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2011, Copyright the Authors

Artificial Organs 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Evaluation of Left Ventricular Relaxation in Rotary Blood

Pump Recipients Using the Pump Flow Waveform:
A Simulation Study

*Francesco Moscato, *Marcus Granegger, *Phornphop Naiyanetr,

Georg Wieselthaler, and *Heinrich Schima
*Center for Medical Physics and Biomedical Engineering and Department of Cardiac Surgery, Medical University of
Vienna; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; and Department of Biomedical
Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, Thailand

Abstract: In heart failure, diastolic dysfunction is respon-
sible for about 50% of the cases, with higher prevalence in
women and elderly persons and contributing similarly to
mortality as systolic dysfunction. Whereas the cardiac sys-
tolic diagnostics in ventricular assist device patients from
pump parameters have been investigated by several
groups, the diastolic behavior has been barely discussed.
This study focuses on the determination of ventricular
relaxation during early diastole in rotary blood pump
(RBP) recipients. In conventional cardiology, relaxation is
usually evaluated by the minimum rate and the time con-
stant of left ventricular pressure decrease, dP/dtmin and tP.
Two new analogous indices derived from the pump flow
waveform were investigated in this study: the minimum
rate and the time constant of pump flow decrease, dQ/dtmin
and tQ. The correspondence between the indices was inves-
tigated in a numerical simulation of the assisted circulation
for different ventricular relaxation states (tP ranging from
24 to 68 ms) and two RBP models characterized by linear
and nonlinear pressure-flow characteristics. dQ/dtmin and tQ
always correlated with the dP/dtmin and tP, respectively
(r > 0.97). These relationships were influenced by the non-
linear pump characteristics during partial support and by
the pump speed during full support. To minimize these
influences, simulation results suggest the evaluation of
dQ/dtmin and tQ at a pump speed that corresponds to the
borderline between partial and full support. In conclusion,
at least in simulation, relaxation can be derived from pump
data. This noninvasively accessible information could
contribute to a continuous estimation of the remaining
cardiac function and its eventual recovery. Key Words:
Ventricular relaxationRotary blood pumpNoninvasive
diagnosticsNumerical simulations.

Complementary to the systolic properties of the
heart, diastolic properties play an important role in
determining the overall pumping function of the
heart. Therefore, diastolic dysfunction has raised
growing concern in the clinical community especially
because of an increasing prevalence of diastolic heart
failure among heart failure patients (1). Diastolic
doi:10.1111/j.1525-1594.2011.01392.x
Received July 2011; revised August 2011.
Address correspondence and reprint requests to Dr. Francesco
Moscato, Center for Medical Physics and Biomedical Engineering,
Medical University of Vienna, AKH-4L, Waehringer Guertel
1820, 1090 Vienna, Austria. E-mail: francesco.moscato@
meduniwien.ac.at
heart failure is responsible for about 50% of heart
failure in the patient population and is more common
in the elderly and in women (13). However, diastolic
dysfunction is not limited to patients with diastolic
heart failure; it also occurs often in patients with
systolic heart failure (37). Diastolic abnormalities in
systolic heart failure patients seem to represent even
more powerful predictors of outcome and mortality
than systolic abnormalities (8).
The diagnosis of diastolic dysfunction involves
measurement of left ventricular relaxation, filling,
diastolic distensibility, and stiffness (3). These mea-
surements involve either invasive procedures (to
measure ventricular pressure and/or volume) or
time-consuming echocardiography (to obtain mor-
phologic and/or functional parameters) (4,9).

