Mb. Ratcliffe et al., The effect of diastolic stiffness on ventricular function after partial ventriculectomy: A finite element simulation, ASAIO J, 46(1), 2000, pp. 111-116
Partial ventriculectomy (PV) has been proposed by Batista and colleagues to
improve cardiac function in patients with dilated cardiomyopathy (DCM); ho
wever, results have been mixed. We tested the hypothesis that preoperative
diastolic function affects the stroke volume/end-diastolic pressure (Starli
ng) relationship after PV. A previously described finite element simulation
of DCM and PV was used. Diastole and end systole were represented by separ
ate elastic finite element models with different unloaded shapes and nonlin
ear material properties. Left ventricular (LV) end-systolic elastance (E-ES
), diastolic compliance (DC), and Starling relationships were calculated. D
C was varied by changing Ogden material property alpha (i) from 12 (complia
nt) to 20 (stiff). PV was simulated at 20% LV mass reduction. The slope of
the Starling relationship increased from 1.82 to 1.21 as alpha (i) increase
d from 12 to 20. Partial ventriculectomy increased the Starling relationshi
p in each case from 1.34 to 1.01 respectively. However, the net result in e
ach case is a decrement in the Starling relationship with resection, and th
e smallest decrement was associated with the highest diastolic stiffness (a
lpha (i) = 20). Partial ventriculectomy depressed the Starling relationship
for all values of diastolic compliance. It is expected that patients with
a higher diastolic stiffness should do better.