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Fandaros M, Kwok C, Wolf Z, Labropoulos N, Yin W. Patient-Specific Numerical Simulations of Coronary Artery Hemodynamics and Biomechanics: A Pathway to Clinical Use. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00731-4. [PMID: 38710896 DOI: 10.1007/s13239-024-00731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Numerical models that simulate the behaviors of the coronary arteries have been greatly improved by the addition of fluid-structure interaction (FSI) methods. Although computationally demanding, FSI models account for the movement of the arterial wall and more adequately describe the biomechanical conditions at and within the arterial wall. This offers greater physiological relevance over Computational Fluid Dynamics (CFD) models, which assume the walls do not move or deform. Numerical simulations of patient-specific cases have been greatly bolstered by the use of imaging modalities such as Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI), Optical Coherence Tomography (OCT), and Intravascular Ultrasound (IVUS) to reconstruct accurate 2D and 3D representations of artery geometries. The goal of this study was to conduct a comprehensive review on CFD and FSI models on coronary arteries, and evaluate their translational potential. METHODS This paper reviewed recent work on patient-specific numerical simulations of coronary arteries that describe the biomechanical conditions associated with atherosclerosis using CFD and FSI models. Imaging modality for geometry collection and clinical applications were also discussed. RESULTS Numerical models using CFD and FSI approaches are commonly used to study biomechanics within the vasculature. At high temporal and spatial resolution (compared to most cardiac imaging modalities), these numerical models can generate large amount of biomechanics data. CONCLUSIONS Physiologically relevant FSI models can more accurately describe atherosclerosis pathogenesis, and help to translate biomechanical assessment to clinical evaluation.
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Affiliation(s)
- Marina Fandaros
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Chloe Kwok
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Zachary Wolf
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook Medicine, 11794, Stony Brook, NY, USA
| | - Wei Yin
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA.
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Keramati H, de Vecchi A, Rajani R, Niederer SA. Using Gaussian process for velocity reconstruction after coronary stenosis applicable in positron emission particle tracking: An in-silico study. PLoS One 2023; 18:e0295789. [PMID: 38096169 PMCID: PMC10721050 DOI: 10.1371/journal.pone.0295789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Accurate velocity reconstruction is essential for assessing coronary artery disease. We propose a Gaussian process method to reconstruct the velocity profile using the sparse data of the positron emission particle tracking (PEPT) in a biological environment, which allows the measurement of tracer particle velocity to infer fluid velocity fields. We investigated the influence of tracer particle quantity and detection time interval on flow reconstruction accuracy. Three models were used to represent different levels of stenosis and anatomical complexity: a narrowed straight tube, an idealized coronary bifurcation with stenosis, and patient-specific coronary arteries with a stenotic left circumflex artery. Computational fluid dynamics (CFD), particle tracking, and the Gaussian process of kriging were employed to simulate and reconstruct the pulsatile flow field. The study examined the error and uncertainty in velocity profile reconstruction after stenosis by comparing particle-derived flow velocity with the CFD solution. Using 600 particles (15 batches of 40 particles) released in the main coronary artery, the time-averaged error in velocity reconstruction ranged from 13.4% (no occlusion) to 161% (70% occlusion) in patient-specific anatomy. The error in maximum cross-sectional velocity at peak flow was consistently below 10% in all cases. PEPT and kriging tended to overestimate area-averaged velocity in higher occlusion cases but accurately predicted maximum cross-sectional velocity, particularly at peak flow. Kriging was shown to be useful to estimate the maximum velocity after the stenosis in the absence of negative near-wall velocity.
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Affiliation(s)
- Hamed Keramati
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Adelaide de Vecchi
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronak Rajani
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiology Department, Guy’s and St, Thomas’s Hospital, London, United Kingdom
| | - Steven A. Niederer
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
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Zhang H, Wu R, Yang N, Xie J, Hou Y. Research on individualized distribution approach of coronary resting blood flow for noninvasive calculation of fractional flow reserve. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107704. [PMID: 37429248 DOI: 10.1016/j.cmpb.2023.107704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The distribution of coronary resting blood flow is critical for accurately calculating the computed tomography (CT) angiography-derived fractional flow reserve (FFRCT). However, the diagnostic accuracy of FFRCT calculated by the fixed exponents between two risk factors and coronary resting blood flow, including myocardial mass and diameter of the coronary artery branch, was insufficient compared with invasive fractional flow reserve (FFR). In this study, we proposed the individualized distribution of coronary resting blood flow based on coronary ultrasound blood flow measurement, to improve the diagnostic accuracy of FFRCT calculation. METHODS Five risk factors and an unknown coefficient K were integrated to calculate the individualized distribution of coronary resting blood flow. The K value was fit using the least square method based on coronary ultrasound blood flow measurement results of 30 volunteers. We developed a novel approach for calculating the individualized distribution of coronary resting blood flow and applied it to calculate FFRCT (FFRCTI). Then, we tested the performance of the individualized distribution approach by comparing it with the approach proposed by Taylor based on coronary ultrasound blood flow measurement results of 13 volunteers. Finally, we tested the diagnostic accuracy of FFRCT calculated by two approaches in invasive FFR of 121 vessels with coronary stenosis. RESULTS We identified five risk factors and 6.83×10-5 for K value, including cardiac output, mean arterial pressure, myocardial mass, coronary artery volume, and diameter of the coronary artery branch, to calculate the individualized distribution of coronary resting blood flow. The mean square error of the individualized distribution approach (0.0088) was significantly less than that of the approach proposed by Taylor (0.0799). The diagnostic accuracy of FFRCTI calculated by the individualized distribution approach (91.74%) was higher than that of the approach proposed by Taylor (FFRCTT) (82.64%). CONCLUSIONS The individualized distribution approach of coronary resting blood flow can significantly improve the diagnostic accuracy of FFRCT calculation compared with invasive FFR, and support its wide clinical application for diagnosing myocardial ischemia caused by coronary stenosis.
