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Impact of Decreased Transmural Conduction Velocity on the Function of the Human Left Ventricle: A Simulation Study
Jiří Vaverka1, Jiří Moudr2, Petr Lokaj3
1Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czech Republic.
Insights
Reduced transmural conduction velocity (TCV) in the human heart prolongs contraction and lowers power output. While not critical for healthy hearts, decreased TCV may impair cardiac function in disease.
Area of Science:
- Cardiovascular Physiology
- Computational Biology
- Biomedical Engineering
Background:
- Transmural conduction velocity (TCV) synchronizes left ventricular (LV) contraction.
- The impact of decreased TCV on LV contractility is not well understood.
Purpose of the Study:
- To investigate the effect of reduced TCV on human LV output parameters.
- To evaluate the contribution of TCV to LV contractility and systemic cardiovascular function.
Main Methods:
- A 3D finite element model of human LV isovolumic contraction was used.
- The model incorporated transmural gradients in electromechanical delay and myocyte shortening velocity.
- Model outputs were integrated into a Windkessel model for systemic simulation.
Main Results:
- A 50% TCV reduction significantly prolonged isovolumic contraction duration (IVCD).
- LV pressure rise (dP/dtmax) slightly decelerated, LV energy consumption increased, and LV power decreased.
- Progressive TCV reduction exacerbated these negative effects.
Conclusions:
- Reduced TCV decreases human LV pumping efficacy due to increased energy consumption and lower power.
- While not critical in healthy hearts, reduced TCV may limit cardiac function in disease states.
Abstract:
This study investigates the impact of reduced transmural conduction velocity (TCV) on output parameters of the human heart. In a healthy heart, the TCV contributes to synchronization of the onset of contraction in individual layers of the left ventricle (LV). However, it is unclear whether the clinically observed decrease of TCV contributes significantly to a reduction of LV contractility. The applied three-dimensional finite element model of isovolumic contraction of the human LV incorporates transmural gradients in electromechanical delay and myocyte shortening velocity and evaluates the impact of TCV reduction on pressure rise (namely, (dP/dt)max) and on isovolumic contraction duration (IVCD) in a healthy LV. The model outputs are further exploited in the lumped "Windkessel" model of the human cardiovascular system (based on electrohydrodynamic analogy of respective differential equations) to simulate the impact of changes of (dP/dt)max and IVCD on chosen systemic parameters (ejection fraction, LV power, cardiac output, and blood pressure). The simulations have shown that a 50% decrease in TCV prolongs substantially the isovolumic contraction, decelerates slightly the LV pressure rise, increases the LV energy consumption, and reduces the LV power. These negative effects increase progressively with further reduction of TCV. In conclusion, these results suggest that the pumping efficacy of the human LV decreases with lower TCV due to a higher energy consumption and lower LV power. Although the changes induced by the clinically relevant reduction of TCV are not critical for a healthy heart, they may represent an important factor limiting the heart function under disease conditions.
