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The effect of diastolic stiffness on ventricular function after partial ventriculectomy: a finite element simulation
M B Ratcliffe1, J Hong, A Salahieh
1Department of Surgery, School of Medicine of the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, 94121, USA.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|February 10, 2000
Summary
Partial ventriculectomy (PV) for dilated cardiomyopathy (DCM) may depress cardiac function. Preoperative diastolic stiffness influences the Starling relationship post-surgery, suggesting stiffer hearts may benefit more from PV.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Computational Biology
Background:
- Partial ventriculectomy (PV) is a surgical technique proposed to improve cardiac function in patients with dilated cardiomyopathy (DCM).
- Clinical outcomes following PV for DCM have been variable, necessitating further investigation into factors influencing its efficacy.
- The impact of preoperative diastolic function on the post-PV cardiac performance, specifically the Starling relationship, remains incompletely understood.
Purpose of the Study:
- To test the hypothesis that preoperative diastolic function influences the stroke volume/end-diastolic pressure (Starling) relationship after partial ventriculectomy (PV) in dilated cardiomyopathy (DCM).
- To investigate the effect of varying degrees of diastolic stiffness on the Starling relationship following simulated PV.
Main Methods:
- Utilized a previously validated finite element simulation model of DCM and PV.
- Represented diastole and end systole using separate elastic finite element models with distinct unloaded shapes and nonlinear material properties.
- Calculated left ventricular (LV) end-systolic elastance (E(ES)), diastolic compliance (DC), and Starling relationships, simulating a 20% LV mass reduction and varying diastolic stiffness (alpha(i) from 12 to 20).
Main Results:
- The slope of the Starling relationship increased with increasing diastolic stiffness (from 1.82 to 1.21 as alpha(i) increased from 12 to 20).
- Partial ventriculectomy consistently increased the Starling relationship in all simulated cases (from 1.34 to 1.01).
- Despite an increase, PV resulted in a net decrement of the Starling relationship, with the smallest decrement observed in cases with the highest diastolic stiffness (alpha(i) = 20).
Conclusions:
- Partial ventriculectomy appears to depress the Starling relationship across all levels of diastolic compliance.
- Patients with greater preoperative diastolic stiffness may experience a less detrimental effect on the Starling relationship after PV.
- These findings suggest that preoperative diastolic stiffness is a critical factor to consider when evaluating the potential benefits of PV in DCM patients.