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Affiliation(s)
- Honghui Zhang
- College of Engineering, Inner Mongolia Minzu University, Tongliao 028000, China
| | - Rile Wu
- Department of Neurology, Tong Liao City Hospital, Tongliao 028007, China
| | - Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
| | - Jinjie Xie
- Department of Echocardiography, Jiahui International Hospital, Shanghai 200233, China
| | - Yang Hou
- Shengjing Hospital, China Medical University, Shenyang 110001, China
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Liu Y, Jiang G, Wang X, An X, Wang F. The relationship between geometry and hemodynamics of the stenotic carotid artery based on computational fluid dynamics. Clin Neurol Neurosurg 2023; 231:107860. [PMID: 37390570 DOI: 10.1016/j.clineuro.2023.107860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/17/2023] [Accepted: 06/24/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE The purpose of this work was to investigate the relationship between the geometric factors and the hemodynamics of the stenotic carotid artery. METHODS We retrospectively reviewed data of patients with carotid stenosis (40%-95%). The Navier-Stokes equations were solved using ANSYS CFX 18.0. Correlation analysis was based on Spearman's test. Geometric variables (p < 0.1 in the univariate analysis) were entered into the logistical regression. A receiver-operating characteristics analysis was used to detect hemodynamically significant lesions. RESULTS 81 patients (96 arteries) were evaluated. The logistic regression analysis revealed that the translesional pressure ratio was significantly correlated with the stenosis degree (OR = 1.147, p < 0.001) and the angle between internal carotid artery and external carotid artery (angle γ) (OR = 0.933, p = 0.01). The translesional wall shear stress ratio was significantly correlated with stenosis degree (OR = 1.094, p < 0.001), lesion length (OR = 0.873, p = 0.01), lumen area of internal carotid artery (OR = 0.867, p = 0.002), and lumen area of common carotid artery (OR = 1.058, p = 0.01). For predicting low translesional pressure ratio, the AUC was 0.71 (p < 0.001) for angle γ, and was 0.87 (p < 0.001) for stenosis degree. For predicting high translesional wall shear stress ratio, the AUC was 0.62 (p = 0.04) for lumen area of internal carotid artery, and was 0.77 (p < 0.001) for stenosis degree. CONCLUSIONS Apart from stenosis degree, other geometric characteristics of lesions may also have an influence on hemodynamics of the stenotic carotid artery.
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Affiliation(s)
- Yongsheng Liu
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guinan Jiang
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xuwen Wang
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiangbo An
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Feng Wang
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
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A spatiotemporal analysis of the left coronary artery biomechanics using fluid-structure interaction models. Med Biol Eng Comput 2023; 61:1533-1548. [PMID: 36790640 DOI: 10.1007/s11517-023-02791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Biomechanics plays a critical role in coronary artery disease development. FSI simulation is commonly used to understand the hemodynamics and mechanical environment associated with atherosclerosis pathology. To provide a comprehensive characterization of patient-specific coronary biomechanics, an analysis of FSI simulation in the spatial and temporal domains was performed. In the current study, a three-dimensional FSI model of the LAD coronary artery was built based on a patient-specific geometry using COMSOL Multiphysics. The effect of myocardial bridging was simulated. Wall shear stress and its derivatives including time-averaged wall shear stress, wall shear stress gradient, and OSI were calculated across the cardiac cycle in multiple locations. Arterial wall strain (radial, circumferential, and longitudinal) and von Mises stress were calculated. To assess perfusion, vFFR was calculated. The results demonstrated the FSI model could identify regional and transient differences in biomechanical parameters within the coronary artery. The addition of myocardial bridging caused a notable change in von Mises stress and an increase in arterial strain during systole. The analysis performed in this manner takes greater advantage of the information provided in the space and time domains and can potentially assist clinical evaluation.
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Geng Y, Liu H, Wang X, Zhang J, Gong Y, Zheng D, Jiang J, Xia L. Effect of microcirculatory dysfunction on coronary hemodynamics: A pilot study based on computational fluid dynamics simulation. Comput Biol Med 2022; 146:105583. [DOI: 10.1016/j.compbiomed.2022.105583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/21/2022] [Accepted: 04/30/2022] [Indexed: 01/09/2023]
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Peng C, Liu J, He W, Qin W, Yuan T, Kan Y, Wang K, Wang S, Shi Y. Numerical simulation in the abdominal aorta and the visceral arteries with or without stenosis based on 2D PCMRI. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3569. [PMID: 34967124 DOI: 10.1002/cnm.3569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
It is important to obtain accurate boundary conditions (BCs) in hemodynamic simulations. This article aimed to improve the accuracy of BCs in computational fluid dynamics (CFD) simulation and analyze the differences in hemodynamics between healthy volunteers and patients with visceral arterial stenosis (VAS). The geometric models of seven cases were reconstructed using the magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA) imaging data. The physiological flow waveforms obtained from 2D Phase Contrast Magnetic Resonance Imaging (PCMRI) were imposed on the aortic inlet and the visceral arteries' outlets. The individualized RCR values of the three-element Windkessel model were imposed on the aortic outlet. CFD simulations were run in the open-source software: svSolver. Two specific time points were selected to compare the hemodynamics of healthy volunteers and patients with VAS. The results suggested that blood in the stenotic visceral arteries flowed at high speed throughout the cardiac cycle. The low pressure is distributed at stenotic lesions. The wall shear stress (WSS) reached 4 Pa near stenotic locations. The low time average wall shear stress (TAWSS), high oscillatory shear index (OSI), and high relative residence time (RRT) concentrated in the abdominal aorta. Besides, the ratios of the areas with low TAWSS, high OSI, and high RRT to the computational domain were higher in patients with VAS than which in the healthy volunteers. The individualized BCs were used for hemodynamic simulations and results suggest that patients with stenosis have a higher risk of blood retention and atherosclerosis formation in the abdominal aorta.
