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Bacigalupi E, Pizzicannella J, Rigatelli G, Scorpiglione L, Foglietta M, Rende G, Mantini C, Fiore FM, Pelliccia F, Zimarino M. Biomechanical factors and atherosclerosis localization: insights and clinical applications. Front Cardiovasc Med 2024; 11:1392702. [PMID: 39119184 PMCID: PMC11306036 DOI: 10.3389/fcvm.2024.1392702] [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: 02/27/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Although the entire vascular bed is constantly exposed to the same risk factors, atherosclerosis manifests a distinct intra-individual pattern in localization and progression within the arterial vascular bed. Despite shared risk factors, the development of atherosclerotic plaques is influenced by physical principles, anatomic variations, metabolic functions, and genetic pathways. Biomechanical factors, particularly wall shear stress (WSS), play a crucial role in atherosclerosis and both low and high WSS are associated with plaque progression and heightened vulnerability. Low and oscillatory WSS contribute to plaque growth and arterial remodeling, while high WSS promotes vulnerable changes in obstructive coronary plaques. Axial plaque stress and plaque structural stress are proposed as biomechanical indicators of plaque vulnerability, representing hemodynamic stress on stenotic lesions and localized stress within growing plaques, respectively. Advancements in imaging and computational fluid dynamics techniques enable a comprehensive analysis of morphological and hemodynamic properties of atherosclerotic lesions and their role in plaque localization, evolution, and vulnerability. Understanding the impact of mechanical forces on blood vessels holds the potential for developing shear-regulated drugs, improving diagnostics, and informing clinical decision-making in coronary atherosclerosis management. Additionally, Computation Fluid Dynamic (CFD) finds clinical applications in comprehending stent-vessel dynamics, complexities of coronary bifurcations, and guiding assessments of coronary lesion severity. This review underscores the clinical significance of an integrated approach, concentrating on systemic, hemodynamic, and biomechanical factors in atherosclerosis and plaque vulnerability among patients with coronary artery disease.
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Affiliation(s)
- Elena Bacigalupi
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Engineering and Geology, University “G. d’ Annunzio” Chieti-Pescara, Pescara, Italy
| | | | - Luca Scorpiglione
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Melissa Foglietta
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Cardiology Department, SS. Annunziata Hospital, Chieti, Italy
| | - Greta Rende
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Franco M. Fiore
- Division of Vascular Surgery, SS. Annunziata Hospital, Chieti, Italy
| | | | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Cardiology Department, SS. Annunziata Hospital, Chieti, Italy
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Huang M, Maehara A, Tang D, Zhu J, Wang L, Lv R, Zhu Y, Zhang X, Zhao C, Jia H, Mintz GS. Impact of residual stress on coronary plaque stress/strain calculations using optical coherence tomography image-based multi-layer models. Front Cardiovasc Med 2024; 11:1395257. [PMID: 38725836 PMCID: PMC11079268 DOI: 10.3389/fcvm.2024.1395257] [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: 03/03/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Mechanical stress and strain conditions play an important role in atherosclerosis plaque progression, remodeling and potential rupture and may be used in plaque vulnerability assessment for better clinical diagnosis and treatment decisions. Single layer plaque models without residual stress have been widely used due to unavailability of multi-layer image segmentation method and residual stress data. However, vessel layered structure and residual stress have large impact on stress/strain calculations and should be included in the models. Methods In this study, intravascular optical coherence tomography (OCT) data of coronary plaques from 10 patients were acquired and segmented to obtain the three-layer vessel structure using an in-house automatic segmentation algorithm. Multi- and single-layer 3D thin-slice biomechanical plaque models with and without residual stress were constructed to assess the impact of residual stress on stress/strain calculations. Results Our results showed that residual stress led to a more uniform stress distribution across the vessel wall, with considerable plaque stress/strain decrease on inner wall and increase on vessel out-wall. Multi-layer model with residual stress inclusion reduced inner wall maximum and mean plaque stresses by 38.57% and 59.70%, and increased out-wall maximum and mean plaque stresses by 572.84% and 432.03%. Conclusion These findings demonstrated the importance of multi-layer modeling with residual stress for more accurate plaque stress/strain calculations, which will have great impact in plaque cap stress calculation and plaque rupture risk assessment. Further large-scale studies are needed to validate our findings.
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Affiliation(s)
- Mengde Huang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Akiko Maehara
- The Cardiovascular Research Foundation, Columbia University, New York, NY, 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
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Rui Lv
- Department of Cardiac Surgery, Shandong Second Provincial General Hospital, Jinan, China
| | - Yanwen Zhu
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Chen Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gary S. Mintz
- The Cardiovascular Research Foundation, Columbia University, New York, NY, United States
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He Z, Luo J, Lv M, Li Q, Ke W, Niu X, Zhang Z. Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques. Front Neurol 2023; 14:1159288. [PMID: 37900593 PMCID: PMC10603250 DOI: 10.3389/fneur.2023.1159288] [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: 02/05/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
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.