Artificial Organs 2012, 36(5):470478

aor_1392 470..478
 VENTRICULAR RELAXATION DIAGNOSTICS USING RBP FLOW
Our group has previously developed an index for
the evaluation of systolic function during rotary
blood pump (RBP) support. This index is derived
noninvasively, requiring only signals available from
the pump (10). We have now looked for a comple-
mentary, noninvasive method to monitor continu-
ously one of the components of the diastolic function:
the ventricular relaxation. Numerical simulations of
the assisted circulation were used to investigate the
correspondence between two classical indices of ven-
tricular relaxation (the minimum rate of ventricular
pressure decrease, dP/dtmin, and the time constant of
ventricular pressure decrease, tP) and two indices
derived from the pump flow waveform. Additionally,
an analytical approach was employed to verify the
correspondence between the indices derived from
ventricular pressure and pump flow.
MATERIALS AND METHODS
The present study focuses on the evaluation of ven-
tricular relaxation in RBP patients during early
diastole. In particular, left ventricular assistance is
considered with the RBP inflow placed in the ven-
tricular apex and outflow in the aorta. Knowledge of
the pump flow is also assumed (either measured at
the pump outflow or estimated from intrinsic pump
signals). When relaxation is impaired, the ventricular
pressure decrease is slowed. Since ventricular pres-
sure pulsatility influences the pulsatility of the pump
flow via the pump pressure-flow characteristics, we
analyzed the features of the flow signal that might
correlate to two classical pressure-derived relaxation
indices: the minimum rate of ventricular pressure
decrease, dP/dtmin, and the time constant of ventricu-
lar pressure decrease, tP (11). Two indices derived
from the pump flow were used and compared to the
classical relaxation indices: the minimum rate of
pump flow decrease, dQ/dtmin, and the time constant
of pump flow decrease, tQ.
Numerical simulations
A complete mathematical model of the cardiovas-
cular system was implemented in Matlab-Simulink
(The MathWorks, Inc., Natick, MA, USA). Details of
the model have been published elsewhere (12,13).
Briefly, the cardiovascular system was modeled as a
closed-loop hydraulic circuit comprising active atria
and ventricles, systemic and pulmonary circulations,
and an autoregulatory feedback loop for the arterial
systemic resistance that ensured the regulation of the
arterial systemic pressure. Left and right ventricles
were modeled by nonlinear time-varying elastances
and internal resistances (14). The left ventricular
471
end-diastolic pressurevolume relationship
(EDPVR) was modeled with an exponential function
(15); the end-systolic pressurevolume relationship
(ESPVR) was modeled as the sum of the EDPVR
and a parabolic function (16). Parameters of the
EDPVR and the ESPVR were derived to correctly
reproduce the cardiac output (CO) curves reported
in reference (17). The systemic and pulmonary arte-
rial systems were modeled by three-element Wind-
kessel models (18). Parameters of the systemic and
pulmonary arterial systems were derived from arte-
rial pressurevolume curves and arterial pulse pres-
sures (19) and further adjusted to match measured
arterial input impedances (20). Each compartment
and the whole model were validated according to the
procedure reported in reference (12).
In contrast to the model described in reference
(13), the normalized elastance function has been
simplified to a biexponential function (21). This
function allowed the adjustment of a parameter
closely related to the time constant of ventricular
pressure relaxation, tP. Six different relaxation
conditions were simulated with resulting values of
tP = 24, 34, 43, 51, 60, and 68 ms. These values
covered the whole range of normal and impaired
relaxation (9,22,23).
A condition of systolic left ventricular failure was
simulated in combination with the six different ven-
tricular relaxation conditions. The hemodynamics of
the unassisted cardiovascular system was character-
ized by a CO of 3.1 L/min, a heart rate of 95 bpm, an
ejection fraction of 23%, a mean aortic pressure
(AoP) of 69 mm Hg, and a mean left atrial pressure
(LAP) of 19 mm Hg.
Two models of RBPs were simulated (24,25). The
first represented a pump with linear pressure-flow
characteristics (Eq. 1). The second represented a
pump with nonlinear quadratic pressure-flow charac-
teristics (Eq. 2). These two models do not represent
any specific RBP used in the clinical practice, but an
idealized theoretical behavior and an axial flow
pump, respectively.
dQ(t )
AoP(t ) P(t ) = a 2 RP Q(t ) LP (1)
dt
dQ(t )
AoP(t ) P(t ) = a 2 [ rP Q(t ) ] Q(t ) LP
dt
(2)
Here, AoP(t) represented the aortic pressure, P(t)
represented the left ventricular pressure, Q(t) repre-
sented the pump flow, w represented the rotational
speed of the impeller, a represented a speed-
related coefficient (a = 8.5710-5 mm Hgs2/rad2), RP
Artif Organs, Vol. 36, No. 5, 2012
472 F. MOSCATO ET AL.