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Affiliation(s)
- Chen Peng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Junzhen Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Qin
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Keqiang Wang
- Institute of Panvascular Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Li N, Li B, Feng Y, Ma J, Zhang L, Liu J, Liu Y. Impact of coronary bifurcated vessels flow-diameter scaling laws on fractional flow reserve based on computed tomography images (FFRCT). MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:3127-3146. [PMID: 35240824 DOI: 10.3934/mbe.2022145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the influence of the blood flow-diameter scaling laws of $ \mathrm{Q}\mathrm{\alpha }{\mathrm{D}}^{3} $, $ \mathrm{Q}\mathrm{\alpha }{\mathrm{D}}^{2.7} $ and $ \text{Q}\alpha \text{D}{}^{7}\!\!\diagup\!\!{}_{3}\; $ on the numerical simulation of fraction flow reserve based on CTA images and to find the optimal exponents. METHODS 1) 26 patients with coronary artery disease were screened according to the inclusion criteria; 2) Microcirculation resistance (Rm) was calculated under the 3, 2.7 and 7/3 power of the flow-diameter scaling law, which were recorded as 3Rm, 2.7Rm and 7/3Rm, respectively; 3) 3Rm, 2.7Rm and 7/3Rm were used as exit boundary conditions to simulate FFRCT, quoted as 3FFRCT, 2.7FFRCT and 7/3FFRCT, respectively; 4) The correlation and diagnostic performance between three kinds of FFRCT and FFR were analyzed. RESULTS The p-values of comparing 3Rm, 2.7Rm and 7/3Rm with FFR were 0.004, 0.005 and 0.010, respectively; the r value between 7/3FFRCT and FFR (0.96) was better than that of 3FFRCT (0.95) and 2.7FFRCT (0.95); the 95% LoA between 7/3FFRCT and FFR (-0.08~0.11) was smaller than that of 3FFRCT (-0.10~0.12) and 2.7FFRCT (-0.09~0.11); the AUC and accuracy of 7/3FFRCT [0.962 (0.805-0.999), 96.15%] were the same as those of 2.7FFRCT [0.962 (0.805-0.999), 96.15%] and better than those of 3FFRCT [0.944 (0.777-0.996), 92.3%]. The prediction threshold of 7/3FFRCT (0.791) was closer to 0.8 than that of 3FFRCT (0.816) and 2.7FFRCT (0.787). CONCLUSION The blood flow-diameter scaling law affects the FFRCT simulation by influencing the exit boundary condition Rm of the calculation. With $ Q\alpha D{}^{7}\!\!\diagup\!\!{}_{3}\; $, FFRCT had the highest diagnostic performance. The blood flow-diameter scaling law provides theoretical support for the blood flow distribution in the bifurcated vessel and improves the FFRCT model.
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Affiliation(s)
- Na Li
- College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bao Li
- College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yili Feng
- College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Junling Ma
- College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Liyuan Zhang
- College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Jian Liu
- Peking University People's Hospital, Beijing, China
| | - Youjun Liu
- College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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Chandola G, Zhang JM, Tan RS, Chai P, Teo L, Allen JC, Low R, Huang W, Leng S, Fam JM, Chin CY, Kassab GS, Low AFH, Tan SY, Chua T, Lim ST, Zhong L. Computed Tomography Coronary Angiography and Computational Fluid Dynamics Based Fractional Flow Reserve Before and After Percutaneous Coronary Intervention. Front Bioeng Biotechnol 2021; 9:739667. [PMID: 34557479 PMCID: PMC8452917 DOI: 10.3389/fbioe.2021.739667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Invasive fractional flow reserve (FFR) is recommended to guide stent deployment. We previously introduced a non-invasive FFR calculation (FFRB) based on computed tomography coronary angiography (CTCA) with reduced-order computational fluid dynamics (CFD) and resistance boundary conditions. Current study aimed to assess the feasibility and accuracy of FFRB for predicting coronary hemodynamics before and after stenting, with invasive FFR as the reference. Twenty-five patients who had undergone CTCA were prospectively enrolled before invasive coronary angiography (ICA) and FFR-guided percutaneous coronary intervention (PCI) on 30 coronary vessels. Using reduced-order CFD with novel boundary conditions on three-dimensional (3D) patient-specific anatomic models reconstructed from CTCA, we calculated FFRB before and after virtual stenting. The latter simulated PCI by clipping stenotic segments from the 3D coronary models and replacing them with segments to mimic the deployed coronary stents. Pre- and post-virtual stenting FFRB were compared with FFR measured pre- and post-PCI by investigators blinded to FFRB results. Among 30 coronary lesions, pre-stenting FFRB (mean 0.69 ± 0.12) and FFR (mean 0.67 ± 0.13) exhibited good correlation (r = 0.86, p < 0.001) and agreement [mean difference 0.024, 95% limits of agreement (LoA): −0.11, 0.15]. Similarly, post-stenting FFRB (mean 0.84 ± 0.10) and FFR (mean 0.86 ± 0.08) exhibited fair correlation (r = 0.50, p < 0.001) and good agreement (mean difference 0.024, 95% LoA: −0.20, 0.16). The accuracy of FFRB for identifying post-stenting ischemic lesions (FFR ≤ 0.8) (residual ischemia) was 87% (sensitivity 80%, specificity 88%). Our novel FFRB, based on CTCA with reduced-order CFD and resistance boundary conditions, accurately predicts the hemodynamic effects of stenting which may serve as a tool in PCI planning.
