Effects of Myocardial Sheetlet Sliding on Left Ventricular Function

Abstract

Abstract Left ventricle myocardium has a complex micro-architecture, which was revealed to consist of myocyte bundles arranged in a series of laminar sheetlets. Recent imaging studies demonstrated that these sheetlets re-orientate and likely slide over each other during the deformations between systole and diastole, and that sheetlet dynamics were altered during cardiomyopathy. However, the biomechanical effect of sheetlet sliding is not well-understood, which is the focus here. We conducted finite element (FE) simulations of the left ventricle (LV) coupled with a Windkessel lumped parameter model to study sheetlet sliding, based on cardiac MRI of a healthy human subject, and modifications to account for hypertrophic and dilated geometric changes during cardiomyopathy remodeling. We modelled sheetlet sliding as a reduced shear stiffness in the sheet-normal direction, and observed that (1) the diastolic sheetlet orientations must depart from alignment with the LV wall plane in order for sheetlet sliding to have an effect on cardiac function, that (2) sheetlet sliding modestly aided cardiac function of the healthy and dilated hearts, in terms of ejection fraction, stroke volume, and systolic pressure generation, but its effects were amplified in hypertrophic/thickened walls, and that (3) where sheetlet sliding aided cardiac function, it increased tissue stresses, particularly in the myocyte direction. We speculate that sheetlet sliding is a tissue architectural adaptation to allow easier deformations of thick LV walls so that LV wall stiffness will not hinder function, and to provide a balance between function and tissue stresses. A limitation here is that sheetlet sliding is modelled as a simple reduction in shear stiffness, without consideration of micro-scale sheetlet mechanics and dynamics.