A comprehensive model for right-left heart interaction under the influence of pericardium and baroreflex
A comprehensive model for right-left heart interaction under the influence of pericardium and baroreflex
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DOI：
10.1152/ajpheart.1997.272.3.h1499
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发表时间：
1997-03-01
影响因子：
4.8
通讯作者：
Chiaramida, SA
中科院分区：
文献类型：
--
作者：
Sun, Y;Beshara, M;Chiaramida, SA
心肺循环的现象学模型的发展与右心和左心之间的相互作用的重点。该模型预测的血液动力学后果的变化循环参数的压力和流量波形的一个广泛的频谱。血流动力学的特征在于使用电模拟，包括经中隔压力耦合、心包容积耦合、胸内压力和心率压力反射控制机制。计算机模拟是通过数值积分28个微分方程，包含非线性和时变系数。该模型的有效性是支持其准确拟合临床压力和多普勒超声心动图记录。该模型表征了二尖瓣狭窄、二尖瓣返流、左心衰竭、右心衰竭、心包填塞、奇脉和Valsalva动作的血流动力学波形。并准确地描述了上述条件下肺毛细血管楔压的波形。敏感性分析表明，模拟的血液动力学是不敏感的后负荷电阻，前负荷电容，胸内压，收缩性和心包液量以外的大多数个别的模型参数。基线血流动力学受房间隔耦合影响最小（高达2%），受心包耦合影响显著（高达20%）。该模型应是有用的定量研究心肺动力学相关的右，左心脏在正常和疾病条件下的相互作用。
A phenomenological model of the cardiopulmonary circulation is developed with a focus on the interaction between the right heart and the left heart. The model predicts the hemodynamic consequences of changing circulatory parameters in terms of a broad spectrum of pressure and flow waveforms. Hemodynamics are characterized by use of an electrical analog incorporating mechanisms for transseptal pressure coupling, pericardial volume coupling, intrathoracic pressure, and baroreflex control of heart rate. Computer simulations are accomplished by numerically integrating 28 differential equations that contain nonlinear and time-varying coefficients. Validity of the model is supported by its accurate fit to clinical pressure and Doppler echocardiographic recordings. The model characterizes the hemodynamic waveforms for mitral stenosis, mitral regurgitation, left heart failure, right heart failure, cardiac tamponade, pulsus paradoxus, and the Valsalva maneuver. The wave shapes of pulmonary capillary wedge pressure under the above conditions are also accurately represented. Sensitivity analysis reveals that simulated hemodynamics are insensitive to most individual model parameters with the exception of afterload resistance, preload capacitances, intrathoracic pressure, contractility, and pericardial fluid volume. Baseline hemodynamics are minimally affected by transseptal coupling (up to 2%) and significantly affected by pericardial coupling (up to 20%). The model should be useful for quantitative studies of cardiopulmonary dynamics related to the right-left heart interaction under normal and disease conditions.