Full-Spectrum Heart Failure Management by Tracking Performance of Multiple Cardiac Chambers via Cardiac Time Intervals

Abstract

Congestive heart failure (CHF) encompasses both reduced and preserved ejection fraction phenotypes. Modern management increasingly demands actionable insights into cardiac function beyond standard vitals. Cardiac time intervals (CTIs), including mitral valve closure (MVC), aortic valve opening (AVO), aortic valve closure (AVC), and mitral valve opening (MVO), as well as isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT), offer a window into the electromechanical timing of systole and diastole. These intervals provide clinically relevant markers of systolic function, diastolic filling dynamics, and chamber compliance. In HFrEF (reduced ejection fraction), CTI monitoring captures deterioration in contractile efficiency; in HFpEF (preserved ejection fraction), diastolic stiffness and shortened filling times can be tracked. Remote CTI monitoring facilitates timely therapy adjustments, prevents hospitalizations, empowers patients in their disease management, and provides clinicians with early warning signals of worsening physiology. CTIs enable a comprehensive, non-invasive assessment of cardiac chamber performance. This is especially relevant across the full spectrum of heart failure, including both HFrEF and HFpEF. The ability to deliver precise cardiac timing data outside of traditional clinical settings makes it a transformative tool for proactive, physiology-based heart failure management.

Keywords

Heart failure (HF) / Acute decompensated heart failure (ADHF) / Multiple cardiac chamber performance / Cardiac time interval (CTIs) / NT-proBNP / Remote management / Wearable device / Non-invasive monitoring

Acknowledgments

The authors acknowledge Aventusoft LLC for providing administrative and technical support, as well as access to relevant technical and clinical information related to the HEMOTAG system that informed portions of this manuscript.

Statement of the Use of Generative AI and AI-Assisted Technologies in the Writing Process

During the preparation of this manuscript, the authors used ChatGPT in order to review language, clarity and grammar of the text. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.

Author Contributions

R.C., F.R.T., J.E.P. and D.S. contributed to the conceptualization, review, and editing of the manuscript. Authors provided critical input, approved the final version, and agree to be accountable for all aspects of the work.

Ethics Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The data are protected under SBIR data protection guidelines for a period of up to 20 years and are therefore not publicly available. Access may be granted by the corresponding author upon reasonable request and with permission from the funding agency.

Funding

This research was funded by the National Heart, Lung, And Blood Institute grant number R44HL145941 and R44HL149561.

Declaration of Competing Interest

None of the authors have any conflicts of interest, financial or otherwise, to declare in regard to this study.

References

[1] Chait R, Ramos Tuarez F, Pino JE, Uppal D, Snipelisky D . Non—Invasive Evaluation by the HEMOTAGTM Recording Device to Tailor Treatment of Acutely Decompensated Heart Failure. Cardiovasc. Sci. 2025, 2, 10007. DOI: 10.70322/cvs.2025.10007

[2] Nudelman BG, Tejeda APT, Patsias I . HEMOTAG: A Novel Non—Invasive Device for Reducing Hospital Readmissions in Acute Decompensated Heart Failure Patients. J. Card. Fail. 2026, 32, 291. DOI: 10.1016/j.cardfail.2025.11.297

[3] Nudelman BG, Patsias I . Remote monitoring with HEMOTAG: Preventing heart failure readmissions through early detection of atrial flutter. JACC 2025, 85(Suppl. S12), 3895. DOI: 10.1016/S0735—1097(25)04379—7

[4] Uppal D, Sanchez A, Lewis A, Juan C, Alonso M, Estep JD, et al. Use of HEMOTAG cardiopulmonary assessment system for predicting clinical decompensation in heart failure in the inpatient setting. J. Am. College Cardiol. 2024, 83, 3569. DOI: 10.1016/s0735—1097(24)05559—1

[5] Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, et al. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res. Pract. 2024, 11, 16. DOI: 10.1186/s44156—024—00051—2

[6] Pollock JD, Makaryus AN . Physiology, Cardiac Cycle. National Library of Medicine. Published 3 October 2022. Available online: https://www.ncbi.nlm.nih.gov/books/NBK459327/ (accessed on 5 December 2025).

