26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F.

Piedimonte

INTERNATIONAL CONGRESS ON COMPUTATIONAL BIOENGINEERING

24th-26th September 2003, Zaragoza, SPAIN

A STUDY ON LV REGIONAL DISSYNCHRONY

BASED ON VENTRICULAR DIFFERENTIAL TIME
VARYING ELASTANCE COMPUTER MODEL
Maurizio Arabia
M.M.A. Consulting
Francesco Maria Colacino & Domenico Lavorato
University of Calabria, Mechanical Engineering Department
Fabio Piedimonte
University of Rome “Tor Vergata”, D.I.S.P.
Antonino G.M. Marullo
University of L’Aquila, Medicina Sperimentale Department

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Introduction

• Investigation and analysis of:

– Regional dissynchrony (source of contraction delay
between different regions of the ventricle)
– Regional reduced contractility (due to a worsening of
ventricle’s elastance curves)
• A computer model of the left ventricle (LV), which is
divided in two regions, has been developed to allow
different working conditions.

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Ventricle Model Description

• LV is represented by a differential time varying elastance (DTVE)
model, including internal resistance (R)
dV t 
P(t )  P0   V (t ), t   R
dt

 V (t ), t    p V (t )   a V (t )   p V (t ) * Fiso   
a
t = t3
t = t2 ; t = t4

P t = t1 ; t = t5
(mmHg)

p
t6 < t < T

V (cm^3)
Undivided physiological LV's PV loop
Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Mathematical Relationships
dV t 
P(t )  P0   V (t ), t   R
dt
 V (t ), t    p V (t )   a V (t )   p V (t )* Fiso  

a
 p  Emin V t   V0  
K K

Vsat  V t   V0  Vsat
t = t3
t = t2 t = t4

P t = t1 t = t5
(mmHg)
  * 2
 V
 a  1   *
 V t  
   P* p
  V  V0  
 
t6 < t < T

V (cm^3)
Undivided physiological LV's PV loop

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Active Atrium Model Description

Similar relations, but:

• no internal resistance R;
• lower vertex (lower P* value) for the active elastance curve;
• Fiso contraction duration much shorter than LV’s and stops when
ventricular contraction phase starts.

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Circulatory system model description

Rvs Lvs
Cvs Pvs Patrium Paorta

Cas Ras

Guyton and Windkessel models

Pi = Patm Pi = Patm

Rvd

Lv

Rvi
Valve model
Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Divided Ventricle: Model Description

• The divided LV has been represented by two DTVE models.

• Its total ventricular contractility split up.
• Pressure is always equal in each portion.
• The total volume V(t) has been divided in two portions V1(t) and
V2(t) by the coefficient:
pf = V1(t)/V(t)

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

mmHg (V2*,P*) (V1*,P*) (V*,P*)

Tot Portion 1 Portion 2

V(t) pfV(t) (1-pf)V(t)

Vsat pfVsat (1-pf)Vsat

V0 p f V0 (1-pf)V0
Vsat
Vsat V* p f V* (1-pf)V*
Vsat
R R/pf R/(1-pf)
Emin/(1-
Emin Emin/pf
p f)
cm^3

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Mathematical Description
dV t 
P(t )  P0   V (t ), t   R
dt
dV1 t 
P(t )  P   V (t ), t   R
0 1 1 1
dt
dV t 
P(t )  P0   2 V2 (t ), t   R2 2
dt

 V (t ), t    p V (t )   a V (t )   p V (t )* Fiso  
 
1 V1 (t ), t    p1 V1 (t )   a1 V1 (t )   p1 V1 (t ) * Fiso1  

 2 V2 (t ), t    p 2 V (t ) 
2 a2 V2 (t )   p 2 V (t )* F
2 iso 2  

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Mathematical Description
 p  Emin V t   V0  
K K

Vsat  V t   V0  Vsat
pf K pf K
 p,1 
Emin
pf

V1 t   p f  V0   
p f  Vsat  V1 t   p f  V0

p f  Vsat 
 p,2 
Emin
    
V2 t   1  p f  V0 

1 p f  K  
1 p f  K  
1 p f   
1  p f  Vsat  V2 t   1  p f  V0   
1  p f  Vsat 
  * 2
  V  V t    *

a  1   * 
P
  V  V0  
 
  2

 a,1 
 1  p f  V  V1 t    *
* 
P  a,2
 

 1    2
1  p f  V  V2 t    *
* 
P
  p V *  p V   1
  f f 0 
  
 f  f 
  1  p V *  1  p V   2
0 

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Mathematical Description
 dV1 t 
 P(t )  P0  1 V1 (t ), t   R1 dt

