The importance of the pericardium for cardiac biomechanics: From physiology to computational modeling

TL;DR

This study emphasizes the critical role of the pericardium in cardiac biomechanics and introduces a simple computational model that improves the accuracy of heart simulations by incorporating pericardial effects.

Contribution

The paper presents a novel, computationally tractable pericardial boundary condition model that enhances the realism of cardiac biomechanics simulations.

Findings

Adding pericardial boundary conditions improves simulation accuracy.

The model accurately predicts heart pumping mechanisms.

Pericardial stiffness influences cardiac motion significantly.

Abstract

The human heart is enclosed in the pericardial cavity. The pericardium consists of a layered thin sac and is separated from the myocardium by a thin film of fluid. It provides a fixture in space and frictionless sliding of the myocardium. The influence of the pericardium is essential for predictive mechanical simulations of the heart. However, there is no consensus on physiologically correct and computationally tractable pericardial boundary conditions. Here we propose to model the pericardial influence as a parallel spring and dashpot acting in normal direction to the epicardium. Using a four-chamber geometry, we compare a model with pericardial boundary conditions to a model with fixated apex. The influence of pericardial stiffness is demonstrated in a parametric study. Comparing simulation results to measurements from cine magnetic resonance imaging reveals that adding pericardial boundary conditions yields a better approximation with respect to atrioventricular plane displacement, atrial filling, and overall spatial approximation error. We demonstrate that this simple model of pericardial-myocardial interaction can correctly predict the pumping mechanisms of the heart as previously assessed in clinical studies. Utilizing a pericardial model can not only provide much more realistic cardiac mechanics simulations but also allows new insights into pericardial-myocardial interaction which cannot be assessed in clinical measurements yet.