Sensitivity of stress and strain calculations to passive material parameters in cardiac mechanical models using unloaded geometries

Cardiac stress (load) and strain (stretch) are widely studied indicators of cardiac function and outcome, but are difficult or impossible to directly measure in relation to the cardiac microstructure. An alternative approach is to estimate these states using computer methods and image-based measurements, but this still requires knowledge of the tissue material properties and the unloaded state, both of which are difficult to determine. In this work, we tested the sensitivity of these two interdependent unknowns (reference geometry and material parameters) on stress and strain calculations in cardiac tissue. Our study used a finite element model of the human ventricle, with a hyperelastic passive material model, and was driven by a cell model mediated active contraction. We evaluated 21 different published parameter sets for the five parameters of the passive material model, and for each set we optimised the corresponding unloaded geometry and contractility parameter to model a single pressure-volume loop. The resulting mechanics were compared, and calculated systolic stresses were largely insensitive to the chosen parameter set when an unloading algorithm was used. Meanwhile, material strain calculations varied substantially depending on the choice of material parameters. These results indicate that determining the correct material and unloaded configuration may be highly important to understand strain driven processes, but less so for calculating stress estimates.