Aortic flow is abnormal in HFpEF

Zia Mehmood, Hosamadin Assadi, Rui Li, Bahman Kasmai, Gareth Matthews, Ciaran Grafton-Clarke, Aureo Sanz-Cepero, Xiaodan Zhao, Liang Zhong, Nay Aung, Kristian Skinner, Charaka Hadinnapola, Peter Swoboda, Andrew j. Swift, Vassilios s Vassiliou, Christopher Miller, Rob j. Van der geest, Steffen Peterson, Pankaj Garg

Research output: Contribution to journalArticlepeer-review


Turbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF.

This case-controlled observational study used two-dimensional phase-contrast cardiovascular magnetic resonance data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10).

Differences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF.HFpEF had significantly higher FDsavg versus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001).

Aortic flow haemodynamics namely FDsavg and sFRR are significantly affected in ageing and HFpEF patients.
Original languageEnglish
Article number577
JournalWellcome Open Research
Early online date15 Dec 2023
Publication statusE-pub ahead of print - 15 Dec 2023


  • Magnetic Resonance Imaging
  • Aortic Flow
  • Haemodynamics
  • HFpEF
  • Cardiac Output


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