Impact of tapering of arterial vessels on blood pressure, pulse wave velocity, and wave intensity analysis using one-dimensional computational model

Noninvasive estimation of central blood pressure through fluid-structure interaction modeling

Central blood pressure (cBP) is considered a superior indicator of cardiovascular fitness than brachial blood pressure (bBP). Even though bBP is easy to measure noninvasively, it is usually higher than cBP due to pulse wave amplification, characterized by the gradual increase in peak systolic pressure during pulse wave propagation. In this study, we aim to develop an individualized transfer function that can accurately estimate cBP from bBP. We first construct a three-dimensional, patient-specific model of the upper limb arterial system using fluid-structure interaction simulations, incorporating variable material properties and complex boundary conditions. Then, we develop an analytical brachial-aortic transfer function based on novel solutions for compliant vessels. The accuracy of this transfer function is successfully validated against numerical simulation results, which effectively reproduce pulse wave propagation and amplification, with key hemodynamic parameters falling within the range of clinical measurements. Further analysis of the transfer function reveals that cBP is a linear combination of bBP and aortic flow rate in the frequency domain, with the coefficients determined by vessel geometry, material properties, and boundary conditions. Additionally, bBP primarily contributes to the steady component of cBP, while the aortic flow rate is responsible for the pulsatile component. Furthermore, local sensitivity analysis indicates that the lumen radius is the most influential parameter in accurately estimating cBP. Although not directly applicable clinically, the proposed transfer function enhances understanding of the underlying physics-highlighting the importance of aortic flow and lumen radius-and can guide the development of more practical transfer functions.

Effects of pedicle subtraction osteotomy on aortic morphology and hemodynamics in ankylosing spondylitis with kyphosis: a finite element analysis study

Osteotomy can correct kyphosis, restore the spinal sequence, and restore the healthy appearance of a patient. However, the aorta is stretched during pedicle subtraction osteotomy (PSO), and some surgeons are concerned about aortic injury. We used finite element analysis to construct an aortic model to simulate hemodynamic changes during osteotomy. 16 patients with ankylosing spondylitis kyphosis who had undergone a two-level osteotomy at the L1 and L3 levels was included in this study. Aortic computed tomography angiography (CTA) was performed, and a 3D image model was constructed. The length, transverse diameter, and curvature of the aorta were used to evaluate morphological changes. Finite element analysis was used to analyze the changes in aortic fluid dynamics. Blood pressure, wall shear stress, and blood flow velocity were compared pre- and postoperatively. The overall length of the aorta before surgery was 424.3 ± 42.9 mm, and the overall length of the aorta after surgery was 436.2 ± 54.8 mm. The aortic curvature decreased from 0.27 ± 0.13 to 0.17 ± 0.09. The mean transverse diameter of the aorta did not change (19.3 ± 6.6 vs. 19.2 ± 7.4 mm, P > 0.05). The blood flow velocity (2.8 ± 1.1 vs. 1.5 ± 0.8 m/s, P < 0.05), blood pressure (6.6 ± 1.7 vs. 4.3 ± 1.2 Kpa, P < 0.05), and wall shear stress (47.6 ± 17.3 vs. 22.3 ± 8.6, P < 0.05) at the T10-L4 level decreased postoperatively. Changes in LL were significantly correlated with changes in ld, dc, blood flow velocity, blood pressure and wall shear stress (ld : r = 0.713, P < 0.001; dc: r = 0.626,P = 0.010; blood flow velocity: r= - 0.541, P = 0.041; blood pressure: r = - 0.601, P = 0.016; wall shear stress: r= - 0.594, P = 0.027). The aorta was stretched, and its curvature decreased. The mean transverse diameter of the aorta did not change. Blood flow velocity, blood pressure, and wall shear stress decreased after surgery. Our study provides hemodynamic support for the possible cardiovascular benefits of osteotomes.

