Optimal control evaluation of left ventricular systolic dynamics.

A model of the contracting left ventricle was developed, in which the left ventricle was represented as a time-varying compliance. The vascular load included the nonlinear (Bernoulli) resistance of the aortic valve, blood inertance, and a Windkessel model of the arterial tree. Owing to the obligatory aerobic nature of the heart, oxygen consumption can be used to characterize the energy utilized by the myocardium. An adaptive control law was developed for determining the systolic time course of ventricular pressure and volume that minimizes cardiac oxygen consumption. Three main determinants of myocardial oxygen consumption were included in the integral criterion function: developed wall tension, inotropic state, and external (mechanical) work. The optimal control problem was solved using the Pontryagin maximum principle. The model could predict, in good agreement with experimentally obtained data, systolic time course of ventricular pressure and volume, as well as directional changes in the duration of isovolumic contraction and ejection phase under various conditions of end-diastolic volume, mean aortic pressure, and inotropic state.