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Affiliation(s)
| | - Jun-Mei Zhang
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lynette Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | | | - Ris Low
- National Heart Centre Singapore, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Chee Yang Chin
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| | - Adrian Fatt Hoe Low
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance Chua
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Rigatelli G, Zuin M, Vassilev D, Mazza A, Bilato C, Roncon L. Pooled prevalence of three major cardiovascular risk factors in patients undergoing left main bifurcation stenting: a systematic review and meta-analysis. Minerva Cardiol Angiol 2021; 70:56-64. [PMID: 33944537 DOI: 10.23736/s2724-5683.21.05666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prevalence of the major risk factors in patients with Left Main (LM) bifurcation disease has not been yet clearly assessed, although it would important for building up bifurcation computational models. We perform a systematic review and metaanalysis on the three major cardiovascular risk factors in patients treated for LM bifurcation disease using either single or 2-stent strategy. MEHTODS In accordance with the PRISMA guidelines, Cochrane Library, Embase, PubMed and Google Scholar were queried to locate articles published between January 2015 to October 2020, comparing single- versus 2-stent strategy and reporting the prevalence of arterial hypertension (HT), hyperlipidaemia (HyperL) and diabetes mellitus (DM). RESULTS Out of a total of 230 articles, 7 articles were included into the final analysis. A total of 4559 patients were enrolled: 2666 (58.4%, mean age 60.4 years, 2318 males) and 1933 patients (42.3%, mean age 64.8 years, 1763 males) received a single- and 2-stent stenting strategies, respectively. A random effect model revealed a pooled prevalence of HT, HyperL and DM in 69.4%, 38.9% and in 31% of cases, respectively. Prevalence of HT was lower in patients treated with single versus 2-stent strategy (63 versus 66.7% of patients, p=0.01) while HyperL and DM were more represented in single versus 2-stent strategy: 41.6 versus 34.1% (p<0.001), and 32.5 versus 31.8% of patients (p=0.61), respectively. CONCLUSIONS In patients with LM bifurcation disease undergoing either single or 2- stent strategy, HT, HyperL and DM are frequent comorbidities. In severe LM disease requiring 2-stent technique, HT is the most prevalent risk factor.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy -
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Dobrin Vassilev
- Department of Cardiology, Alexandrovska University School of Medicine, Sofia, Bulgaria
| | - Alberto Mazza
- Hypertension Management Centre of Excellence, Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | - Loris Roncon
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
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Biglarian M, Firoozabadi B, Saidi MS. Atheroprone sites of coronary artery bifurcation: Effect of heart motion on hemodynamics-dependent monocytes deposition. Comput Biol Med 2021; 133:104411. [PMID: 33932644 DOI: 10.1016/j.compbiomed.2021.104411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Atherosclerosis as a common cardiovascular disease is a result of both adverse hemodynamics conditions and monocyte deposition within coronary arteries. It is known that the adhesion of monocytes on the arterial wall and their interaction with the vascular surface are one of the main parameters in the initiation and progression of atherosclerosis. In this work, hemodynamic parameters and monocyte deposition have been investigated in a 3D computational model of the Left Anterior Descending coronary artery (LAD) and its first diagonal branch (D1) under the heart motion. A one-way Lagrangian approach is performed to trace the monocyte particles under different blood flow regimes and heart motion conditions. The hemodynamic results show that the myocardial wall, and also the flow divider wall can be candidates for atheroprone sites. The dynamic movement and pulsatile inlet changed the flow rate between branches about 21% compared to the static case and steady inlet. On the other hand, the calculation of monocytes' depositional behavior illustrates that they settle down downstream the LAD-D1 bifurcation and on the myocardial wall. The deposition rate is closely associated with the inlet type and changing the steady inlet to the sinusoidal and real physiologic profile showed a 150% increase in the deposition rate. These results ensure that the myocardial wall and LAD-D1 bifurcation are the desirable locations for atherosclerosis. These results are in good agreement with the clinical observations.
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Affiliation(s)
- Mohit Biglarian
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Bahar Firoozabadi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Mohammad Said Saidi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
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12
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Miranda E, Sousa LC, António CC, Castro CF, Pinto SIS. Role of the left coronary artery geometry configuration in atherosusceptibility: CFD simulations considering sPTT model for blood. Comput Methods Biomech Biomed Engin 2021; 24:1488-1503. [PMID: 33661071 DOI: 10.1080/10255842.2021.1894555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The achievement of clinically viable methodologies to simulate the hemodynamics in patient-specific coronary arteries is still a major challenge. Therefore, the novelty of this work is attained by the introduction of the viscoelastic property of blood in the numerical simulations, to study the role of the left coronary artery (LCA) geometry configuration in the atherosusceptibility. Apparently healthy patients were used and four different methodologies were tested. The methodology giving the most accurate results at the same time of having the lowest computational time is the one considering the viscoelastic property of blood and computational fluid dynamics. A Pearson correlation analysis was used to highlight relationships between geometric configuration and hemodynamic descriptors based on the simulated wall shear stress (WSS). The left main stem (LMS) has the greatest atherosusceptibility followed by the left anterior descending artery (LAD) since the relative residence time (RRT) average values are 3.81 and 3.70 Pa-1, respectively. The geometric parameters with relevant contribution to directional flow change are the cross-sectional areas, especially the one of LMS segment (ALMS), and the curvature of LMS segment. For LMS and LAD segments, when ALMS increases, blood flow disturbance (r = 0.81 in LMS and r = 0.74 in LAD) and atherosusceptibility (r = 0.84 in LMS and r = 0.85 in LAD) increases. When the LMS curvature decreases, the WSS magnitude (r = 0.80 in LMS and r = 0.83 in LAD) decreases, and disturbance (r=-0.80 in LMS and r=-0.91 in LAD) and atherosusceptibility (r=-0.74 in LMS and r=-0.74 in LAD) increases.
