Rate acceleration in heart failure with preserved ejection fraction: towards different strokes for different folks
Year: 2025
Type: article
Abstract: This commentary refers to ‘Accelerated atrial pacing reduces left-heart filling pressure: a combined clinical-computational study’, by T. van Loon et al., https://doi.org/10.1093/eurheartj/ehae718 and the discussion piece ‘Increasing heart rate in heart failure with preserved ejection fraction: a sensible way to go?’, by P. Sen et al., https://doi.org/10.1093/eurheartj/ehaf109. We appreciate the thoughtful commentary by Sen et al. on our work investigating heart rate acceleration in heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation. Their insights raise important considerations that merit further discussion. The authors raise a methodological concern regarding the generalizability of computer modelling, questioning whether accuracy in simulating one physiological parameter guarantees equivalent response across related cardiac variables. It is important to realize that our computational approach fundamentally differs from statistical modelling or data fitting. CircAdapt integrates well-established physical laws and the physiological principles that govern cardiac and vascular mechanics, haemodynamics, and tissue properties in a closed-loop model of the human heart and circulation. When the model replicates an observed haemodynamic response to, for example a pacing intervention, this match arises naturally from these underlying biophysical principles rather than from parameter tuning. While the model's predictive capacity has been extensively validated across a wide range of cardiac conditions and pacing strategies,1,2 we acknowledge that computational results alone cannot replace in vivo validation. Rather, these simulations serve as valuable tools to understand underlying mechanisms and generate well-founded hypotheses for subsequent clinical studies. This is particularly relevant as emerging digital twin technologies3 enable model parameterization to be personalized to individual patient characteristics, creating a precise ‘cardiovascular fingerprint’ that could guide therapeutic optimization. This approach has the potential to transform our simulations from general mechanistic explorations into clinically relevant tools for treatment planning, while remaining firmly grounded in fundamental cardiovascular physiology.
Source: European Heart Journal
Authors: Tim van Loon, Kevin Vernooy, Joost Lumens
Institution: Maastricht University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4408846329