a c

b d

FIG. 1. (a) Left ventricular pressure P(t) during relaxation obtained from a simulation plotted together with the relationship of Eq. 3; (b)
time derivative of the left ventricular pressure dP(t)/dt obtained from the same simulation; (c) pump flow Q(t) during relaxation obtained
from the same simulation plotted together with the relationship of Eq. 5 and the numerical fitting (bold line); (d) time derivative of the pump
flow dQ(t)/dt obtained from the same simulation.

represented the slope of the linear pressure-flow
characteristics (RP = 0.625 mm Hgs/mL), rP repre-
sented the quadratic coefficient of the nonlinear
pressure-flow characteristics (rP = 4.1610-3 mm Hg
s2/mL2), and LP represented the fluid inertance
(LP = 0.020 mm Hgs2/mL).
Simulations were performed for both pump
models and the six relaxation conditions, with the
pump speed changing every 20 s from 7.5 to
12.5 krpm in steps of 0.5 krpm. One representative
cycle for each pump speed was extracted from the
signals once the simulation reached steady state. The
dP/dtmin and the dQ/dtmin were calculated by taking
the minimum of the first time derivative of pressure
and flow, respectively (Fig. 1b,d). The tQ was calcu-
lated by fitting an exponential function to the
decreasing portion of the flow waveform, using a least
squares criterion. The start point for the fitting was at
the time when dQ(t)/dt was minimal, the end point
was 25 ms before Q(t) reached its minimum. These
two points corresponded approximately to the usual
start and end points used to calculate the time con-
stant from the ventricular pressure decay: start when
dP(t)/dt is minimal and end 5 ms before mitral valve
opening (26). Figure 1c shows the exponential fitting
superimposed onto the simulated pump flow
waveform.
Plots of the dQ/dtmin versus dP/dtmin and of tQ
versus tP were generated from simulation results
from both the linear and nonlinear pump models, and
regressions coefficients were calculated.
Finally, tQ was evaluated at a constant tP (0.043 s)
and average pump flow (6 L/min), using various con-
ditions of ventricular preload and afterload. In par-
ticular, the LAP was changed over a range of 50%
of the baseline value during support (10 mm Hg) and
AoP over the range of 18% of the baseline value
during support (86 mm Hg).

Artif Organs, Vol. 36, No. 5, 2012

 VENTRICULAR RELAXATION DIAGNOSTICS USING RBP FLOW
Analytical relationships
For a more complete understanding of the interac-
tion between flow and pressure relaxation param-
eters, the relationships dQ/dtmin versus dP/dtmin and tQ
versus tP were derived analytically by using the fol-
lowing simplifications and assumptions:
1 The ventricular pressure decrease and its time
derivative were treated as exponential functions of
time (11):
P(t ) = ( P0 P ) e t P + P (3)
dP(t ) ( P P ) t P
= 0 e (4)
dt P
Here, P(t) represents the left ventricular pressure;
P0 represents the pressure at time t = 0+, when relax-
ation starts and the first time derivative of pressure is
minimal (dP/dtmin); P represents the pressure asymp-
tote for t ; and tP represents the time constant of
pressure decrease. Figure 1a shows the left ventricu-
lar pressure obtained from a numerical simulation
plotted together with Eq. 3. Figure 1b shows the time
derivative of the ventricular pressure and the dP/dtmin
for the same simulation data.
2 The linear RBP model was considered (Eq. 1).
3 The AoP was considered constant.
FIG. 2. Relationship between dQ/dtmin and dP/dtmin calculated
from the simulation data (squares) and the analytical relationship
(circles) of Eq. 6. Data from linear pump characteristics and three
different ventricular relaxation conditions (tP) are shown. Each
point marker represents a different pump speed going from 7.5 to
12.5 krpm from the bottom left corner to the upper right corner of
the picture.
473
FIG. 3. One cycle of the pump flow waveforms calculated from
simulations with linear pump characteristics at different pump
speeds and at a ventricular relaxation tP of 0.043 s (dotted lines);
exponential fitting used to identify the tQ is superimposed (solid
lines).
4 A mono-exponential function Q ( t ) was used for
the determination of the flow time constant, tQ, in
the form of Eq. 5.
( t tn )
Q ( t ) = (Qi Q ) e Q
+ Q (5)
Here, tn is the time when the first time derivative of
pump flow is minimal, Qi is the value of the flow at
time tn, Q is the flow asymptote for t , and tQ is
the time constant of pump flow decrease. Figure 1c
shows the pump flow obtained from a numerical
simulation plotted together with the curve in Eq. 5
and the numerical fit. Figure 1d shows the time
derivative of the pump flow and the dQ/dtmin for the
same simulation data.
The analytical relationships between dQ/dtmin and
dP/dtmin and between tQ and tP were plotted along
with the simulation results for comparison.
RESULTS
Figures 24 refer to the linear pump
characteristics. In Fig. 2, the relationship between
dQ/dtmin and dP/dtmin for three different values of tP
are displayed. Squares represent the simulation data
and circles the relationship obtained from the ana-
lytical approach (Eq. 6). In Fig. 3, the simulated
pump flow waves corresponding to the different
pump speeds and a tP equal to 0.043 s are shown.
The exponential fit used to calculate the tQ
is superimposed. Figure 4 shows the relationship
Artif Organs, Vol. 36, No. 5, 2012
474 F. MOSCATO ET AL.