Computational framework for the generation of one-dimensional vascular models accounting for uncertainty in networks extracted from medical images

One-dimensional (1D) cardiovascular models offer a non-invasive method to answer medical questions, including predictions of wave-reflection, shear stress, functional flow reserve, vascular resistance and compliance. This model type can predict patient-specific outcomes by solving 1D fluid dynamics equations in geometric networks extracted from medical images. However, the inherent uncertainty in in vivo imaging introduces variability in network size and vessel dimensions, affecting haemodynamic predictions. Understanding the influence of variation in image-derived properties is essential to assess the fidelity of model predictions. Numerous programs exist to render three-dimensional surfaces and construct vessel centrelines. Still, there is no exact way to generate vascular trees from the centrelines while accounting for uncertainty in data. This study introduces an innovative framework employing statistical change point analysis to generate labelled trees that encode vessel dimensions and their associated uncertainty from medical images. To test this framework, we explore the impact of uncertainty in 1D haemodynamic predictions in a systemic and pulmonary arterial network. Simulations explore haemodynamic variations resulting from changes in vessel dimensions and segmentation; the latter is achieved by analysing multiple segmentations of the same images. Results demonstrate the importance of accurately defining vessel radii and lengths when generating high-fidelity patient-specific haemodynamics models. KEY POINTS: This study introduces novel algorithms for generating labelled directed trees from medical images, focusing on accurate junction node placement and radius extraction using change points to provide haemodynamic predictions with uncertainty within expected measurement error. Geometric features, such as vessel dimension (length and radius) and network size, significantly impact pressure and flow predictions in both pulmonary and aortic arterial networks. Standardizing networks to a consistent number of vessels is crucial for meaningful comparisons and decreases haemodynamic uncertainty. Change points are valuable to understanding structural transitions in vascular data, providing an automated and efficient way to detect shifts in vessel characteristics and ensure reliable extraction of representative vessel radii.

Elastic jump propagation across a blood vessel junction

The theory of small-amplitude waves propagating across a blood vessel junction has been well established with linear analysis. In this study, we consider the propagation of large-amplitude, nonlinear waves (i.e. shocks and rarefactions) through a junction from a parent vessel into two (identical) daughter vessels using a combination of three approaches: numerical computations using a Godunov method with patching across the junction, analysis of a nonlinear Riemann problem in the neighbourhood of the junction and an analytical theory which extends the linear analysis to the following order in amplitude. A unified picture emerges: an abrupt (prescribed) increase in pressure at the inlet to the parent vessel generates a propagating shock wave along the parent vessel which interacts with the junction. For modest driving, this shock wave divides into propagating shock waves along the two daughter vessels and reflects a rarefaction wave back towards the inlet. However, for larger driving the reflected rarefaction wave becomes transcritical, generating an additional shock wave. Just beyond criticality this new shock wave has zero speed, pinned to the junction, but for further increases in driving this additional shock divides into two new propagating shock waves in the daughter vessels.

Coal mining environment causes adverse effects on workers

Background

The objective of this study is to study the adverse effects of coal mining environment on workers to discover early effective biomarkers.

Methods

The molecular epidemiological study was conducted with 502 in-service workers, who were divided into miner and auxiliary. We measured the individual levels of dust exposure for participants. Clinical examinations were conducted by qualified doctors. Peripheral blood was collected to measure biochemistry, hemogram, and karyocyte apoptosis.

Results

All workers were healthy who have not found with any diseases that can be diagnosed medically in the physical examination and showed no difference in dust exposure level, age, height, weight, and body mass index between groups. The working years of miners were lower than that of auxiliaries (p < 0.001). Compared with auxiliaries, the concentration and percentage of lymphocytes (p = 0.040, p = 0.012), basophils (p = 0.027, p = 0.034), and red blood cells (p < 0.001) and the concentration of hemoglobin of miners were lower (p < 0.001). The percentage of neutrophils (p = 0.003), the concentration of mean corpuscular hemoglobin concentration (p = 0.002), and the proportion of karyocyte apoptosis in miners were higher (p < 0.001). Miners presented higher blood urea nitrogen (p < 0.001), ratio of blood urea nitrogen to creatinine (p < 0.001), the high density lipoprotein cholesterol (p < 0.001), lower creatinine (p < 0.05), and cholesterol (p < 0.001).