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Affiliation(s)
- E Miranda
- Engineering Faculty, University of Porto, Porto, Portugal
| | - L C Sousa
- Engineering Faculty, University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering (LAETA-INEGI), Porto, Portugal
| | - C C António
- Engineering Faculty, University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering (LAETA-INEGI), Porto, Portugal
| | - C F Castro
- Engineering Faculty, University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering (LAETA-INEGI), Porto, Portugal
| | - S I S Pinto
- Engineering Faculty, University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering (LAETA-INEGI), Porto, Portugal
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Tajeddini F, Nikmaneshi MR, Firoozabadi B, Pakravan HA, Ahmadi Tafti SH, Afshin H. High precision invasive FFR, low-cost invasive iFR, or non-invasive CFR?: optimum assessment of coronary artery stenosis based on the patient-specific computational models. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3382. [PMID: 32621661 DOI: 10.1002/cnm.3382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/15/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
The objective of this paper is to apply computational fluid dynamic (CFD) as a complementary tool for clinical tests to not only predict the present and future status of left coronary artery stenosis but also to evaluate some clinical hypotheses. In order to assess the present status of the coronary artery stenosis severity, and thereby selecting the most appropriate type of treatment for each patient, fractional flow reserve (FFR), instantaneous wave free-ratio (iFR), and coronary flow reserve (CFR) are calculated. To examine FFR, iFR, and CFR results, the effect of geometric features of stenoses, including diameter reduction (%), lesion length (LL), and minimum lumen diameter (MLD), is studied on them. It is observed that FFR is a more conservative index than iFR and CFR to assess the severity of coronary stenosis. In addition, it is seen that FFR, iFR, and CFR decrease by increasing LL and decreasing MLD. Therefore, the morphological indices, LL/MLD and LL/MLD̂4, with the calculated conservative cut-off values equal to 5.5 and 3.6, are considered. Next, some controversial clinical hypotheses about the assessment of the severity of coronary stenosis are evaluated numerically. These include the examination of FFR, iFR, and CFR accuracies, investigating the effect of coronary hyperemia on iFR, as well as the reliability of the hybrid iFR-FFR decision-making strategy. The presented numerical model can also be used as a predictive tool to identify the atherosuseptible sites of arteries by calculating the time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT).
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Affiliation(s)
- Farshad Tajeddini
- Center of Excellence in Energy Conversion, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mohammad Reza Nikmaneshi
- Center of Excellence in Energy Conversion, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Bahar Firoozabadi
- Center of Excellence in Energy Conversion, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | | | | | - Hossein Afshin
- Center of Excellence in Energy Conversion, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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14
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Hashemi J, Rai S, Ghafghazi S, Berson RE. Blood residence time to assess significance of coronary artery stenosis. Sci Rep 2020; 10:11658. [PMID: 32669566 PMCID: PMC7363809 DOI: 10.1038/s41598-020-68292-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 06/15/2020] [Indexed: 01/09/2023] Open
Abstract
Coronary artery stenosis is a narrowing of coronary lumen space caused by an atherosclerotic lesion. Fractional flow reserve (FFR) is the gold standard metric to assess physiological significance of coronary stenosis, but requires an invasive procedure. Computational modeling in conjunction with patient-specific imaging demonstrates formation of regions of recirculatory flow distal to a stenosis, increasing mean blood residence time relative to uninhibited flow. A new computational parameter, mean blood residence time (BloodRT), was computed for 100 coronary artery segments for which FFR was known. A threshold for BloodRT was determined to assess the physiological significance of a stenosis, analogous to diagnostic threshold for FFR. Model sensitivity and specificity of BloodRT for diagnosis of hemodynamically significant coronary stenosis was 98% and 96% respectively, compared with FFR. When applied to clinical practice, this could potentially allow practicing cardiologists to accurately assess the severity of coronary stenosis without resorting to invasive techniques.
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Affiliation(s)
- Javad Hashemi
- Department of Chemical Engineering, University of Louisville, Louisville, KY, USA
| | - Shesh Rai
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Shahab Ghafghazi
- Department of Medicine, University of Louisville, Louisville, KY, USA.
| | - R Eric Berson
- Department of Chemical Engineering, University of Louisville, Louisville, KY, USA.