FIG. 4. Relationship between tQ and tP. Box and whiskers rep-
resent the calculated tQ from the simulation data at different
speed steps (n = 11) and six different ventricular relaxation con-
ditions (tP). Together with the simulation data, also the analytical
relationship of Eq. 7 is shown. Data from the linear pump char-
acteristics are shown.
FIG. 5. Relationship between dQ/dtmin and dP/dtmin calculated
from the simulation data. Data from the nonlinear pump charac-
teristics and three different ventricular relaxation conditions (tP)
are shown. Each point marker represents a different pump speed
going from 7.5 to 12.5 krpm from the bottom left corner to the
upper right corner of the picture.

Figures 5 and 6 refer to the nonlinear pump

between tQ and tP. Here, boxes and whiskers
characteristics. In Fig. 5, the relationships between
represent the calculated tQ from the simulation data
dQ/dtmin and dP/dtmin calculated for three different
at different speeds (n = 11) and different tP. The rela-
ventricular tP are shown. The partial support condi-
tionship obtained from the analytical approach
tion at low pump speeds causes the aortic valve to
(Eq. 7) is also depicted. In Fig. 4, the small dispersion
open during systole so that the curve becomes non-
of the simulation data points shows that the tQ versus
linear (changing values of dQ/dtmin for an almost con-
tP relationship is nearly independent of speed. Linear
stant dP/dtmin). In Fig. 6, the relationship between tQ
regression coefficients of the dQ/dtmin versus dP/dtmin
and tP is depicted for different pump speeds. Linear
and tQ versus tP relationships, calculated for the
regression coefficients of the dQ/dtmin versus dP/dtmin
linear pump characteristics at each single relaxation
state and pump speed, respectively, lead to values
r > 0.99.
Equations 6 and 7 are the analytical relationships
between the relaxation indices obtained from ven-
tricular pressure and those obtained from the pump
flow. A detailed derivation of these equations is given
in the Appendix.

dQ 1 P dP
(6)
dtmin e LP RP dtmin

LP
Q 2 P (7)
RP

In Eqs. 6 and 7, dQ/dtmin and dP/dtmin are the

minimum rates of pump flow and ventricular pres-
sure decrease, tQ and tP are the time constants of
pump flow ventricular pressure decrease, RP is the
FIG. 6. Relationship between tQ and tP. Data from nonlinear
slope of the linear pressure-flow static characteristics, pump characteristics at six different ventricular relaxation condi-
LP is the fluid inertance, and e is the Eulers number. tions (tP) and for six different pump speeds are shown.