 P(t )  P   V (t ), t   R dV2 t 
 0 2 2 2
dt

 dV t  
2 P(t )  2 P0   V (t ), t   R 
 dt 

R1 p f  R2 (1  p f )  2R

R R
R1  ; R 2 
pf 1- pf
Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

How to use the model…

• The two portions’ contractility laws can work in different mode:
– by setting their phase – the result is a model named “regional
Dissynchrony”
– by reducing the contractility of one region

1. Regional Dissynchrony is obtained by setting different timing to

the ventricular contraction function Fiso of the two regions.
2. Reduced contractility is realised by introducing different values
for P* (P1* and P2*) to each ventricular portion (It is possible to
modify both the contractility laws or just only one of them).

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Computer Simulations
• Cases a) and b) – Physiological Undivided and Divided LV
validate the divided model for LV. Indeed, if its working
conditions are physiologic, it behaves as an undivided
physiological LV
• Case c) – Regional Dissynchrony
LV’s divided model with Fiso phase shift and physiological
contractility
• Case d) – Regional Reduced Contractility
LV’s divided model without Fiso phase shift and one region
reduced contractility
• Case e) – Regional Dissinchrony and Reduced Contractility
LV’s divided model with Fiso phase shift and one region reduced
contractility
Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

a) LV’s undivided physiological model

HR 80 VVES 42.45
PAt-ave 8.46 VVED 114.3
PAo-ave 98.73 VAES 37.14
QA-ave 5.64 VAED 69.92
PP 0%  0
Pressure (mmHg)

Left Atrium Left VentricleAorta

Physiologic

Left Ventricle Flow Rate (cm^3/s)

Diastole Systole

Volumes (cm^3)
Left Ventricle Left Atrium

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

b) LV’s divided physiological model

The LV has been divided
in two parts working
The LV has been divided in physiological conditions
in equal parts working
in physiological conditions ABCD - 66% Physiological Portion
EFGH - 34% Physiological Portion
G C
Two coincident PV loops
and elastance curves F B

H D E A

Two PV loops
Volumes (cm^3) Volumes (cm^3)
Total Total
66% Portion
34% Portion

Portions - 50%
LV and its Portions' Volume Waveforms LV and its Portions' Volume Waveforms
Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

c) LV’s divided model with Fiso phase shift and

physiological contractility – Regional Dissinchrony
HR 80 VVES 56.31
PAt-ave 9.70 VVED 116.75 ABCD - 66% Physiological Portion
PAo-ave 90.79 VAES 45.78 EFGH - 34% Phase Shifted Portion

QA-ave 4.74 VAED 75.03

PP 34%  30% F
B
C
G C
B F E
ABCD - Physiologic
EFGH - Pathologic
G H A
D H A E
D
PV loops Two PV loops. The LV has been divided in two parts
Pressure (mmHg) LV and its Portions' Flow Rate Waveforms (cm^3/s)
34% Path. Portion Total
Left Atrium Aorta
Left Ventricle
Left Ventricle Flow Rate (cm^3/s)
66% Phys. Portion
Diastole Systole
LV and its Portions' Volume Waveforms (cm^3)
Total 66% Phys. Portion
Volumes (cm^3)
Left Ventricle Left Atrium
34% Path. Portion

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

d) LV’s divided model without Fiso phase shift and one region
reduced contractility – Regional Reduced Contractility
HR 80 VVES 75.19
PAt-ave 9.65 VVED 138.58
ABCD - 66% Physiological Portion
PAo-ave 91.09 VAES 47.61 EFG - 34% Portion with Reduced
QA-ave 4.97 VAED 75 Contractility
PP 34%  0
* *
P1 480 P 2 150 G
C G C
B F F
ABCD - Physiologic B
EFGH - Pathologic

D H A E

PV loops D
E A
Pressure (mmHg)
Two PV loops. The LV has been divided in two parts
Left Atrium Aorta
Left Ventricle Volumes (cm^3)
Left Ventricle Flow Rate (cm^3/s) 34% Path. Portion 66% Phys. Portion Total
Diastole Systole

Volumes (cm^3)
Left Ventricle
Left Atrium LV and its Portions' Volume Waveforms

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

e) LV’s divided model with Fiso phase shift and one region reduced
contractility – Regional Dissynchrony and Reduced Contractility
HR 80 VVES 113.17
PAt-ave 17.76 VVED 170.87 ABC - 66% Physiological Portion
PAo-ave 90.43 VAES 90.71 EF - 34% Portion with Phase Shifting
QA-ave 4.52 VAED 103.32 and Reduced Contractility
PP 34%  30%
P*1 480 P*2 150 C F
ABCD - Physiologic B
C
G EFGH - Pathologic
F
B

