University of Queensland - IIT Delhi Academy of Research (UQIDAR), Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India; School of Mechanical and Mining Engineering, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India.
Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh.
Comput Biol Med. 2024 Sep;180:109019. doi: 10.1016/j.compbiomed.2024.109019. Epub 2024 Aug 16.
Recent clinical studies have reported that heart failure with preserved ejection fraction (HFpEF) can be divided into two phenotypes based on the range of ejection fraction (EF), namely HFpEF with higher EF and HFpEF with lower EF. These phenotypes exhibit distinct left ventricle (LV) remodelling patterns and dynamics. However, the influence of LV remodelling on various LV functional indices and the underlying mechanics for these two phenotypes are not well understood. To address these issues, this study employs a coupled finite element analysis (FEA) framework to analyse the impact of various ventricular remodelling patterns, specifically concentric remodelling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH), with and without LV wall thickening on LV functional indices. Further, the geometries with a moderate level of remodelling from each pattern are subjected to fibre stiffening and contractile impairment to examine their effect in replicating the different features of HFpEF. The results show that with severe CR, LV could exhibit the characteristics of HFpEF with higher EF, as observed in recent clinical studies. Controlled fibre stiffening can simultaneously increase the end-diastolic pressure (EDP) and reduce the peak longitudinal strain (e) without significant reduction in EF, facilitating the moderate CR geometries to fit into this phenotype. Similarly, fibre stiffening can assist the CH and 'EH with wall thickening' cases to replicate HFpEF with lower EF. These findings suggest that potential treatment for these two phenotypes should target the bio-origins of their distinct ventricular remodelling patterns and the extent of myocardial stiffening.
最近的临床研究报告指出，射血分数保留型心力衰竭（HFpEF）可以根据射血分数（EF）范围分为两种表型，即 EF 较高的 HFpEF 和 EF 较低的 HFpEF。这些表型表现出不同的左心室（LV）重塑模式和动力学。然而，LV 重塑对各种 LV 功能指标的影响以及这两种表型的潜在力学机制尚不清楚。为了解决这些问题，本研究采用耦合有限元分析（FEA）框架来分析各种心室重塑模式（包括同心重塑（CR）、同心肥厚（CH）和偏心肥厚（EH））对 LV 功能指标的影响，以及有无 LV 壁增厚。此外，对每个模式下具有中度重塑程度的几何形状进行纤维僵硬和收缩损伤，以检查它们在复制 HFpEF 不同特征方面的效果。结果表明，严重的 CR 可使 LV 表现出 EF 较高的 HFpEF 特征，这与最近的临床研究一致。受控纤维僵硬可以在不显著降低 EF 的情况下同时增加舒张末期压力（EDP）并降低峰值纵向应变（e），使中度 CR 几何形状更符合这种表型。同样，纤维僵硬可以帮助 CH 和“有壁增厚的 EH”病例复制 EF 较低的 HFpEF。这些发现表明，针对这两种表型的潜在治疗方法应针对其不同的心室重塑模式的生物起源和心肌僵硬程度。
