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Lv R, Wang L, Maehara A, Matsumura M, Guo X, Samady H, Giddens DP, Zheng J, Mintz GS, Tang D. Combining IVUS + OCT Data, Biomechanical Models and Machine Learning Method for Accurate Coronary Plaque Morphology Quantification and Cap Thickness and Stress/Strain Index Predictions. J Funct Biomater 2023; 14:jfb14010041. [PMID: 36662088 PMCID: PMC9864708 DOI: 10.3390/jfb14010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/25/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Assessment and prediction of vulnerable plaque progression and rupture risk are of utmost importance for diagnosis, management and treatment of cardiovascular diseases and possible prevention of acute cardiovascular events such as heart attack and stroke. However, accurate assessment of plaque vulnerability assessment and prediction of its future changes require accurate plaque cap thickness, tissue component and structure quantifications and mechanical stress/strain calculations. Multi-modality intravascular ultrasound (IVUS), optical coherence tomography (OCT) and angiography image data with follow-up were acquired from ten patients to obtain accurate and reliable plaque morphology for model construction. Three-dimensional thin-slice finite element models were constructed for 228 matched IVUS + OCT slices to obtain plaque stress/strain data for analysis. Quantitative plaque cap thickness and stress/strain indices were introduced as substitute quantitative plaque vulnerability indices (PVIs) and a machine learning method (random forest) was employed to predict PVI changes with actual patient IVUS + OCT follow-up data as the gold standard. Our prediction results showed that optimal prediction accuracies for changes in cap-PVI (C-PVI), mean cap stress PVI (meanS-PVI) and mean cap strain PVI (meanSn-PVI) were 90.3% (AUC = 0.877), 85.6% (AUC = 0.867) and 83.3% (AUC = 0.809), respectively. The improvements in prediction accuracy by the best combination predictor over the best single predictor were 6.6% for C-PVI, 10.0% for mean S-PVI and 8.0% for mean Sn-PVI. Our results demonstrated the potential using multi-modality IVUS + OCT image to accurately and efficiently predict plaque cap thickness and stress/strain index changes. Combining mechanical and morphological predictors may lead to better prediction accuracies.
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Affiliation(s)
- Rui Lv
- School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
- Correspondence: (L.W.); (D.T.); Tel.: +1-508-831-5332 (D.T.)
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY 10019, USA
| | - Mitsuaki Matsumura
- The Cardiovascular Research Foundation, Columbia University, New York, NY 10019, USA
| | - Xiaoya Guo
- School of Science, Nanjing University of Posts and Telecommunications, Nanjing 210023, China
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Don P. Giddens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Gary S. Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY 10019, USA
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609, USA
- Correspondence: (L.W.); (D.T.); Tel.: +1-508-831-5332 (D.T.)
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Wang C, Ren Y, Li J. Ultrasonic Imaging of Cardiovascular Disease Based on Image Processor Analysis of Hard Plaque Characteristics. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4304524. [PMID: 36277887 PMCID: PMC9584660 DOI: 10.1155/2022/4304524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease detection and analysis using ultrasonic imaging expels errors in manual clinical trials with precise outcomes. It requires a combination of smart computing systems and intelligent image processors. The disease characteristics are analyzed based on the configuration and precise tuning of the processing device. In this article, a characteristic extraction technique (CET) using knowledge learning (KL) is introduced to improve the analysis precision. The proposed method requires optimal selection of disease features and trained similar datasets for improving the characteristic extraction. The disease attributes and accuracy are identified using the standard knowledge update. The image and data features are segmented using the variable processor configuration to prevent false rates. The false rates due to unidentifiable plaque characteristics result in weak knowledge updates. Therefore, the segmentation and data extraction are unanimously performed to prevent feature misleads. The knowledge base is updated using the extracted and identified plaque characteristics for consecutive image analysis. The processor configurations are manageable using the updated knowledge and characteristics to improve precision. The proposed method is verified using precision, characteristic update, training rate, extraction ratio, and time factor.