Conclusion

The coal mining environment impacted mining workers' immune function, renal function, and the hematopoietic system, including BUN/CRE, HGB, RBC, and LYMPH, which could be used as early biomarkers to screen the health of coal miners.

Interpretable and accurate curve-fitting method for arterial pulse wave modeling and decomposition

Arterial pulse waveforms contain a wealth of information about the cardiovascular system. There is a lack of physical meaning in the mathematical model of arterial pulse waves, while the physical model fails to offer individuality as too many assumptions are involved. In this article, we focus on promoting the interpretability of the arterial pulse mathematical model. The proposed method is based on newly developed 3-term fitting functions individualized by the physiological parameter assignment, which are the peak times of the reflected and dicrotic waves in a pulse. In this manner, the model allows decomposition of the pulse into sub-signals with clear physiological significance. With nearly 10,000 pulse fitting experiments, it is demonstrated that the proposed method outperforms the standard methods in fitting accuracy while providing parameters linked to hemodynamic characteristics and common clinical indices such as the peripheral augmentation index (pAI). The proposed method innovatively maintains the individuality and accuracy of mathematical models while improving the interpretability of their parameters. The applications of this newly developed method, which explicitly incorporates hemodynamic characteristics, are expected to be particularly valuable in future pulse wave decomposition studies.

Signatures of obstructions and expansions in the arterial frequency response

BACKGROUND AND OBJECTIVE

The blood pressure and flow waveforms carry valuable information about the condition of the cardiovascular system and a patient's health. Waveform analysis in health and pathological conditions can be performed in the time or frequency domains; the information to be emphasised defines the use of either domain. However, physicians are more familiar with the time domain, and the changes in the waveforms due to cardiovascular diseases and ageing are better characterised in such domain. On the other hand, the analysis of the vascular and geometrical variables determining the signatures in the frequency response of local vascular anomalies, such as aneurysms and stenoses, has not been thoroughly explored. This paper aims to characterise the signatures of obstructions (stenoses) and expansions (aneurysms) in the frequency response of tapered arteries.

METHODS

The first step in our methodology was to incorporate the viscous response of the arterial wall into a one-dimensional elastic formulation that solves the governing equations in the frequency domain. As a second step, we imposed a volumetric flow excitation in arteries simulating the aorta with increasing geometry complexity: from straight to tapered arteries with local expansions or obstructions; and we assessed the frequency response.

RESULTS

We found that the obstructions and expansions cause characteristic signatures in an artery's frequency response that are distinguishable from a health condition. The signatures of obstruction and expansions differ; the obstructions increase the magnitude of fundamental frequency and work as a close boundary condition. On the other hand, the expansions diminish the fundamental frequency and work as an open boundary condition. Furthermore, such signatures correlate to the distance between the artery's inlet and the anomaly's starting point and have the potential to pinpoint abnormalities non-invasively.

CONCLUSIONS

We found that the obstructions and expansions cause characteristic signatures in an artery's frequency response that have the potential to detect and follow up on the development of vascular abnormalities. For the latter purpose, constant monitoring may be required; despite this not being a common clinical practice, the new wearable technology offers the possibility of continuous monitoring of biophysical markers such as the pressure waveform.

Arterial wave dynamics preservation upon orthostatic stress: a modelling perspective

Pressure-flow travelling waves are a key topic for understanding arterial haemodynamics. However, wave transmission and reflection processes induced by body posture changes have not been thoroughly explored yet. Current in vivo research has shown that the amount of wave reflection detected at a central level (ascending aorta, aortic arch) decreases during tilting to the upright position, despite the widely proved stiffening of the cardiovascular system. It is known that the arterial system is optimized when in the supine position, i.e. propagation of direct waves is enabled and reflected waves are trapped, protecting the heart; however, it is not known whether this is preserved with postural changes. To shed light on these aspects, we propose a multi-scale modelling approach to inquire into posture-induced arterial wave dynamics elicited by simulated head-up tilting. In spite of remarkable adaptation of the human vasculature following posture changes, our analysis shows that, upon tilting from supine to upright: (i) vessel lumens at arterial bifurcations remain well matched in the forward direction, (ii) wave reflection at central level is reduced due to the backward propagation of weakened pressure waves produced by cerebral autoregulation, and (iii) backward wave trapping is preserved.