Artif Organs, Vol. 36, No. 5, 2012

 VENTRICULAR RELAXATION DIAGNOSTICS USING RBP FLOW
TABLE 1. Percentage changes in the calculation of tQ for different preload and
afterload conditions
LAP AoP
Preload increase +50%
Preload decrease -50%
Afterload increase +18%
Afterload decrease -18%
Values were calculated in all cases for a tP of 0.043 s and average pump flow of 6 L/min.
tP, time constant of ventricular pressure decrease; tQ, time constant of pump flow decrease;
LAP, left atrial pressure; AoP, aortic pressure.
and tQ versus tP relationships, calculated for the non-
linear pump characteristics at each single relaxation
state and pump speed, respectively, lead to values
r > 0.97.
Finally, in Table 1, the changes from baseline of the
time constant of flow decay (tQ) are shown under
different preload and afterload conditions. Results
are reported as percentage changes for each condi-
tion studied, using both the linear and nonlinear
pump models.
DISCUSSION
Proper monitoring of the assisted ventricle seems
crucial to determine if and when weaning is possible,
but also to preserve residual function in case of per-
manent support. Monitoring of ventricular function
involves not only conventional ultrasound and cath-
eter examinations, but also continuous noninvasive
monitoring from the pump available signals. Indeed,
systolic as well as diastolic ventricular properties,
heart rhythm, and aortic valve condition (if it stays
always closed during the heart cycle or not) all leave
a fingerprint on the pump flow signal. This study increasing speed despite an almost constant dP/dtmin.
investigated by numerical simulations the possibility
of monitoring ventricular relaxation from the pump
flow only. This diagnostic tool could contribute to a
more comprehensive picture of the ventricular func-
tion and its changes during mechanical assistance.
In addition to that, understanding and monitoring
diastolic dysfunction and its course (or at least ven-
tricular relaxation, as in the present study) could
eventually encourage RBP use in patients with dias-
tolic dysfunction alone. However, further studies of
the peculiar hemodynamic condition of this class of
patients and the interaction with a RBP are needed.
In the present study, it could be shown, at least in
numerical simulations, that the relaxation parameters
dQ/dtmin and tQ derived from the pump flow are ana-
logues to the classical, pressure-derived ones dP/dtmin
and tP.
475
Linear model Nonlinear model
tQ tQ
6.0% 9.5%
-4.5% -9.4%
0.0% -1.4%
1.5% 1.4%
In both the case of a linear and quadratic pump
characteristics, dQ/dtmin correlated well with dP/dtmin
(Figs. 2 and 5, respectively). Impaired relaxation is
said to be present if the absolute value of dP/dtmin is
lower than 1100 mm Hg/s (27). However, the major
drawback of dP/dtmin (and consequently of dQ/dtmin)
is its sensitivity to ventricular end-systolic pressure
(27), which can be strongly influenced by the pump
speed during a full support condition (i.e., when
aortic valve stays always closed). For this reason,
during full support, both dQ/dtmin and dP/dtmin
decrease in absolute value for increasing pump speed
(Figs. 2 and 5). The condition of partial support (i.e.,
aortic valve opening during systole) also deserves
consideration. For the linear case (Fig. 2), both the
differential pressure and the flow pulsatility are not
influenced much by the pump speed and so the
resulting dP/dtmin and dQ/dtmin tend to remain
constant. However, for the nonlinear case (Fig. 5),
flow pulsatility is influenced by pump speed despite
an almost constant differential pressure, with a reduc-
tion of pulsatility for increasing speeds. Therefore,
dQ/dtmin significantly decreased in absolute value for
This introduced a significant deviation of this rela-
tionship from linearity.
Simulation results therefore suggest evaluating the
dQ/dtmin at a pump support level that corresponds to
the borderline between partial and full support,
where neither the pump speed nor the pump nonlin-
earity influences the dQ/dtmin and the dP/dtmin.
Both in case of a linear and nonlinear pump model,
tQ correlated with tP (Figs. 4 and 6). For the linear
pump model, the relationship did not depend on
either pump speed or partial/full support conditions,
as the small dispersion of the data in Fig. 4 at different
pump speeds shows. On the other hand, for the non-
linear pump model, the slope of this relationship
showed a strong dependency on pump speed (Fig. 6),
increasing for decreasing speed and especially during
partial support at low speed/flow (7.5 krpm in Fig. 6),
Artif Organs, Vol. 36, No. 5, 2012
476 F. MOSCATO ET AL.
where the nonlinearity effects predominate. Never-
theless, for each given speed, a proportional relation-
ship between tQ and tP exists and a coherent increase
or decrease of tP follows an increase or decrease of tQ.
Results in Fig. 6 can be interpreted considering that
the quadratic pressure-flow pump characteristic has a
slope that depends on the pump flow ([rP |Q(t)|] in
Eq. 2). Higher pump speeds lead to higher pump flows
that in turn result in a bigger pressure-flow character-
istic slope in comparison to a low speed/flow condi-
tion. A bigger pressure-flow characteristic slope
determines a shallower relationship between tQ and tP