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Affiliation(s)
- Zhiwei He
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiaying Luo
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mengna Lv
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingwen Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Ke
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xuan Niu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaohui Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Carpenter HJ, Ghayesh MH, Zander AC, Li J, Di Giovanni G, Psaltis PJ. Automated Coronary Optical Coherence Tomography Feature Extraction with Application to Three-Dimensional Reconstruction. Tomography 2022; 8:1307-1349. [PMID: 35645394 PMCID: PMC9149962 DOI: 10.3390/tomography8030108] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Coronary optical coherence tomography (OCT) is an intravascular, near-infrared light-based imaging modality capable of reaching axial resolutions of 10–20 µm. This resolution allows for accurate determination of high-risk plaque features, such as thin cap fibroatheroma; however, visualization of morphological features alone still provides unreliable positive predictive capability for plaque progression or future major adverse cardiovascular events (MACE). Biomechanical simulation could assist in this prediction, but this requires extracting morphological features from intravascular imaging to construct accurate three-dimensional (3D) simulations of patients’ arteries. Extracting these features is a laborious process, often carried out manually by trained experts. To address this challenge, numerous techniques have emerged to automate these processes while simultaneously overcoming difficulties associated with OCT imaging, such as its limited penetration depth. This systematic review summarizes advances in automated segmentation techniques from the past five years (2016–2021) with a focus on their application to the 3D reconstruction of vessels and their subsequent simulation. We discuss four categories based on the feature being processed, namely: coronary lumen; artery layers; plaque characteristics and subtypes; and stents. Areas for future innovation are also discussed as well as their potential for future translation.
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Affiliation(s)
- Harry J. Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
- Correspondence: (H.J.C.); (M.H.G.)
| | - Mergen H. Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
- Correspondence: (H.J.C.); (M.H.G.)
| | - Anthony C. Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Jiawen Li
- School of Electrical Electronic Engineering, University of Adelaide, Adelaide, SA 5005, Australia;
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, SA 5005, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, SA 5005, Australia
| | - Giuseppe Di Giovanni
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (G.D.G.); (P.J.P.)
| | - Peter J. Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; (G.D.G.); (P.J.P.)
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
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Song Q, Chen M, Shang J, Hu Z, Cai H. Analysis of Predictive Model of Coronary Vulnerable Plaque under Hemodynamic Numerical Simulation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3434910. [PMID: 35035824 PMCID: PMC8759851 DOI: 10.1155/2022/3434910] [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: 08/20/2021] [Revised: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Vulnerable plaque is considered to be the cause of most clinical coronary arteries, and linear cytokines are an important factor causing plaque instability. Early prediction of vulnerable plaque is of great significance in the treatment of cardiovascular diseases. METHODS Computational fluid dynamics (CFD) was used to simulate the hemodynamics around plaques, and the serum biochemical markers in 224 patients with low-risk acute coronary syndrome (ACS) were analyzed. Vulnerable plaques were predicted according to the distribution of biochemical markers in serum. RESULTS CFD can accurately capture the hemodynamic characteristics around the plaque. The patient's age, history of hyperlipidemia, apolipoprotein B (apoB), adiponectin (ADP), and sE-Selection were risk factors for vulnerable plaque. Area under curve (AUC) values corresponding to the five biochemical markers were 0.601, 0.523, 0.562, 0.519, 0.539, and the AUC value after the combination of the five indicators was 0.826. CONCLUSION The combination of multiple biochemical markers to predict vulnerable plaque was of high diagnostic value, and this method was convenient and noninvasive, which was worthy of clinical promotion.
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Affiliation(s)
- Qiang Song
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jin Shang
- Department of Medical Iimaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Zhi Hu
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Hui Cai
- Department of Vascular Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
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Kadry K, Olender ML, Marlevi D, Edelman ER, Nezami FR. A platform for high-fidelity patient-specific structural modelling of atherosclerotic arteries: from intravascular imaging to three-dimensional stress distributions. J R Soc Interface 2021; 18:20210436. [PMID: 34583562 DOI: 10.1098/rsif.2021.0436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The pathophysiology of atherosclerotic lesions, including plaque rupture triggered by mechanical failure of the vessel wall, depends directly on the plaque morphology-modulated mechanical response. The complex interplay between lesion morphology and structural behaviour can be studied with high-fidelity computational modelling. However, construction of three-dimensional (3D) and heterogeneous models is challenging, with most previous work focusing on two-dimensional geometries or on single-material lesion compositions. Addressing these limitations, we here present a semi-automatic computational platform, leveraging clinical optical coherence tomography images to effectively reconstruct a 3D patient-specific multi-material model of atherosclerotic plaques, for which the mechanical response is obtained by structural finite-element simulations. To demonstrate the importance of including multi-material plaque components when recovering the mechanical response, a computational case study was conducted in which systematic variation of the intraplaque lipid and calcium was performed. The study demonstrated that the inclusion of various tissue components greatly affected the lesion mechanical response, illustrating the importance of multi-material formulations. This platform accordingly provides a viable foundation for studying how plaque micro-morphology affects plaque mechanical response, allowing for patient-specific assessments and extension into clinically relevant patient cohorts.
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Affiliation(s)
- Karim Kadry
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Laboratory of Hemodynamics and Cardiovascular Technology, Swiss Federal Institute of Technology, MED 3.2922, 1015 Lausanne, Switzerland
| | - Max L Olender
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Farhad R Nezami
- Thoracic and Cardiac Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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