Patient-specific left ventricular hypertrophy under severe hypertension: mechanistic insights from Hill-type computational simulations

Hill's force-velocity relationship is a fundamental property of myocardial contraction, yet its mechanical role in patient-specific left ventricular hypertrophy (LVH) remains underexplored. This study systematically evaluated the consequences of including versus omitting Hill-type velocity dependence in magnetic resonance imaging (MRI)-derived three-dimensional (3D) finite element (FE) models of three hypertrophic left ventricles subjected to stage 3 hypertensive loading. Incorporating velocity dependence moderated peak systolic pressure, tempered early fibre shortening, sustained mid-systolic deformation, and yielded smoother pressure-volume behaviour with improved energetic efficiency. In contrast, omitting velocity dependence amplified systolic pressure generation, accelerated contraction prematurely, and increased stroke work by 15%. Regional analysis across all three patient-specific LVH models consistently demonstrated that the absence of velocity dependence elevated fibre stress by 15-25%, most prominently in subendocardial and high-curvature regions, accompanied by reduced mid-systolic strain. A biophysical damping formulation was implemented to ensure numerical stability across heterogeneous LVH geometries. Together, these findings provide mechanistic insight into how sarcomere shortening dynamics govern regional ventricular adaptation and advance the physiological fidelity of cardiac simulations under severe hypertensive conditions.