as can be inferred by Eq. 7 (where now RP is not
constant but corresponds to the flow dependent term
[rP |Q(t)|] in Eq. 2). Additionally, for very low pump
speed/flow eventually leading to a condition of partial
support with backflow (7.5 krpm in Fig. 6), the nonlin-
earity of the pressure-flow characteristics strongly
amplifies the flow pulsatility for slight changes in dif-
ferential pressure, which increases the slope of the
relationship between tQ and tP. Backflow or even a
condition of very low pump flow should be therefore
avoided when evaluating the tQ.
Simulation results therefore suggest that also the
evaluation of tQ shall be performed at a pump
support level that corresponds to the borderline
between partial and full support.
Finally, Table 1 shows a moderate influence of
preload on the evaluation of the tQ (6 and 9.5% for
linear and nonlinear pump characteristics for a 50%
change in LAP, respectively) but no influence of after-
load.
Some additional aspects and limitations of the
present study should be considered.
The data presented here were obtained from
numerical simulations of assisted heart hemodynam-
ics, and, therefore, the results must be validated in
subsequent animal and/or clinical studies. Neverthe-
less, the model was based on a careful literature
review (1423) and clinical experience, and it is
believed to be a valid tool for elucidating the
complex interaction between ventricular relaxation,
pump characteristics, and the flow waveform.
A simple biexponential model (21) for the normal-
ized contractility function was used that led to
monoexponential ventricular pressure decay and
rise. Although logistic (28) or even more complex
(26) models have been proposed for a better repre-
sentation of ventricular pressure decay, a monoexpo-
nential curve with nonzero asymptote adequately
describes the ventricular pressure decay in most clini-
cal cases (9,22,23). The rising portion has been also
modeled with an exponential curve even if this does
not reflect real ventricular behavior (29). However,
Artif Organs, Vol. 36, No. 5, 2012
this simplification does not have any effect on relax-
ation, which was the focus of the present study.
This study did not include the influence of mea-
surement noise. In case of noisy signals, an approach
based on signal averaging over multiple beats must
be implemented (30). The multiple-beat averaging
method would allow a robust calculation of physi-
ologically relevant features from the noisy flow signal
(dQ/dtmin and tQ).
Clearly, a comprehensive evaluation of the diastolic
function must include, together with relaxation, the
aspects of myocardial diastolic distensibility, stiffness,
and passive ventricular filling. An evaluation of these
properties from the pump flow waveform seems diffi-
cult but possible, as a wide variety of diastolic pump
flow shapes can be observed in patients that reflect
both ventricular filling and diastolic properties.
Current investigations are ongoing to elucidate the
relative changes in the pump flow shape at different
speeds and how these changes relate to diastolic
stiffness and filling properties.Nevertheless,the evalu-
ation of relaxation alone can already provide infor-
mation about diastolic function, as structures and
processes that alter relaxation can also result in mea-
surable abnormalities in stiffness and vice versa
(4,7,31,32).
Finally, the evaluation of ventricular relaxation
presented here requires the measurement of pump
flow, which is not commonly available in clinically
implanted pumps. However, an estimation of pump
flow with adequate frequency response would suffice
for this diagnostic purpose.
CONCLUSIONS
Numerical simulations suggest that ventricular
relaxation properties could be determined in rotary
blood pump recipients noninvasively by using two
indices calculated from the pump flow waveform
(dQ/dtmin and tQ). These indices corresponded, in the
simulations, to the classical, pressure-derived relax-
ation indices. A noninvasive assessment of relaxation
could contribute to the overall evaluation of heart
function and its potential for recovery under RBP
assistance.
Acknowledgments: This work was supported in
part by the Oesterreichische Nationalbank Jubilae-
umsfonds zur Foerderung der Forschungs- und
Lehraufgaben der Wissenschaft (Jubilaeumsfonds-
projekt Nr. 13692).The authors thank Prof. Edward F.
Leonard from Columbia University, New York, NY,
for his advice.
 VENTRICULAR RELAXATION DIAGNOSTICS USING RBP FLOW
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APPENDIX
Analytical derivation of dQ/dtmin vs. dP/dtmin
The solution of Eq. 1 subjected to the forcing func-
tion in Eq. 3 is Eq. A1:
Rp (Q0 Q ) Lp Lp t
1 p R
t
Q (t ) = p e p + e + Q
Lp Rp p Rp
(A1)
Here tP is the time constant of ventricular pressure
relaxation, RP is the slope of the linear pressure-flow
static characteristics, LP is the fluid inertance, Q0 is
the pump flow at time t = 0+, and Q is the pump flow
asymptote for t . Both Q0 and Q are a function
of pump speed (w) and of ventricular (P) and aortic
(AoP) pressures as well as of parameter RP, and can
be derived from Eq. 1 as shown in Eqs. A2 and A3.
a 2 AoP + P0
Q0 = (A2)
Rp
Artif Organs, Vol. 36, No. 5, 2012
478 F. MOSCATO ET AL.

