Importance of Atrial Compliance in Cardiac Performance

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Abstract
Effects of changes in atrial compliance on cardiac performance were analyzed using a circulatory analog model. The atrium was assumed to be a noncontracting chamber with a constant compliance. It connected the venous return system, which was represented by mean circulatory filling pressure and a venous return resistance in accordance with Guyton's concept, with the ventricle, which was characterized by a time-varying elasticity. Atrial compliance was increased from near zero to a value at which atrial volume was twice ventricular stroke volume, while the parameters of ventricular contractility were kept unchanged. Cardiac output increased from 2,400 to 3,240 ml/min with increases in atrial compliance from 0.1 to 20 ml/mm Hg (venous return resistance 0.1 mm Hg sec/ml), whereas mean atrial pressure simultaneously decreased from 3.0 to 2.2 mm Hg. This result indicates that cardiac performance in terms of the cardiac output-mean atrial pressure relationship was markedly improved by increases in atrial compliance in spite of constant ventricular contractility. The analysis of the model strongly suggests that natural atrial compliance in situ, by pooling venous return flow during systole and supplying it to the ventricle during diastole, facilitates the transformation of the continuous venous return flow into the intermittent ventricular filling flow.