E
A H E A
D

PV loops Two PV loops. The LV has been divided in two parts

Pressure (mmHg) LV and its Portions' Flow Rate Waveforms (cm^3/s)
Total
Left Atrium
Left Ventricle Aorta

Left Ventricle Flow Rate (cm^3/s)

Diastole Systole 34% Path. Portion 66% Phys. Portion

LV and its Portions' Volume Waveforms (cm^3)

Total 34% Path. Portion 66% Phys. Portion
Volumes (cm^3)
Left Ventricle
Left Atrium

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte
Cases a) & b) Pressure (mmHg) Case c) Pressure (mmHg)

Left Atrium Left VentricleAorta Left Atrium Aorta

Left Ventricle

Left Ventricle Flow Rate (cm^3/s) Left Ventricle Flow Rate (cm^3/s)
Diastole Systole Diastole Systole

Volumes (cm^3)
Volumes (cm^3)
Left Ventricle Left Atrium Left Ventricle Left Atrium

Case d) Pressure (mmHg) Case e) Pressure (mmHg)

Left Atrium Aorta Left Atrium

Left Ventricle Left Ventricle Aorta

Left Ventricle Flow Rate (cm^3/s) Left Ventricle Flow Rate (cm^3/s)
Diastole Systole Diastole Systole

Volumes (cm^3) Volumes (cm^3)

Left Ventricle Left Ventricle
Left Atrium Left Atrium

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte
Cases a) & b) HR 80 VVES 42.45 Case c) HR 80 VVES 56.31
PAt-ave 8.46 VVED 114.3 PAt-ave 9.70 VVED 116.75
PAo-ave 98.73 VAES 37.14 PAo-ave 90.79 VAES 45.78
QA-ave 5.64 VAED 69.92 QA-ave 4.74 VAED 75.03
PP 0%  0
PP 34%  30%
C
G
B F
Physiologic ABCD - Physiologic
EFGH - Pathologic
D H A E

HR 80 VVES 75.19 PV loops80

HR VVES 113.17
Case d) PAt-ave 9.65 VVED 138.58 Case e) PAt-ave 17.76 VVED 170.87
PAo-ave 91.09 VAES 47.61 PAo-ave 90.43 VAES 90.71
QA-ave 4.97 VAED 75 QA-ave 4.52 VAED 103.32
PP 34%  0 PP 34%  30%
*
P*1 *
480 P 2 150 P*1 480 P 2 150
C G ABCD - Physiologic
C
B F G EFGH - Pathologic
ABCD - Physiologic F
B
EFGH - Pathologic

D H A E
A H E
D
PV loops
PV loops

Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte
Cases a) & b) HR 80 VVES 42.45 Case c)
PAt-ave 8.46 VVED 114.3 ABCD - 66% Physiological Portion
PAo-ave 98.73 VAES 37.14 EFGH - 34% Phase Shifted Portion
QA-ave 5.64 VAED 69.92
PP 0%  0 B
F
C
E

Physiologic
G H A
D
Two PV loops. The LV has been divided in two parts
Case d) ABC - 66% Physiological Portion
EF - 34% Portion with Phase Shifting
ABCD - 66% Physiological Portion
EFG - 34% Portion with Reduced and Reduced Contractility
Contractility
Case e)
C F
C G B
F
B

E
A
D A
E

Two PV loops. The LV has been divided in two parts Two PV loops. The LV has been divided in two parts
Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.
26.09.2003 M. Arabia; F. M. Colacino; D. Lavorato; A. G. M. Marullo; F. Piedimonte

Conclusions
• Computer test showed the strong influence of the pathologies on the
LV performance.
– From external point of view the Starling flowrate-preload-
afterload relation worsened and, as a consequence, flowrate
decreased and preload and pulmonary venous pressure increased;
moreover, pressure and flow waveforms morphology worsened.
– From internal point of view mean ventricular volume and wall
stress increased, mechanical efficiency decreased, and pressure
volume loop worsened.
• This study can be used as a tool for the evaluation of the follow-up of a
ventricle affected by LV regional dissinchrony after pacing.
• New ways for regional dissynchrony diagnosis. ECG does not reveal
its presence. If we would have an estimation of the main parameters to
be used in our model, we could depict the LV’s performance of a
patient.
Univ. of Calabria, Mechanical Eng Dept; MMA Consulting; Univ. of L’Aquila, Medicina Sperimentale Dept;
Univ. of Rome “Tor Vergata”, D.I.S.P.