A systems approach to cardiovascular health and disease with a focus on aortic wave dynamics

Cardiovascular diseases (CVDs) have reached an epidemic proportion in the US and worldwide with serious consequences in terms of human suffering and economic impact. More than one third of American adults are suffering from CVDs. The total direct and indirect costs of CVDs are more than $500 billion per year. Therefore, there is an urgent need to develop noninvasive diagnostics methods, to design minimally invasive assist devices, and to develop economical and easy-to-use monitoring systems for cardiovascular diseases. In order to achieve these goals, it is necessary to gain a better understanding of the subsystems that constitute the cardiovascular system. The aorta is one of these subsystems whose role in cardiovascular functioning has been underestimated. Traditionally, the aorta and its branches have been viewed as resistive conduits connected to an active pump (left ventricle of the heart). However, this perception fails to explain many observed physiological results. My goal in this thesis is to demonstrate the subtle but important role of the aorta as a system, with focus on the wave dynamics in the aorta.

The operation of a healthy heart is based on an optimized balance between its pumping characteristics and the hemodynamics of the aorta and vascular branches. The delicate balance between the aorta and heart can be impaired due to aging, smoking, or disease. The heart generates pulsatile flow that produces pressure and flow waves as it enters into the compliant aorta. These aortic waves propagate and reflect from reflection sites (bifurcations and tapering). They can act constructively and assist the blood circulation. However, they may act destructively, promoting diseases or initiating sudden cardiac death. These waves also carry information about the diseases of the heart, vascular disease, and coupling of heart and aorta. In order to elucidate the role of the aorta as a dynamic system, the interplay between the dominant wave dynamic parameters is investigated in this study. These parameters are heart rate, aortic compliance (wave speed), and locations of reflection sites. Both computational and experimental approaches have been used in this research. In some cases, the results are further explained using theoretical models.

The main findings of this study are as follows: (i) developing a physiologically realistic outflow boundary condition for blood flow modeling in a compliant vasculature; (ii) demonstrating that pulse pressure as a single index cannot predict the true level of pulsatile workload on the left ventricle; (iii) proving that there is an optimum heart rate in which the pulsatile workload of the heart is minimized and that the optimum heart rate shifts to a higher value as aortic rigidity increases; (iv) introducing a simple bio-inspired device for correction and optimization of aortic wave reflection that reduces the workload on the heart; (v) deriving a non-dimensional number that can predict the optimum wave dynamic state in a mammalian cardiovascular system; (vi) demonstrating that waves can create a pumping effect in the aorta; (vii) introducing a system parameter and a new medical index, Intrinsic Frequency, that can be used for noninvasive diagnosis of heart and vascular diseases; and (viii) proposing a new medical hypothesis for sudden cardiac death in young athletes.

Rings faithfully represented on their left socle

In 1964 A. W. Goldie [1] posed the problem of determining all rings with identity and minimal condition on left ideals which are faithfully represented on the right side of their left socle. Goldie showed that such a ring which is indecomposable and in which the left and right principal indecomposable ideals have, respectively, unique left and unique right composition series is a complete blocked triangular matrix ring over a skewfield. The general problem suggested above is very difficult. We obtain results under certain natural restrictions which are much weaker than the restrictive assumptions made by Goldie.

We characterize those rings in which the principal indecomposable left ideals each contain a unique minimal left ideal (Theorem (4.2)). It is sufficient to handle indecomposable rings (Lemma (1.4)). Such a ring is also a blocked triangular matrix ring. There exist r positive integers K₁,..., K_r such that the i,j^th block of a typical matrix is a K_i x K_j matrix with arbitrary entries in a subgroup D_ij of the additive group of a fixed skewfield D. Each D_ii is a sub-skewfield of D and D_ri = D for all i. Conversely, every matrix ring which has this form is indecomposable, faithfully represented on the right side of its left socle, and possesses the property that every principal indecomposable left ideal contains a unique minimal left ideal.

The principal indecomposable left ideals may have unique composition series even though the ring does not have minimal condition on right ideals. We characterize this situation by defining a partial ordering ρ on {i, 2,...,r} where we set iρj if D_ij ≠ 0. Every principal indecomposable left ideal has a unique composition series if and only if the diagram of ρ is an inverted tree and every D_ij is a one-dimensional left vector space over D_ii (Theorem (5.4)).

We show (Theorem (2.2)) that every ring A of the type we are studying is a unique subdirect sum of less complex rings A₁,...,A_s of the same type. Namely, each A_i has only one isomorphism class of minimal left ideals and the minimal left ideals of different A_i are non-isomorphic as left A-modules. We give (Theorem (2.1)) necessary and sufficient conditions for a ring which is a subdirect sum of rings A_i having these properties to be faithfully represented on the right side of its left socle. We show ((4.F), p. 42) that up to technical trivia the rings A_i are matrix rings of the form

[...]. Each Q_j comes from the faithful irreducible matrix representation of a certain skewfield over a fixed skewfield D. The bottom row is filled in by arbitrary elements of D.

In Part V we construct an interesting class of rings faithfully represented on their left socle from a given partial ordering on a finite set, given skewfields, and given additive groups. This class of rings contains the ones in which every principal indecomposable left ideal has a unique minimal left ideal. We identify the uniquely determined subdirect summands mentioned above in terms of the given partial ordering (Proposition (5.2)). We conjecture that this technique serves to construct all the rings which are a unique subdirect sum of rings each having the property that every principal-indecomposable left ideal contains a unique minimal left ideal.