A multiscale approach for determining the morphology of endothelial cells at a coronary artery

Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques

Atherosclerosis is an important cause of cerebrovascular and cardiovascular disease (CVD). Lipid infiltration, inflammation, and altered vascular stress are the critical mechanisms that cause atherosclerotic plaque formation. The hallmarks of the progression of atherosclerosis include plaque ulceration, rupture, neovascularization, and intraplaque hemorrhage, all of which are closely associated with the occurrence of CVD. Assessing the severity of atherosclerosis and plaque vulnerability is crucial for the prevention and treatment of CVD. Integrating imaging techniques for evaluating the characteristics of atherosclerotic plaques with computer simulations yields insights into plaque inflammation levels, spatial morphology, and intravascular stress distribution, resulting in a more realistic and accurate estimation of plaque state. Here, we review the characteristics and advancing techniques used to analyze intracranial and extracranial atherosclerotic plaques to provide a comprehensive understanding of atheroma.

Long-term prognostic impact of paravalvular leakage on coronary artery disease requires patient-specific quantification of hemodynamics

Transcatheter aortic valve replacement (TAVR) is a frequently used minimally invasive intervention for patient with aortic stenosis across a broad risk spectrum. While coronary artery disease (CAD) is present in approximately half of TAVR candidates, correlation of post-TAVR complications such as paravalvular leakage (PVL) or misalignment with CAD are not fully understood. For this purpose, we developed a multiscale computational framework based on a patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-structure interaction model to quantify metrics of global circulatory function, metrics of global cardiac function and local cardiac fluid dynamics in 6 patients. Based on our findings, PVL limits the benefits of TAVR and restricts coronary perfusion due to the lack of sufficient coronary blood flow during diastole phase (e.g., maximum coronary flow rate reduced by 21.73%, 21.43% and 21.43% in the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)). Moreover, PVL may increase the LV load (e.g., LV load increased by 17.57% (N = 6)) and decrease the coronary wall shear stress (e.g., maximum wall shear stress reduced by 20.62%, 21.92%, 22.28% and 25.66% in the left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)), which could promote atherosclerosis development through loss of the physiological flow-oriented alignment of endothelial cells. This study demonstrated that a rigorously developed personalized image-based computational framework can provide vital insights into underlying mechanics of TAVR and CAD interactions and assist in treatment planning and patient risk stratification in patients.

Numerical study of the effect of hemodynamic variables on LDL concentration through the single layer of the Left Anterior Descending coronary artery (LAD) under the heart pulse

Heart attack is one of the most common causes of death in the world. Coronary artery disease is the most recognized cause of heart attack whose onset and progression have been attributed to low-density lipoprotein (LDL) passing through the wall of the artery. In this paper, hemodynamic variables as well as the concentration of LDL through the coronary porous artery at the Left Anterior Descending coronary artery (LAD), and its first diagonal branch (D1) under the heart motion investigated using computational simulation. The geometry that has been studied in this paper is the first bifurcation of Left Anterior Descending (LAD) that has been placed on a perimeter of hypothetical sphere representative of the heart geometry. Sinusoidal variations of sphere radii, simulated pulsating movement of the heart. Blood has been considered as a Newtonian and incompressible flow with pulsatile flow rate and real physiological profile. The plasma filtration boundary condition used over the walls in order to simulate the concentration of LDL to a one-layer artery wall. Variations in the concentration of LDL on the artery wall and its relation to oscillation on shear stress on the artery wall under different conditions are presented. Moreover, the effects of the pulsating inlet flow and dynamic movement of the artery are explored. The results declared that minimum shear stress and maximum LDL concentration take place at the bifurcation and on the myocardial wall which is in complete agreement with clinical studies. Furthermore, it has been shown that the heart pulse has a slight effect on the average time of concentration (0.1% increase); however, by analyzing all time steps, one could observe that the maximum concentration rises in some time steps; where this increases the possibility of LDL presence and helps them diffuse inside the artery wall.

Impact of physiological loads of arterial wall on nucleus deformation in endothelial cells: A computational study

INTRODUCTION

Computational modeling can enhance the understanding of cell mechanics. To achieve this, finite element models of endothelial cells were proposed with shapes mimicking their natural state inside the endothelium within the cardiovascular system. Implementing the recently proposed bendo-tensegrity concept, these models consider flexural (buckling) as well as tensional/compressional behavior of microtubules and also incorporate the waviness of intermediate filaments.

MATERIALS AND METHODS

Four different models were created (flat and domed hexagons, both regular and elongated in the direction of blood flow) and loaded by biaxial deformation, blood pressure, and shear load from blood flow - natural physiological conditions of the arterial endothelium - aiming to investigate the "in situ" mechanical response of the cell.

RESULTS

The impact of individual components of loads on the nucleus deformation (more specifically on the first principal strain) potentially influencing mechanotransduction was investigated and the role of the cytoskeleton and its constituents in the mechanical response of the endothelial cell was assessed. The results show (i) the impact of pulsating blood pressure on cyclic deformations of the nucleus, which increase substantially with decreasing axial pre-stretch of the cell, (ii) the importance of relatively low shear stresses in the cell response and nucleus deformation.

CONCLUSION

Not only the pulsatile blood pressure but also the wall shear stress may induce significant deformation of the nucleus and thus trigger remodelation processes in endothelial cells.

Atheroprone sites of coronary artery bifurcation: Effect of heart motion on hemodynamics-dependent monocytes deposition

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.

Endothelial Cells Morphology in Response to Combined WSS and Biaxial CS: Introduction of Effective Strain Ratio

Introduction

Endothelial cells (ECs) morphology strongly depends on the imposed mechanical stimuli. These mechanical stimuli include wall shear stress (WSS) and biaxial cyclic stretches (CS). Under combined loading, the effect of CS is not as simple as pure CS. The present study investigates the morphological response of ECs to the realistic mechanical stimuli.

Methods

The cell population is theoretically studied using our previous validated model. The mechanical stimuli on ECs are described using four parameters; WSS magnitude (0 to 2.0 Pa), WSS angle (- 50° to 50°), and biaxial CS in two perpendicular directions (0 to 10%). The morphology of ECs is reported using four parameters; average shape index (SI) and orientation angle (OA) of the cell population as well as the standard deviation (SD) of SI and OA as measures for scattering of cells' SI and OA from these average values.

Results

A new effective strain ratio (ESR) is defined as the ratio of the undesirable CS to the desirable one. The obtained results of the model, illustrated that the SI and OA of cells increase with absolute value of ESR. In addition, the scattering in the SI of cells decreases with the absolute value of ESR, which means that the cell shapes become more regular. It is shown that the angular irregularity of cells increases at higher ESR values.

Conclusions

The results indicated that, the defined ESR is a stand-alone parameter for describing the realistic mechanical loading on the ECs and their morphological response.

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

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).