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Affiliation(s)
- Chunxia Wang
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, 252000 Shandong, China
| | - Yufeng Ren
- Department of Ultrasound, Dongchangfu Hospital of Traditional Chinese Medicine, Liaocheng, 252000 Shandong, China
| | - Jing Li
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, 252000 Shandong, China
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Guo X, Maehara A, Yang M, Wang L, Zheng J, Samady H, Mintz GS, Giddens DP, Tang D. Predicting Coronary Stenosis Progression Using Plaque Fatigue From IVUS-Based Thin-Slice Models: A Machine Learning Random Forest Approach. Front Physiol 2022; 13:912447. [PMID: 35620594 PMCID: PMC9127388 DOI: 10.3389/fphys.2022.912447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Coronary stenosis due to atherosclerosis restricts blood flow. Stenosis progression would lead to increased clinical risk such as heart attack. Although many risk factors were found to contribute to atherosclerosis progression, factors associated with fatigue is underemphasized. Our goal is to investigate the relationship between fatigue and stenosis progression based on in vivo intravascular ultrasound (IVUS) images and finite element models. Methods: Baseline and follow-up in vivo IVUS and angiography data were acquired from seven patients using Institutional Review Board approved protocols with informed consent obtained. Three hundred and five paired slices at baseline and follow-up were matched and used for plaque modeling and analysis. IVUS-based thin-slice models were constructed to obtain the coronary biomechanics and stress/strain amplitudes (stress/strain variations in one cardiac cycle) were used as the measurement of fatigue. The change of lumen area (DLA) from baseline to follow-up were calculated to measure stenosis progression. Nineteen morphological and biomechanical factors were extracted from 305 slices at baseline. Correlation analyses of these factors with DLA were performed. Random forest (RF) method was used to fit morphological and biomechanical factors at baseline to predict stenosis progression during follow-up. Results: Significant correlations were found between stenosis progression and maximum stress amplitude, average stress amplitude and average strain amplitude (p < 0.05). After factors selection implemented by random forest (RF) method, eight morphological and biomechanical factors were selected for classification prediction of stenosis progression. Using eight factors including fatigue, the overall classification accuracy, sensitivity and specificity of stenosis progression prediction with RF method were 83.61%, 86.25% and 80.69%, respectively. Conclusion: Fatigue correlated positively with stenosis progression. Factors associated with fatigue could contribute to better prediction for atherosclerosis progression.
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Affiliation(s)
- Xiaoya Guo
- School of Science, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Mingming Yang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, United States
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Gary S Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
| | - Don P Giddens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
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Cai Y, Li Z. Mathematical modeling of plaque progression and associated microenvironment: How far from predicting the fate of atherosclerosis? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106435. [PMID: 34619601 DOI: 10.1016/j.cmpb.2021.106435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Mathematical modeling contributes to pathophysiological research of atherosclerosis by helping to elucidate mechanisms and by providing quantitative predictions that can be validated. In turn, the complexity of atherosclerosis is well suited to quantitative approaches as it provides challenges and opportunities for new developments of modeling. In this review, we summarize the current 'state of the art' on the mathematical modeling of the effects of biomechanical factors and microenvironmental factors on the plaque progression, and its potential help in prediction of plaque development. We begin with models that describe the biomechanical environment inside and outside the plaque and its influence on its growth and rupture. We then discuss mathematical models that describe the dynamic evolution of plaque microenvironmental factors, such as lipid deposition, inflammation, smooth muscle cells migration and intraplaque hemorrhage, followed by studies on plaque growth and progression using these modelling approaches. Moreover, we present several key questions for future research. Mathematical models can complement experimental and clinical studies, but also challenge current paradigms, redefine our understanding of mechanisms driving plaque vulnerability and propose future potential direction in therapy for cardiovascular disease.
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Affiliation(s)
- Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Zhiyong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China; School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4001, Australia
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Darmoch F, Ullah W, Al-Khadra Y, Sattar Y, Pacha HM, Zghouzi M, Soud M, Bagur R, Naidu SS, Goldsweig AM, Mamas M, Brilakis ES, Alraies MC. Characteristics and hospital outcomes of coronary atherectomy within the United States: a multivariate and propensity-score matched analysis. Expert Rev Cardiovasc Ther 2021; 19:865-870. [PMID: 34330193 DOI: 10.1080/14779072.2021.1963233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suboptimal stent delivery and deployment in calcified coronary lesions are associated with a poor clinical outcome. METHODS Using the National Inpatient Sample database, we identified patients undergoing percutaneous coronary intervention (PCI). Comparison between procedural and hospital outcomes between patients who underwent atherectomy and those who did not. RESULTS A total of 2,035,039 patients underwent PCI, of which 50,095 (2.4%) underwent lesion modification using atherectomy. After adjustment for baseline differences, patients who underwent atherectomy were found to have higher rates of in-hospital mortality (3.3% vs 2.2% adjusted Odds Ratio, aOR, 1.39; 95% confidence interval [CI], 1.31-1.46, P < 0.001), coronary artery dissection (1.7% vs 1.1%, aOR, 1.56; 95%, 1.45-1.67, P < 0.001) vascular complications (1.6% vs 1.0%, aOR, 1.52; 95%, 1.42-1.64, P < 0.001), major bleeding (6.3% vs 4.7%, aOR, 1.24; 95%, 1.18-1.28, P < 0.001), and acute kidney injury (AKI) (10.9%vs 9.1%, aOR, 1.07; 95%, 1.04-1.11, P < 0.001) when compared with non-atherectomy patients. Concomitant intravascular ultrasound (IVUS) imaging improved mortality, while other complication rates were not affected by imaging. CONCLUSION Coronary atherectomy was performed in patients with multiple comorbidities and was associated with higher in-hospital mortality and complications than the non-atherectomy group.