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15
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Freidoonimehr N, Arjomandi M, Sedaghatizadeh N, Chin R, Zander A. Transitional turbulent flow in a stenosed coronary artery with a physiological pulsatile flow. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3347. [PMID: 32362019 DOI: 10.1002/cnm.3347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
The turbulence in the blood flow, caused by plaque deposition on the arterial wall, increases by the combined effect of the complex plaque geometries and the pulsatile blood flow. The correlation between the plaque geometry, the pulsatile inlet flow and the induced turbulence in a constricted artery is investigated in this study. Pressure drop, flow velocity and wall shear stress are determined for stenosed coronary artery models with three different degrees of asymmetric stenosis and for different heart working conditions. A Computational Fluid Dynamics model, validated against experimental data published in the literature, was developed to simulate the blood pulsatile flow inside a stenosed coronary artery model. The transitional flow behaviour was quantified by investigation of the changes in the turbulence kinetic energy. It was shown that the separation starts from the side of the asymmetric stenosis and spreads to its opposite side further downstream. The results suggest that there is a high risk of the formation of a secondary stenosis at a downstream distance equal to 10 times of the artery diameter at the side and bottom regions of the first stenosis due to the existence of the recirculation zones and low shear stresses. Finally, a stenosed patient-specific coronary artery model was employed to illustrate the applicability of the obtained results for real geometry models. The results of this study provide a good prediction of pressure drop and blood flow rate, which can be applied in the investigation of the heart muscle workout and the required heart power.
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Affiliation(s)
- Navid Freidoonimehr
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia, Australia
| | - Maziar Arjomandi
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia, Australia
| | - Nima Sedaghatizadeh
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia, Australia
| | - Rey Chin
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia, Australia
| | - Anthony Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia, Australia
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16
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Donadoni F, Pichardo-Almarza C, Homer-Vanniasinkam S, Dardik A, Díaz-Zuccarini V. Multiscale, patient-specific computational fluid dynamics models predict formation of neointimal hyperplasia in saphenous vein grafts. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:292-306. [PMID: 32566808 PMCID: PMC7296340 DOI: 10.1016/j.jvscit.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/15/2019] [Indexed: 11/28/2022]
Abstract
Stenosis due to neointimal hyperplasia (NIH) is among the major causes of peripheral graft failure. Its link to abnormal hemodynamics in the graft is complex, and isolated use of hemodynamic markers is insufficient to fully capture its progression. Here, a computational model of NIH growth is presented, establishing a link between computational fluid dynamics simulations of flow in the lumen and a biochemical model representing NIH growth mechanisms inside the vessel wall. For all three patients analyzed, NIH at proximal and distal anastomoses was simulated by the model, with values of stenosis comparable to the computed tomography scans.
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Affiliation(s)
- Francesca Donadoni
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom
| | - Cesar Pichardo-Almarza
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Certara Quantitative Systems Pharmacology (QSP), Canterbury, United Kingdom
| | - Shervanthi Homer-Vanniasinkam
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Alan Dardik
- Yale University School of Medicine, Vascular Biology and Therapeutics, New Haven, Conn.,Department of Surgery, VA Connecticut Healthcare Systems, West Haven, Conn
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, Multiscale Cardiovascular Engineering Group, University College London, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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17
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Wan M, Ma L, Zhao X, Leng S, Zhang JM, Tan RS, Zhong L. Automatic Segmentation of Coronary Artery Lumen via Anisotropic Graph-cuts .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4871-4874. [PMID: 31946952 DOI: 10.1109/embc.2019.8856353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronary fractional flow reserve (FFR) is the ratio of distal to proximal pressure in a stenotic lesion and defines its presence of ischemia (i.e. FFR≤0.8). However, FFR requires pressure to be measured invasively across the lesion, which is barrier to wider use of the methods. Computational fluid dynamics (CFD) applied to computed tomography coronary angiography (CTCA) enable the computation of FFR (i.e. CT-FFR) noninvasively. The accurate coronary artery geometrical model is the prerequisite for CT-FFR. We aimed to develop a method to automatically segment the coronary artery lumen based on anisotrophic graph-cuts. 5 patients with coronary artery disease underwent CTCA. CTCA images were enhanced by Hessian Matrix filter and then to derive vesselness images and vessel directions. Centrelines were extracted using the shortest path algorithm. We modified the edge energy term based on the dissimilarity of neighboring voxels intensities. The inner product of vessel directions of two neighboring voxels was multiplied as well. All cases were automatically segmented successfully with average computational time of 79.5 seconds. Our anisotropic graph-cuts method reduced unnatural bumps on the lumen than classic graph-cuts methods. Our anisotrophic graph-cuts based method improved coronary lumen segmentation and downstream coronary geometry modelling, will play an important role for real-time CT-FFR computation in clinical practice.
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18
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Doutel E, Viriato N, Carneiro J, Campos JBLM, Miranda JM. Geometrical effects in the hemodynamics of stenotic and non-stenotic left coronary arteries-numerical and in vitro approaches. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3207. [PMID: 30983149 DOI: 10.1002/cnm.3207] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/09/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
Atherosclerosis is a common cardiovascular disease found in the left coronary artery (LCA), closely linked to local hemodynamic, which, in turn, is highly influenced by the artery geometry. The hemodynamics in the LCA was studied in a patient-specific geometry without any sign of disease using both numerical and in vitro approaches. The influence of non-planarity was evaluated through two models of the patient-specific LCA that deviate from its original geometry in their planarity. Afterwards, in all models, irregular stenoses were created by a procedure in which the stenosis emerges by diffusion from low wall shear stress (WSS) areas. The WSS distribution and flow patterns were evaluated in all the models. The experimental results validate the numerical code developed to study the blood flow assuming a steady state Newtonian behavior. Comparison between the planar and non-planar idealized LCA revealed no significant differences in low WSS regions forming stenotic regions with identical shape. In the patient-specific LCA, the low WSS regions are not consistent with the idealized models leading to a different stenosis shape. The results revealed that the non-planarity has an unquestionable effect in helicity. It was also demonstrated that eccentricity of the vessels cross section and the position of the apex in relation to the axis of the parent branch contribute to the flow patterns observed. Numerical results of pulsatile blood flow assuming a non-Newtonian behavior, in the patient-specific LCA, reinforce the non-planarity effect in local hemodynamics.