A predictive patient-specific computational model of coronary artery bypass grafts for potential use by cardiac surgeons to guide selection of graft configurations

Cardiac surgeons face a significant degree of uncertainty when deciding upon coronary artery bypass graft configurations for patients with coronary artery disease. This leads to significant variation in preferred configuration between different surgeons for a particular patient. Additionally, for the majority of cases, there is no consensus regarding the optimal grafting strategy. This situation results in the tendency for individual surgeons to opt for a “one size fits all” approach and use the same grafting configuration for the majority of their patients neglecting the patient-specific nature of the diseased coronary circulation. Quantitative metrics to assess the adequacy of coronary bypass graft flows have recently been advocated for routine intraoperative use by cardiac surgeons. In this work, a novel patient-specific 1D-0D computational model called “COMCAB” is developed to provide the predictive haemodynamic parameters of functional graft performance that can aid surgeons to avoid configurations with grafts that have poor flow and thus poor patency. This model has significant potential for future expanded applications.

Mapping physiological and pathological functions of cortical vasculature through aggregation-induced emission nanoprobes assisted quantitative, in vivo NIR-II imaging

Cerebrovascular disease includes all disorders that affect cerebrovascular and cerebral circulation. Unfortunately, there is currently a lack of a systematic method to image blood vessels directly and achieve accurate quantification. Herein, we build a non-invasive, quantitative imaging and characterization system applicable to mapping physiological and pathological functions of cortical vasculature. Assisted by aggregation-induced emission (AIE) luminogens with either excitation or emission at near-infrared-II (NIR-II) region, large-depth and/or high signal-to-background ratio images of cerebral blood vessels from mice and marmosets are captured, based on which we develop an optical metric of vessel thickness in an automated, pixel-wise manner and both two-dimensional (2D) and three-dimensional (3D) contexts. By monitoring time-dependent cerebrovascular images in marmosets, periodic changes in the diameter of vibrating cerebral blood vessels are found to be regulated mainly by heartbeat. In mice photothrombosis model, vessel alterations throughout the whole process of thrombotic stroke are found to be stage-dependent. From a large field of view, the distance-dependent vessel thickness variation before and right after stroke is obtained away from the thrombus site. Importantly, a buffer zone exists right surrounding the lesion, indicating the inhomogeneity of vascular morphological changes. Biologically excretable AIE nanoparticles are used for assessing physiological and pathological functions, offering great potential for clinical translation.

Transfer-function-free technique for the noninvasive determination of the human arterial pressure waveform

The estimation of central aortic blood pressure is a cardinal measurement, carrying effective physiological, and prognostic data beyond routine peripheral blood pressure. Transfer function-based devices effectively estimate aortic systolic and diastolic blood pressure from peripheral pressure waveforms, but the reconstructed pressure waveform seems to preserve features of the peripheral waveform. We sought to develop a new method for converting the local diameter distension waveform into a pressure waveform, through an exponential function whose parameters depend on the local wave speed. The proposed method was then tested at the common carotid artery. Diameter and blood velocity waveforms were acquired via ultrasound at the right common carotid artery while simultaneously recording pressure at the left common carotid artery via tonometer in 203 people (122 men, 50 ± 18 years). The wave speed was noninvasively estimated via the lnDU-loop method and then used to define the exponential function to convert the diameter into pressure. Noninvasive systolic and mean pressures estimated by the new technique were 3.8 ± 21.8 (p = 0.015) and 2.3 ± 9.6 mmHg (p = 0.011) higher than those obtained using tonometery. However, differences were much reduced and not significant in people >35 years (0.6 ± 18.7 and 0.8 ± 8.3 mmHg, respectively). This proof of concept study demonstrated that local wave speed, estimated from noninvasive local measurement of diameter and flow velocity, can be used to determine an exponential function that describes the relationship between local pressure and diameter. This pressure-diameter function can then be used for the noninvasive estimation of local arterial pressure.