Exploration of Cardiology

Table 1. Summary of the published studies on HDF

Study population	Method	Parameters	Period of the cardiac cycle analyzed	Findings (as reported in the abstract of the article)	Reference
Healthy subjects, DCM	CMR	Sax-max/Lax-max force ratio	Entire diastole; early filling phase; late filling phase	The LV hemodynamic filling forces showed a similar temporal progression among healthy subjects, whereas DCM patients had forces that were more heterogeneous in their direction and magnitude during diastole	[16]
Healthy volunteers/athletes	CMR	Peak values; average amplitude (RMS); early diastolic filling impulse	First third of systole; middle third of early filling; final third of atrial contraction; systole; diastole; E-wave; A-wave	Force patterns were similar between healthy subjects and athletes, indicating potential utility as a cardiac function biomarker	[10]
Heart failure with LBBB	CMR	Sax-max force/Lax-max force; average amplitude (RMS)	Entire diastole; early filling phase; late filling phase	HDF may serve as an additional tool for considering the risks imposed by conduction abnormalities in heart failure patients and prove to be useful in predicting response to CRT	[13]
CRT	Echo	RMS longitudinal; RMS transversal; RMS transversal/RMS longitudinal	Entire cardiac cycle	Pacing-induced realignment of HDFs is associated with CRT efficacy at follow-up	[22]
Heart failure	CMR	Average amplitude (RMS); peak forces; in the transverse plane and the apical-to-basal direction	Entire cardiac cycle	LV hemodynamic forces noninvasively computed using the newly developed mathematic model may significantly improve the detection of early myocardial systolic dysfunction when volumetric and deformation cardiac measures are still intact	[12]
Healthy volunteers	Echo	Average amplitude (RMS); LV impulse (AUC)	Entire cardiac cycle; systolic phase; LV suction	This approach could differentiate normality from pathology by providing average HDF parameters, differentiated by age and gender	[7]
Healthy volunteers	Echo	Longitudinal; transverse; systolic impulse (AUC); systolic peak of the longitudinal forces; average amplitude (RMS); angle (orientation)	Entire cardiac cycle; systole; diastole	Knowledge of the physiologic range of LV HDF may prompt their implementation into the clinical routine and allow a more comprehensive assessment of the LV function	[9]
Diastolic dysfuntion	Echo	Mean amplitude of the longitudinal forces (RMS)	Diastole	A scoring system including HDFs might improve the accuracy of echocardiography in estimating LV filling pressures	[26]
HFpEF	CMR	Average amplitude (RMS); peak forces; in the transverse plane and the apical-to-basal direction	Entire cardiac cycle; systole; diastole; with/without volume normalization	LV hemodynamic force analysis, whether indexed to LV volumes or not, is not ready for clinical trials on HFpEF assessment	[15]
Post-MI	CMR	Average amplitude (RMS); longitudinal (A-B) HDFs; horizontal (L-S) HDFs; L-S/A-B HDFs ratio; angle (orientation)	Entire cardiac cycle; systole; diastole	Misalignment of diastolic hemodynamic forces after STEMI is associated with adverse LV remodeling after 4 months	[23]
HFrEF	Echo	Average amplitude (RMS); longitudinal (A-B) HDFs; horizontal (L-S) HDFs; L-S/A-B HDFs ratio; angle (orientation)	Entire cardiac cycle; systole; diastole	In patients with HFrEF, therapy with sacubitril/valsartan improves HDF distribution	[28]
HFpEF	CMR	Average amplitude (RMS); peak systolic HDF; systolic impulse (AUC); systolic–diastolic transition (LV deceleration and LV suction)	Entire cardiac cycle; early diastolic filling/diastolic deceleration; late diastolic filling/atrial thrust; early diastolic filling/late diastolic filling	Assessment of HDF indicates impairment of LV systolic ejection force in HFpEF which is associated with cardiovascular events	[14]
CRT	CMR	Average amplitude (RMS); A-B strength; L-S strength; I-A strength	Entire cardiac cycle; systole; diastole	HDF parameters can predict the response to CRT in heart failure patients, aiding in the selection of candidates who are more likely to benefit from the therapy	[21]
