A New Mathematical Model for LVAD-Supported Ventricles: Direct Parameterization from Ramp-Test Clinical Data and Verification via Hybrid Modeling

Abstract

BackgroundConventional left ventricular assist device ramp metrics are load dependent, obscuring intrinsic myocardial recovery. A mechanistic, patient-specific representation of ventricular mechanics, identifiable from routine clinical data, could provide quantitative indices of intrinsic left ventricular (LV) function for longitudinal recovery surveillance. ObjectiveTo develop and verify a ramp-integrated, patient-specific model of HeartMate 3-assisted LV function that can yield indices of intrinsic myocardial contractility and remodeling. MethodsWe represented LV pressure-volume (PV) behavior with a PV envelope composed of a monotonic passive PV relation (pPVR) and a unimodal active PV relation (aPVR). We developed a parameterization procedure to infer the patient-specific shape of this envelope directly from routine ramp-test data. We then embedded the parameterized envelope within the PSCOPE framework, a hybrid platform that couples a lumped-parameter network to a physical HeartMate 3 flow loop, to reproduce clinical ramp hemodynamics. Percent residuals between simulated outputs and the corresponding clinical measurements verified the implementation of the PV envelope within PSCOPE. ResultsIn three HeartMate 3 recipients, the PSCOPE models reproduced ramp hemodynamics with residuals generally [≤] 20% across pump speeds and measured variables. Cardiac index residuals ranged from 0-18.5%, systemic and pulmonary arterial pressure residuals remained [≤] 18.4%, and pulmonary arterial wedge pressure residuals remained [≤] 20%. The PSCOPE models matched central venous pressure within [≤] 3 mmHg in all cases, although one setting yielded a 33.3% residual due to a low reference pressure. For one patient, the model reproduced ramp hemodynamics at a speed deliberately withheld from PV-envelope parameterization with residuals [≤] 10%, supporting cross-speed generalizability. Patient-specific PV envelopes also revealed clinically meaningful heterogeneity in LV diastolic stiffness, volume threshold for declining systolic function, operating PV points for peak systolic function, and contractile reserve. ConclusionsRamp-integrated parameterization of the monotonic pPVR and unimodal aPVR yields a compact, mechanistic PV envelope that is identifiable from routine clinical data and verifiable within PSCOPE. The resulting indices characterize intrinsic LV function and may enhance longitudinal recovery surveillance and inform LVAD management. Prospective multicenter validation is warranted to confirm the generalizability and clinical utility of this approach.