Influence of left-ventricular shape on passive filling properties and end-diastolic fiber stress and strain.

Passive filling is a major determinant for the pump performance of the left ventricle and is determined by the filling pressure and the ventricular compliance. In the quantification of the passive mechanical behaviour of the left ventricle and its compliance, focus has been mainly on fiber orientation and constitutive parameters. Although it has been shown that the left-ventricular shape plays an important role in cardiac (patho-)physiology, the dependency on left-ventricular shape has never been studied in detail. Therefore, we have quantified the influence of left-ventricular shape on the overall compliance and the intramyocardial distribution of passive fiber stress and strain during the passive filling period. Hereto, fiber stress and strain were calculated in a finite element analysis of passive inflation of left ventricles with different shapes, ranging from an elongated ellipsoid to a sphere, but keeping the initial cavity volume constant. For each shape, the wall volume was varied to obtain ventricles with different wall thickness. The passive myocardium was described by an incompressible hyperelastic material law with transverse isotropic symmetry along the muscle fiber directions. A realistic transmural distribution in fiber orientation was assumed. We found that compliance was not altered substantially, but the transmural distribution of both passive fiber stress and strain was highly dependent on regional wall curvature and thickness. A low curvature wall was characterized by a maximum in the transmural fiber stress and strain in the mid-wall region, while a steep subendocardial transmural gradient was present in a high curvature wall. The transmural fiber stress and strain gradients in a low and high curvature wall were, respectively, flattened and steepened by an increase in wall thickness.