[7] Tsutsui H, Urabe Y, Mann DL, Tagawa H, Carabello BA, Cooper G, et al. Effects of chronic mitral regurgitation on diastolic function in isolated cardiocytes. Circ. Res. 1993, 72, 1110-1123. DOI: 10.1161/01.RES.72.5.1110

[8] Biering—Sørensen T. Cardiac Time Intervals by Tissue Doppler Imaging M—mode echocardiography: Reproducibility, Reference values, Association with Clinical Characteristics and Prognostic Implications. Dan. Med. J. 2016, 63, B5279. Available online: https://www.researchgate.net/profile/Tor—Biering—Sorensen/publication/305903418_Cardiac_time_intervals_by_tissue_Doppler_imaging_M—mode_echocardiography_reproducibility_reference_values_association_with_clinical_characteristics_and_prognostic_implications/links/57a6177508aefe6167b69740/Cardiac—time—intervals—by—tissue—Doppler—imaging—M—mode—echocardiography—reproducibility—reference—values—association—with—clinical—characteristics—and—prognostic—implications.pdf (accessed on 5 December 2025).

[9] Alhakak AS, Sengeløv M, Jørgensen PG, Bruun NE, Johnsen C, Abildgaard U, et al. Left ventricular systolic ejection time is an independent predictor of all—cause mortality in heart failure with reduced ejection fraction. Eur. J. Heart Fail. 2022, 23, 240-249. DOI: 10.1002/ejhf.2022

[10] Alhakak AS, Teerlink JR, Lindenfeld J, Böhm M, Rosano GMC, Biering—Sørensen T . The Significance of Left Ventricular Ejection Time in Heart Failure with Reduced Ejection Fraction. Eur. J. Heart Fail. 2021, 23, 541-551. DOI: 10.1002/ejhf.2125

[11] Napoli N . CardioMEMS Sensor Reliably Safe, Cuts Hospitalizations by More than Half. American College of Cardiology. Published 17 March 2019. Available online: https://www.acc.org/about—acc/press—releases/2019/03/17/09/05/cardiomems—sensor—reliably—safe (accessed on 5 December 2025).

[12] CardioMEMS HF System Clinical Evidence. Cardiovascular Abbott. Zamani. Available online: https://www.cardiovascular.abbott/us/en/hcp/products/heart—failure/pulmonary—pressure—monitors/cardiomems/clinical—evidence.html (accessed on 5 December 2025).

[13] Sohn DW . Heart Failure Due to Abnormal Filling Function of the Heart. J. Cardiol. 2011, 57, 148-159. DOI: 10.1016/j.jjcc.2011.01.001

[14] Lala A, Barghash MH, Giustino G, Alvarez—Garcia J, Konje S, Parikh A, et al. Early Use of Remote Dielectric Sensing After Hospitalization to Reduce Heart Failure Readmissions. ESC Heart Fail. 2021, 8, 1047-1054. DOI: 10.1002/ehf2.13026

[15] Nishimura RA, Tajik AJ . Evaluation of Diastolic Filling of Left Ventricle in Health and Disease: Doppler Echocardiography Is the Clinician’s Rosetta Stone. J. Am. Coll. Cardiol. 1997, 30, 8-18. DOI: 10.1016/S0735—1097(97)00144—7

[16] Aziz F, Luqman—Arafath TK, Enweluzo C, Dutta S, Zaeem M . Diastolic Heart Failure: A Concise Review. J. Clin. Med. Res. 2013, 5, 327. DOI: 10.4021/jocmr1532w

[17] Weissler AM, Stack RS, Lee CC, Reddy BP, Taylor ML . Left ventricular performance in coronary artery disease by systolic time intervals and echocardiography. Trans. Am. Clin. Climatol. Assoc. 1976, 87, 36-47.

