Aortoventricular mechanical matching: simulation of normal and pathological conditions

A mechanical mock of the cardiovascular system was used to simulate different conditions of ventricular-arterial mechanical matching. Four ventricles and four aortas with different elastances were set up, and all possible connection combinations tested by sampling ventricular and aortic pressures and flows. The mechanical energy produced by the simulated ventricles and the amount transferred to the aorta in the different connection conditions were calculated. The results demonstrate a clear dependence between the mechanical work production of the ventricles and the ventricular elastance (slope of the end-systolic pressure–volume relation) (from 20.42 ± 0.02 mJ/beat to 12.10 ± 0.02 mJ/beat), and an efficiency of energy transfer to the aorta strongly dependent on ventricular-aortic mechanical matching (from 56% to 20.7%). These results show that, even in optimal simulated conditions, only 56% of the energy produced is transferred to the load; and highlight the important role of mechanical aspects in conditions of very limited cardiovascular performance (i.e. final stages of heart failure), where energy transfer efficiency may be as low as 20.7%. This evidence emphasizes that the mechanical aspects must also be entertained in the evolution of complex cardiovascular pathologies, evaluating the possibility of combining mechanical and pharmaceutical interventions.