Global longitudinal strain and circumferential strain are found to be reduced in HFpEF, which some have interpreted that the global left ventricular (LV) contractility is impaired. This finding is, however, contradicted by a preserved ejection fraction (EF) and confounded by changes in LV geometry and afterload resistance that may also affect the global strains. To reconcile these issues, we used a validated computational framework consisting of a finite element LV model to isolate the effects of HFpEF features in affecting systolic function metrics. Simulations were performed to quantify the effects on myocardial strains due to changes in LV geometry, active tension developed by the tissue, and afterload. We found that only a reduction in myocardial contractility and an increase in afterload can simultaneously reproduce the blood pressures, EF and strains measured in HFpEF patients. This finding suggests that it is likely that the myocardial contractility is reduced in HFpEF patients.

发现 HFpEF 的整体纵向应变和周向应变降低，一些人将其解释为整体左心室 (LV) 收缩力受损。然而，这一发现与保留的射血分数 (EF) 相矛盾，并且与 LV 几何形状和后负荷阻力的变化相混淆，这些变化也可能影响整体应变。为了调和这些问题，我们使用了一个经过验证的计算框架，该框架由一个有限元 LV 模型组成，以隔离 HFpEF 特征对影响收缩功能指标的影响。执行模拟以量化由于 LV 几何形状、组织产生的主动张力和后负荷的变化对心肌应变的影响。我们发现只有降低心肌收缩力和增加后负荷才能同时重现血压，在 HFpEF 患者中测量的 EF 和应变。这一发现表明，HFpEF 患者的心肌收缩力可能降低。