[18] Reant P, Dijos M, Donal E, Mignot A, Ritter P, Bordachar P, et al. Systolic time intervals as simple echocardiographic parameters of left ventricular systolic performance: correlation with ejection fraction and longitudinal two—dimensional strain. Eur. J. Echocardiogr. 2010, 11, 834-844. DOI: 10.1093/ejechocard/jeq084

[19] Oki T, Miyoshi H, Oishi Y, Iuchi A, Kusunose K, Yamada H, et al. Heart Failure With Preserved Ejection Fraction―Time for a Paradigm Shift Beyond Diastolic Function ―. Circ. Rep. 2019, 1, 8-16. DOI: 10.1253/circrep.CR—18—0017

[20] Mayo Clinic . Heart Failure with Preserved Ejection Fraction (HFpEF): More Than Diastolic Dysfunction. Published 20 May 2015. Available online: https://www.mayoclinic.org/medical—professionals/cardiovascular—diseases/news/heart—failure—with—preserved—ejection—fraction—hfpef—more—than—diastolic—dysfunction/mac—20430055 (accessed on 5 December 2025).

[21] Patel PA, Ambrosy AP, Phelan M, Alenezi F, Chiswell K, Van Dyke MK, et al. Association Between Systolic Ejection Time and Outcomes in Heart Failure by Ejection Fraction. Eur. J. Heart Fail. 2020, 22, 1174-1182. DOI: 10.1002/ejhf.1659

[22] Isovolumic Relaxation Time—An Overview. Available online: https://www.sciencedirect.com/topics/medicine—and—dentistry/isovolumic—relaxation—time (accessed on 5 December 2025).

[23] Kagami K, Obokata M, Harada T, Kato T, Wada N, Adachi T, et al. Diastolic Filling Time, Chronotropic Response, and Exercise Capacity in Heart Failure and Preserved Ejection Fraction With Sinus Rhythm. J. Am. Heart Assoc. 2022, 11. DOI: 10.1161/JAHA.121.026009

[24] Alhakak AS, Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Jørgensen PG, et al. Age— and sex—based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study. Clin. Res. Cardiol. 2023, 114, 430-442. DOI: 10.1007/s00392—023—02269—2

[25] Tavakolian K. Systolic Time Intervals and New Measurement Methods. Cardiovasc. Eng. Technol. 2016, 7, 118-125. DOI: 10.1007/s13239—016—0262—1

[26] Abraham WT, Adamson PB, Hasan A, Bourge RC, Pamboukian SV, Aaron MF, et al. Safety and accuracy of a wireless pulmonary artery pressure monitoring system in patients with heart failure. Am. Heart J. 2011, 161, 558-566. DOI: 10.1016/j.ahj.2010.10.041

[27] Rakita V. CardioMEMS^TM Device for Monitoring Advanced Heart Failure: 5 Things to Know . Temple Health. Published 16 December 2021. Available online: https://www.templehealth.org/about/blog/cardiomems—device—monitoring—advanced—heart—failure—5—things—to—know (accessed on 5 December 2025).

[28] Patel AH, Natarajan B, Pai RG . Current Management of Heart Failure with Preserved Ejection Fraction. Int. J. Angiol. 2022, 31, 166-178. DOI: 10.1055/s—0042—1756173

[29] Amir O, Ben—Gal T, Weinstein JM, Schliamser J, Burkhoff D, Abbo A, et al. Evaluation of remote dielectric sensing (ReDS) technology—guided therapy for decreasing heart failure re—hospitalizations. Int. J. Cardiol. 2017, 240, 279-284. DOI: 10.1016/j.ijcard.2017.02.120

[30] ReDS^TM Pro System Remote Dielectric Sensing . Sensible Medical. Published 15 January 2025. Available online: https://sensible—medical.com/solution/ (accessed on 5 December 2025).

[31] Adamson PB, Abraham WT, Bourge RC, Costanzo MR, Hasan A, Yadav C, et al. Wireless Pulmonary Artery Pressure Monitoring Guides Management to Reduce Decompensation in Heart Failure With Preserved Ejection Fraction. Circ. Heart Fail. 2014, 7, 935-944. DOI: 10.1161/CIRCHEARTFAILURE.113.001229

[32] Alvarez—Garcia J, Lala A, Rivas—Lasarte M, De Rueda C, Brunjes D, Lozano—Jimenez S, et al. Remote Dielectric Sensing Before and After Discharge in Patients With ADHF. JACC Heart Fail. 2024, 12, 695-706. DOI: 10.1016/j.jchf.2024.01.002

