Dependence of heart chamber dimensions and dynamics on chamber demands and myocardial properties

A heart chamber undergoes eccentric hypertrophy in response to a chronic elevation of stroke-displacement demand, and it undergoes concentric hypertrophy in response to a chronic elevation of systolic-pressure demand. Both of these adaptations, which occur in various combinations, involve two myocardial plastic properties, "stretch normalization" and "stress normalization". We have developed a model which predicts dimensions and dynamics of the left ventricle as functions of myocardial properties and of the loads to which the chamber is adapted. The model involves: a stress-normalization rule which describes how myocardial volume depends on average systolic pressure, cavity volumes and the responsiveness of growth to stress; a stretch-normalization rule which describes how the cavity volume of standard stretch relates to average end-diastolic and end-systolic volumes; and a pressure-volume-curve equation giving isometric pressures as functions of cavity volume and myocardial volume relative to standard-stretch cavity volume, and elastic properties including contractility. The model shows how the relations among average dimensions, dynamics and loads depend on myocardial properties, particularly contractility and the growth response to stress. These properties are the main determinants of myocardial performance. In addition to the load adaptations mentioned above, the model predicts eccentric hypertrophy incident to reduced contractility, chronic dilation incident to reduced growth response to stress, myocardial stricture incident to excessive growth response to stress, and concentric hypertrophy (similar to high-pressure adaptation) incident to deposition of inert material. It allows some refinements in the evaluation of myocardial performance and in the evaluation of the abnormal properties responsible for abnormal performance.