a 2 AoP + P Here, the almost-equal sign accounts for the sim-

Q = (A3) plification introduced by setting the damping ratio
Rp
equal to one.
Equation A1 represents the solution of a second-
order system with two distinct time constants (since it
Analytical derivation of tQ vs. tP
is generally an overdamped system). The damping
To derive the relationship of tQ versus tP, the func-
ratio for this system (z) calculated using parameters
tion in Eq. 5 has to be first evaluated by imposing its
values for tP, RP, and LP in the range of those usually
passage through Qi (defined as the flow Q(t) of
encountered in the clinical practice, is never bigger
Eq. A4 at t = tn) and Q. Thus, by substitution in
than 1.2. This observation allows a further simplifica-
Eq. 5, one obtains:
tion by imposing z = 1 and deriving an approximate
form for Q(t) and its time derivative dQ(t)/dt. These
( t tn )
are shown in Eqs. A4 and A5. 2
Q
Q ( t ) = (Q0 Q ) e + Q (A8)
e

t t
t
Q(t ) = (Q0 Q ) e tn
+ e tn
+ Q (A4) From the first time derivative of Eq. A8, one can
tn
now calculate the minimum:

t
t
dQ ( t )
= (Q0 Q ) 2 e tn (A5) dQ ( t ) 2 (Q Q )
dt tn = 0 (A9)
dtmin e Q
Here, tn is the reciprocal of the natural frequency
(wn) and can be calculated as shown in Eq. A6. This This minimum is set equal to the one calculated in
term corresponds to the time when the dQ(t)/dt Eq. A7 thus obtaining:
reaches its minimum.
1 P dP 2 Q Q
0 (A10)
1 LP P e LP RP dtmin e Q
tn = = (A6)
n RP
From Eq. A10, one can finally obtain the relation-
By calculating the minima from Eqs. 4 and A5 and
ship between tQ and tP using the relationships
using the relationship between Q0 and P0 and Q and
between Q0 and P0 and Q and p, Eqs. A2 and A3,
p, Eqs. A2 and A3, one can finally derive the rela-
and the dP/dtmin calculated from Eq. 4.
tionship between dQ/dtmin and dP/dtmin.

dQ 1 P dP LP
(A7) Q 2 P (A11)
dtmin e LP RP dtmin RP

Artif Organs, Vol. 36, No. 5, 2012

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