[33] Boehmer JP, Hariharan R, Devecchi FG, Smith AL, Molon G, Capucci A, et al. A Multisensor Algorithm Predicts Heart Failure Events in Patients With Implanted Devices. JACC Heart Fail. 2017, 5, 216-225. DOI: 10.1016/j.jchf.2016.12.011

[34] Singh JP, Wariar R, Ruble S, Kwan B, Averina V, Stolen CM, et al. Prediction of Heart Failure Events With the HeartLogic Algorithm: Real—World Validation. J. Card. Fail. 2024, 30, 509-512. DOI: 10.1016/j.cardfail.2023.10.478

[35] Mohebali D, Kittleson MM . Remote monitoring in heart failure: current and emerging technologies in the context of the pandemic. Heart 2021, 107, 366-372. DOI: 10.1136/heartjnl—2020—318062

[36] Chaudhry SI, Mattera JA, Curtis JP, Spertus JA, Herrin J, Lin Z, et al. Telemonitoring in Patients with Heart Failure. N. Engl. J. Med. 2010, 363, 2301-2309. DOI: 10.1056/NEJMoa1010029

[37] O’Riordan M. Smart Scale Better at Predicting HF Events Than Weight—Based Monitoring. Published 11 March 2024. Available online: https://www.tctmd.com/news/smart—scale—better—predicting—hf—events—weight—based—monitoring (accessed on 5 December 2025).

[38] Littrell A. AI—Powered Stethoscope Enhances Early Heart Failure Detection in Primary Care. Available online: https://www.medicaleconomics.com/view/ai—powered—stethoscope—enhances—early—heart—failure—detection—in—primary—care (accessed on 25 November 2025).

[39] Peters NS . Triple Cardiovascular Disease Detection with an Artificial Intelligence—Enabled Stethoscope (TRICORDER). Clinicaltrials.gov. Published 11 July 2024. Available online: https://clinicaltrials.gov/study/NCT05987670 (accessed on 5 December 2025).

[40] Guo L, Pressman GS, Kieu SN, Marrus SB, Mathew G, Prince J, et al. Automated Detection of Reduced Ejection Fraction Using an ECG—Enabled Digital Stethoscope. JACC Adv. 2025, 4, 101619. DOI: 10.1016/j.jacadv.2025.101619

[41] Heart Failure Management System (HFMS). Zoll. Published 2024. Available online: https://cardiac.zoll.com/patients/heart—failure—management—system (accessed on 5 December 2025).

[42] Prithul Bom B. K211585—Bodyport Cardiac Scale. FDA; 2022. Available online: https://www.accessdata.fda.gov/cdrh_docs/pdf21/K211585.pdf (accessed on 5 December 2025).

[43] Stevenson LW, Ross HJ, Rathman LD, Boehmer JP . Remote Monitoring for Heart Failure Management at Home. J. Am. College Cardiol. 2023, 81, 2272-2291. DOI: 10.1016/j.jacc.2023.04.010

[44] Heart Failure Management System (HFMS) Reduce Heart Failure Readmissions and Improve Patient Outcomes. Published 2024. Available online: https://cardiac.zoll.com/medical—professionals/heart—failure—management—system (accessed on 5 December 2025).

[45] Boehmer JP, Cremer S, Abo—Auda WS, Stokes DR, Hadi A, McCann PJ, et al. Impact of a Novel Wearable Sensor on Heart Failure Rehospitalization. JACC Heart Fail. 2024, 12, 2011-2022. DOI: 10.1016/j.jchf.2024.07.022

[46] Simmonds SJ, Cuijpers I, Heymans S, Jones EAV . Cellular and Molecular Differences between HFpEF and HFrEF: A Step Ahead in an Improved Pathological Understanding. Cells 2020, 9, 242. DOI: 10.3390/cells9010242

[47] Işilay Zeybek ZM, Racca V, Pezzano A, Tavanelli M, Di Rienzo M . Can Seismocardiogram Fiducial Points Be Used for the Routine Estimation of Cardiac Time Intervals in Cardiac Patients? Front. Physiol. 2022, 13, 825918. DOI: 10.3389/fphys.2022.825918