CRT	Echo	Average amplitude (RMS); A-B strength; L-S strength; L-S/A-B ratio; angle (orientation); systolic impulse (AUC)	Entire cardiac cycle; systolic thrust	HDF in CRT recipients reflect the acute effect of CRT and the effect of LV reverse remodeling on intraventricular pressure gradients. Whether HDF analysis provides incremental value over established Echo parameters, remains to be determined	[19]
Dilated cardiomyopathy	CMR	IVPG	Entire cardiac cycle; systolic ejection; isovolumic relaxation; E-wave deceleration; A-wave acceleration	In the absence of pressure reversal, lower systolic ejection force, E-wave decelerative force, and overall LV-IVPG are powerful predictors of outcome, independent of clinical and imaging parameters	[17]
After TAVI	Echo	Average amplitude (RMS); angle (orientation); systolic impulse (AUC); time from R wave to peak systole; time of transition; time from the start of relaxation to positive peak of diastolic	Entire cardiac cycle; systolic phase; transition; suction	Echo analysis of HDFs could help differentiate patients with LV function recovery after TAVI from patients with persistent hemodynamic dysfunction	[25]
CRT	Echo	Average amplitude (RMS); A-B strength; L-S strength; angle (orientation); systolic impulse (AUC)	Entire cardiac cycle; systolic thrust	Six months after CRT, the orientation of HDF improves in LV responders and LV non-responders, while the magnitude of A-B HDF only improves in LV responders	[19]
Healthy volunteers	CMR	Average amplitude (RMS); L-S/A-B HDF ratio; LV impulse (AUC)	Entire cardiac cycle; systole; diastole; systolic/diastolic transition; diastolic deceleration; atrial thrust	The study provided comprehensive normal values of HDF assessments with specific age and sex stratification	[8]
Post-aortic coarctation repair	Echo	Average amplitude (RMS); LV impulse (AUC)	Entire cardiac cycle; systolic phase; LV suction	Patients with coarctation of the aorta had lower LV myocardial strain and HDF parameters values, independently associated with hospitalization for heart failure	[24]
Athletes, hypertensive patients	CMR	Average amplitude (RMS); longitudinal (A-B) HDFs; horizontal (L-S) HDFs; L-S/A-B HDFs ratio; angle (orientation); hemodynamic work (AUC); peak; duration	Entire cardiac cycle; systolic phase; suction; early LV filling; atrial thrust	HDF allows distinction between the hemodynamic patterns of athletes and patients with hypertension	[11]
Non-ischemic LV cardiomyopathy	CMR	Unsupervised clustering of longitudinal and transversal HDF	Entire cardiac cycle	Analyzing both longitudinal and transversal HDF throughout the cardiac cycle enables the identification of distinct phenotypes with prognostic value beyond EF and LGE in non-ischemic LV cardiomyopathy	[18]

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A-B: apical-basal; AUC: area under the curve; CMR: cardiac magnetic resonance; CRT: cardiac resynchronization therapy; DCM: dilated cardiomyopathy; Echo: echocardiographic; EF: ejection fraction; HDF: hemodynamic forces; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; I-A: inferior-anterior; IVPG: intraventricular pressure gradients; L-S: lateral-septal; LBBB: left bundle branch block; LGE: late gadolinium enhancement; LV: left ventricular; RMS: root mean square; STEMI: S-T segment elevation myocardial infarction; TAVI: transcatheter aortic valve implantation

Declarations

Author contributions

AS: Conceptualization, Writing—original draft, Writing—review & editing, Supervision. GT: Conceptualization, Writing—review & editing. AZ, BT, ZK, and DJ: Validation. NZ: Visualization, Validation.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Not applicable.

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Not applicable.

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Not applicable.

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Funding

This work was supported by the Ministry of Science and Higher Education of the Republic of Kazakhstan [AP23490021]. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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