • Håkan Arheden

Summary, in English

BACKGROUND: A hydraulic force generated by blood moving the atrio-ventricular plane is a novel mechanism of diastolic function. The direction and magnitude of the force is dependent on the geometrical relationship between the left atrium and ventricle and is measured as the short-axis atrio-ventricular area difference (AVAD). In short, the net hydraulic force acts from a larger area towards a smaller. It is currently unknown how cardiac remodeling affects this mechanism. The aim of the study was therefore to investigate this diastolic mechanism in patients with pathological or physiological remodeling.

METHODS: 70 subjects (n=11 heart failure with preserved ejection fraction (HFpEF), n=10 heart failure with reduced ejection fraction (HFrEF), n=7 signs of isolated diastolic dysfunction, n=10 hypertrophic cardiomyopathy (HCM), n=10 cardiac amyloidosis, n=18 triathletes and n=14 controls) were included. Subjects underwent Cardiac MR and short-axis images of the left atrium and ventricle were delineated. AVAD was calculated as ventricular area minus atrial area and used as an indicator of net hydraulic force.

RESULTS: At the onset of diastole, AVAD in HFpEF was median -9.2 cm2 versus -4.4 cm2 in controls, p=0.02). The net hydraulic force was directed towards the ventricle for both, but larger in HFpEF. HFrEF was the only group with a positive median value 11.6 cm2 and net hydraulic force was throughout diastole directed towards the atrium.

CONCLUSION: The net hydraulic force may impede cardiac filling throughout diastole in HFpEF, worsening diastolic dysfunction. In contrast, it may work favorably in patients with dilated ventricles and aid ventricular filling.


  • Human Movement: health and rehabilitation
  • Lund Cardiac MR Group
  • Pediatrisk radiologi
  • Diagnostic Radiology, (Lund)
  • Clinical Physiology (Lund)
  • WCMM-Wallenberg Centre for Molecular Medicine
  • Cardiovascular Research - Hypertension
  • EpiHealth: Epidemiology for Health
  • Heart Failure and Mechanical Support
  • Cardiovascular Epigenetics
  • Cardiology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Molecular Epidemiology and Cardiology

Publishing year







Journal of Applied Physiology





Document type

Journal article


American Physiological Society


  • Cardiac and Cardiovascular Systems



Research group

  • Human Movement: health and rehabilitation
  • Lund Cardiac MR Group
  • Pediatrisk radiologi
  • Cardiovascular Research - Hypertension
  • Heart Failure and Mechanical Support
  • Cardiovascular Epigenetics
  • Molecular Epidemiology and Cardiology


  • ISSN: 1522-1601