Model selection for ventricular mechanics: A sensitivity analysis approach

Quantitative characterization of left ventricle pump properties has been recognized as being of great significance for both physiological and clinical purposes. Several descriptions have been proposed in the past to this end, where the ventricle is viewed as an isovolumic pressure generator coupled to an internal impedance, considered as either only viscous, only elastic or viscoelastic. Though these models have been used widely, the respective advantages and limits have not been fully elucidated. In this paper, six models for the left ventricular pumping function, of the viscoelastic type, are compared using both simulated and experimental data in a typical parameter estimation approach. Elastic and viscous parameters are estimated starting from ventricular pressure and aortic flow, together with the isovolumic pressure at the same preload. The basis for the comparison is the well-established criterion relating the fit obtained from collected data and the covariance matrix of the parameter estimates. The latter allows evaluation of the so-called indifference region in the parameter space, which is represented by an ellipse if both elastic and viscous elements are present. The properties of the indifference region are synthetically represented by two indices linked to the area and the eccentricity of the ellipse: the first represents the mean accuracy of the parameter estimate, the second gives information about the different sensitivities to variation of single parameters. This comparison, in both simulated and experimental cases, generally leads to preference for a model where elastance and viscosity vary with time in linear proportion to the isovolumically developed ventricular pressure. Appropriate description of the elastic effect reveals it to be very crucial while the viscous effect, though improving the fitting of data, is less critical.