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Affiliation(s)
- Erica Doutel
- Altice Labs, Rua Eng° José Ferreira Pinto Basto, Aveiro, Portugal
| | - Nuno Viriato
- INEGI, Institute of Mechanical Engineering, FEUP, Faculty of Engineering, University of Porto, Porto, Portugal
| | - João Carneiro
- Transport Phenomena Research Center, Chemical Engineering Department, Faculty of Engineering, University of Porto, Porto, Portugal
| | - João B L M Campos
- Transport Phenomena Research Center, Chemical Engineering Department, Faculty of Engineering, University of Porto, Porto, Portugal
| | - João M Miranda
- Transport Phenomena Research Center, Chemical Engineering Department, Faculty of Engineering, University of Porto, Porto, Portugal
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19
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Zhao J, Ai D, Yang Y, Song H, Huang Y, Wang Y, Yang J. Deep feature regression (DFR) for 3D vessel segmentation. ACTA ACUST UNITED AC 2019; 64:115006. [DOI: 10.1088/1361-6560/ab0eee] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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20
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Model and Application to Support the Coronary Artery Diseases (CAD): Development and Testing. Interdiscip Sci 2018; 12:50-58. [PMID: 30535963 DOI: 10.1007/s12539-018-0311-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/23/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Cardiovascular diseases are among the main causes of morbidity, disability, and mortality. Most of them occur because of an atherosclerotic plaque developing within a coronary artery, which can cause a narrowing of the vessel lumen (coronary stenosis) or even break it. It is, therefore, useful to evaluate the role of the stress state of the endothelial layer of the arterial tissue, both for the maintenance of the blood circulation and for the implications in presence of a pathology that can lead to thromboembolic complications. The aim of the following study was to develop and test an application that is able to evaluate specific hemodynamic shear stress indicators in coronary arteries at different percentages of stenosis and in different patients' specific conditions. The application, based on Java, allows users to view the results of simulations performed on a coronary anatomy that can be customized with a stenosis of different degrees and positions. Being in possession of a predictive tool for disturbed flow factors may be important for the location and development of atherosclerotic plaque. Moreover, the application can be a valid tool to help in the evaluation of the condition and in the follow-up of the coronary affected by pathology.
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21
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Coccarelli A, Hasan HM, Carson J, Parthimos D, Nithiarasu P. Influence of ageing on human body blood flow and heat transfer: A detailed computational modelling study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3120. [PMID: 29932495 PMCID: PMC6220937 DOI: 10.1002/cnm.3120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/04/2018] [Accepted: 06/13/2018] [Indexed: 05/17/2023]
Abstract
Ageing plays a fundamental role in arterial blood transport and heat transfer within a human body. The aim of this work is to provide a comprehensive methodology, based on biomechanical considerations, for modelling arterial flow and energy exchange mechanisms in the body accounting for age-induced changes. The study outlines a framework for age-related modifications within several interlinked subsystems, which include arterial stiffening, heart contractility variations, tissue volume and property changes, and thermoregulatory system deterioration. Some of the proposed age-dependent governing equations are directly extrapolated from experimental data sets. The computational framework is demonstrated through numerical experiments, which show the impact of such age-related changes on arterial blood pressure, local temperature distribution, and global body thermal response. The proposed numerical experiments show that the age-related changes in arterial convection do not significantly affect the tissue temperature distribution. Results also highlight age-related effects on the sweating mechanism, which lead to a significant reduction in heat dissipation and a subsequent rise in skin and core temperatures.
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Affiliation(s)
- Alberto Coccarelli
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversityUK
| | - Hayder M. Hasan
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversityUK
| | - Jason Carson
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversityUK
| | | | - Perumal Nithiarasu
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversityUK
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22
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Zhong L, Zhang JM, Su B, Tan RS, Allen JC, Kassab GS. Application of Patient-Specific Computational Fluid Dynamics in Coronary and Intra-Cardiac Flow Simulations: Challenges and Opportunities. Front Physiol 2018; 9:742. [PMID: 29997520 PMCID: PMC6028770 DOI: 10.3389/fphys.2018.00742] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/28/2018] [Indexed: 12/13/2022] Open
Abstract
The emergence of new cardiac diagnostics and therapeutics of the heart has given rise to the challenging field of virtual design and testing of technologies in a patient-specific environment. Given the recent advances in medical imaging, computational power and mathematical algorithms, patient-specific cardiac models can be produced from cardiac images faster, and more efficiently than ever before. The emergence of patient-specific computational fluid dynamics (CFD) has paved the way for the new field of computer-aided diagnostics. This article provides a review of CFD methods, challenges and opportunities in coronary and intra-cardiac flow simulations. It includes a review of market products and clinical trials. Key components of patient-specific CFD are covered briefly which include image segmentation, geometry reconstruction, mesh generation, fluid-structure interaction, and solver techniques.