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Affiliation(s)
- Fahed Darmoch
- Department of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Yasser Al-Khadra
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York, USA
| | - Homam Moussa Pacha
- Department ofCardiology, University of Texas Health Science Center, Houston, Texas, USA
| | - Mohamed Zghouzi
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Andrew M Goldsweig
- Department of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mamas Mamas
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - M Chadi Alraies
- Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
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Wang D, Serracino-Inglott F, Feng J. Numerical simulations of patient-specific models with multiple plaques in human peripheral artery: a fluid-structure interaction analysis. Biomech Model Mechanobiol 2020; 20:255-265. [PMID: 32915332 PMCID: PMC7892515 DOI: 10.1007/s10237-020-01381-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
Atherosclerotic plaque in the femoral is the leading cause of peripheral artery disease (PAD), the worse consequence of which may lead to ulceration and gangrene of the feet. Numerical studies on fluid-structure interactions (FSI) of atherosclerotic femoral arteries enable quantitative analysis of biomechanical features in arteries. This study aims to investigate the hemodynamic performance and its interaction with femoral arterial wall based on the patient-specific model with multiple plaques (calcified and lipid plaques). Three types of models, calcification-only, lipid-only and calcification-lipid models, are established. Hyperelastic material coefficients of the human femoral arteries obtained from experimental studies are employed for all simulations. Oscillation of WSS is observed in the healthy downstream region in the lipid-only model. The pressure around the plaques in the two-plaque model is lower than that in the corresponding one-plaque models due to the reduction of blood flow domain, which consequently diminishes the loading forces on both plaques. Therefore, we found that stress acting on the plaques in the two-plaque model is lower than that in the corresponding one-plaque models. This finding implies that the lipid plaque, accompanied by the calcified plaque around, might reduce its risk of rupture due to the reduced the stress acting on it.
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Affiliation(s)
- Danyang Wang
- Department of Engineering, Manchester Metropolitan University, Manchester, UK
| | | | - Jiling Feng
- Department of Engineering, Manchester Metropolitan University, Manchester, UK.
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Arzani A. Coronary artery plaque growth: A two-way coupled shear stress-driven model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3293. [PMID: 31820589 DOI: 10.1002/cnm.3293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/30/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
Atherosclerosis in coronary arteries can lead to plaque growth, stenosis formation, and blockage of the blood flow supplying the heart tissue. Several studies have shown that hemodynamics play an important role in the growth of coronary artery plaques. Specifically, low wall shear stress (WSS) appears to be the leading hemodynamic parameter promoting atherosclerotic plaque growth, which in turn influences the blood flow and WSS distribution. Therefore, a two-way coupled interaction exists between WSS and atherosclerosis growth. In this work, a computational framework was developed to study the coupling between WSS and plaque growth in coronary arteries. Computational fluid dynamics (CFD) was used to quantify WSS distribution. Surface mesh nodes were moved in the inward normal direction according to a growth model based on WSS. After each growth stage, the geometry was updated and the CFD simulation repeated to find updated WSS values for the next growth stage. One hundred twenty growth stages were simulated in an idealized tube and an image-based left anterior descending artery. An automated framework was developed using open-source software to couple CFD simulations with growth. Changes in plaque morphology and hemodynamic patterns during different growth stages are presented. The results show larger plaque growth towards the downstream segment of the plaque, agreeing with the reported clinical observations. The developed framework could be used to establish hemodynamic-driven growth models and study the interaction between these processes.
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Affiliation(s)
- Amirhossein Arzani
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona
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