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Affiliation(s)
- Liang Zhong
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jun-Mei Zhang
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Boyang Su
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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23
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Yu Y, Zhou Y, Ma Q, jia S, Wu S, Sun Y, Liu X, Zhao Y, Liu Y, Shi D. The conical stent in coronary artery improves hemodynamics compared with the traditional cylindrical stent. Int J Cardiol 2017; 227:166-171. [DOI: 10.1016/j.ijcard.2016.11.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/05/2016] [Indexed: 11/16/2022]
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24
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Computational study of the risk of restenosis in coronary bypasses. Biomech Model Mechanobiol 2016; 16:313-332. [DOI: 10.1007/s10237-016-0818-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
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25
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Zhang JM, Zhong L, Luo T, Lomarda AM, Huo Y, Yap J, Lim ST, Tan RS, Wong ASL, Tan JWC, Yeo KK, Fam JM, Keng FYJ, Wan M, Su B, Zhao X, Allen JC, Kassab GS, Chua TSJ, Tan SY. Simplified Models of Non-Invasive Fractional Flow Reserve Based on CT Images. PLoS One 2016; 11:e0153070. [PMID: 27187726 PMCID: PMC4871505 DOI: 10.1371/journal.pone.0153070] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/23/2016] [Indexed: 01/10/2023] Open
Abstract
Invasive fractional flow reserve (FFR) is the gold standard to assess the functional coronary stenosis. The non-invasive assessment of diameter stenosis (DS) using coronary computed tomography angiography (CTA) has high false positive rate in contrast to FFR. Combining CTA with computational fluid dynamics (CFD), recent studies have shown promising predictions of FFRCT for superior assessment of lesion severity over CTA alone. The CFD models tend to be computationally expensive, however, and require several hours for completing analysis. Here, we introduce simplified models to predict noninvasive FFR at substantially less computational time. In this retrospective pilot study, 21 patients received coronary CTA. Subsequently a total of 32 vessels underwent invasive FFR measurement. For each vessel, FFR based on steady-state and analytical models (FFRSS and FFRAM, respectively) were calculated non-invasively based on CTA and compared with FFR. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 90.6% (87.5%), 80.0% (80.0%), 95.5% (90.9%), 88.9% (80.0%) and 91.3% (90.9%) respectively for FFRSS (and FFRAM) on a per-vessel basis, and were 75.0%, 50.0%, 86.4%, 62.5% and 79.2% respectively for DS. The area under the receiver operating characteristic curve (AUC) was 0.963, 0.954 and 0.741 for FFRSS, FFRAM and DS respectively, on a per-patient level. The results suggest that the CTA-derived FFRSS performed well in contrast to invasive FFR and they had better diagnostic performance than DS from CTA in the identification of functionally significant lesions. In contrast to FFRCT, FFRSS requires much less computational time.
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Affiliation(s)
- Jun-Mei Zhang
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Liang Zhong
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- * E-mail:
| | - Tong Luo
- California Medical Innovations Institute, San Diego, CA 92121, United States of America
| | - Aileen Mae Lomarda
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Yunlong Huo
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, 100871, China
| | - Jonathan Yap
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Soo Teik Lim
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Ru San Tan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Aaron Sung Lung Wong
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Jack Wei Chieh Tan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Khung Keong Yeo
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Jiang Ming Fam
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Felix Yung Jih Keng
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Min Wan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, 330031, China
| | - Boyang Su
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Xiaodan Zhao
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | | | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, CA 92121, United States of America
| | - Terrance Siang Jin Chua
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Swee Yaw Tan
- National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
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26
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Brass LF, Diamond SL. Transport physics and biorheology in the setting of hemostasis and thrombosis. J Thromb Haemost 2016; 14:906-17. [PMID: 26848552 PMCID: PMC4870125 DOI: 10.1111/jth.13280] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/20/2016] [Accepted: 01/26/2016] [Indexed: 02/02/2023]
Abstract
The biophysics of blood flow can dictate the function of molecules and cells in the vasculature with consequent effects on hemostasis, thrombosis, embolism, and fibrinolysis. Flow and transport dynamics are distinct for (i) hemostasis vs. thrombosis and (ii) venous vs. arterial episodes. Intraclot transport changes dramatically the moment hemostasis is achieved or the moment a thrombus becomes fully occlusive. With platelet concentrations that are 50- to 200-fold greater than platelet-rich plasma, clots formed under flow have a different composition and structure compared with blood clotted statically in a tube. The platelet-rich, core/shell architecture is a prominent feature of self-limiting hemostatic clots formed under flow. Importantly, a critical threshold concentration of surface tissue factor is required for fibrin generation under flow. Once initiated by wall-derived tissue factor, thrombin generation and its spatial propagation within a clot can be modulated by γ'-fibrinogen incorporated into fibrin, engageability of activated factor (FIXa)/activated FVIIIa tenase within the clot, platelet-derived polyphosphate, transclot permeation, and reduction of porosity via platelet retraction. Fibrin imparts tremendous strength to a thrombus to resist embolism up to wall shear stresses of 2400 dyne cm(-2) . Extreme flows, as found in severe vessel stenosis or in mechanical assist devices, can cause von Willebrand factor self-association into massive fibers along with shear-induced platelet activation. Pathological von Willebrand factor fibers are A Disintegrin And Metalloprotease with ThromboSpondin-1 domain 13 resistant but are a substrate for fibrin generation due to FXIIa capture. Recently, microfluidic technologies have enhanced the ability to interrogate blood in the context of stenotic flows, acquired von Willebrand disease, hemophilia, traumatic bleeding, and drug action.
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Affiliation(s)
- Lawrence F. Brass
- Departments of Medicine and Systems Pharmacology, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott L. Diamond
- Departments of Medicine and Systems Pharmacology, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Medicine and Engineering, Department of Chemical Engineering, University of Pennsylvania, Philadelphia, PA, USA
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