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Tomizawa N, Fujimoto S, Takahashi D, Nozaki Y, Fan R, Kudo A, Kawaguchi Y, Takamura K, Hiki M, Kadowaki S, Ikeda F, Kumamaru KK, Watada H, Minamino T, Aoki S. Energy loss is related to CT fractional flow reserve progression in type 2 diabetes mellitus patients. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100328. [PMID: 38511178 PMCID: PMC10945932 DOI: 10.1016/j.ahjo.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 03/22/2024]
Abstract
Background We aimed to investigate the diagnostic value of energy loss (EL) and baseline CT fractional flow reserve (CT-FFR) computed using computational fluid dynamics to predict functional progression of coronary stenosis in patients with type 2 diabetes mellitus. Methods This single-center prospective study included 61 patients with type 2 diabetes mellitus (mean age, 61 years ±9 [SD]; 43 men) showing 20-70 % stenosis who underwent serial coronary CT performed at 2-year interval between October 2015 and March 2020. A mesh-free simulation was performed to calculate the CT-FFR and EL. Functional progression was defined as ≥ 0.05 decrease in CT-FFR on the second coronary CT. Models using baseline CT-FFR and EL were compared by analyzing the receiver operating characteristic (ROC) curve. Results Of the 94 vessels evaluated, 25 vessels (27 %) showed functional progression. EL at distal stenosis (ELdis) of vessels with functional progression was higher than that of vessels without functional progression (27.6 W/m3 [interquartile range (IQR): 15.0, 53.0] vs. 5.7 W/m3 [IQR: 2.3, 10.1], p < 0.001). Multivariable analysis showed that ELdis (per unit Ln(EL); odds ratio, 11.8; 95 % CI: 4.0-34.9; p < 0.001) remained as a predictor of functional progression after adjustment for diameter stenosis and baseline CT-FFR. The area under the ROC curve using ELdis (0.89; 95 % CI: 0.82-0.96) was higher than that using baseline CT-FFR (0.71; 95 % CI: 0.59-0.83; p < 0.001). Conclusion When ELdis and baseline CT-FFR were considered, ELdis was a better predictor of functional progression of coronary stenosis.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yui Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ruiheng Fan
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Kadowaki
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fuki Ikeda
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K. Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Diabetes, Endocrinology, and Metabolism, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Chiastra C, Zuin M, Rigatelli G, D’Ascenzo F, De Ferrari GM, Collet C, Chatzizisis YS, Gallo D, Morbiducci U. Computational fluid dynamics as supporting technology for coronary artery disease diagnosis and treatment: an international survey. Front Cardiovasc Med 2023; 10:1216796. [PMID: 37719972 PMCID: PMC10501454 DOI: 10.3389/fcvm.2023.1216796] [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: 05/04/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Computational fluid dynamics (CFD) is emerging as an effective technology able to improve procedural outcomes and enhance clinical decision-making in patients with coronary artery disease (CAD). The present study aims to assess the state of knowledge, use and clinical acceptability of CFD in the diagnosis and treatment of CAD. Methods We realized a 20-questions international, anonymous, cross-sectional survey to cardiologists to test their knowledge and confidence on CFD as a technology applied to patients suffering from CAD. Responses were recorded between May 18, 2022, and June 12, 2022. Results A total of 466 interventional cardiologists (mean age 48.4 ± 8.3 years, males 362), from 42 different countries completed the survey, for a response rate of 45.9%. Of these, 66.6% declared to be familiar with the term CFD, especially for optimization of existing interventional techniques (16.1%) and assessment of hemodynamic quantities related with CAD (13.7%). About 30% of respondents correctly answered to the questions exploring their knowledge on the pathophysiological role of some CFD-derived quantities such as wall shear stress and helical flow in coronary arteries. Among respondents, 85.9% would consider patient-specific CFD-based analysis in daily interventional practice while 94.2% declared to be interested in receiving a brief foundation course on the basic CFD principles. Finally, 87.7% of respondents declared to be interested in a cath-lab software able to conduct affordable CFD-based analyses at the point-of-care. Conclusions Interventional cardiologists reported to be profoundly interested in adopting CFD simulations as a technology supporting decision making in the treatment of CAD in daily practice.
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Affiliation(s)
- Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Department of Cardiology, Madre Teresa Hospital, Padova, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | | | - Yiannis S. Chatzizisis
- Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Diego Gallo
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Tomizawa N, Fujimoto S, Mita T, Takahashi D, Nozaki Y, Fan R, Kudo A, Kawaguchi Y, Takamura K, Hiki M, Kurita M, Kumamaru KK, Watada H, Minamino T, Aoki S. Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus. Radiol Cardiothorac Imaging 2023; 5:e230016. [PMID: 37693191 PMCID: PMC10483244 DOI: 10.1148/ryct.230016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023]
Abstract
Purpose To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus. Materials and Methods This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis. Results Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec-1; IQR: 730-1253 vs 443 sec-1; IQR: 295-602; P < .001) than vessels without progression. The area under the receiver operating characteristic curve of vorticity (0.91; 95% CI: 0.84, 0.97) was higher than that of HRP and LL (0.69; 95% CI: 0.56, 0.82; P < .01). Diagnostic accuracy of vorticity (85%; 80 of 94 vessels; 95% CI: 76, 92) was higher than that of HRP and LL (72%; 68 of 94 vessels; 95% CI: 62, 81; P = .004). Conclusion In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL.Keywords: Coronary Artery, Vorticity, Functional Plaque Progression, Type 2 Diabetes, Vasculature, CT Angiography, Computational Fluid Dynamics, Fractional Flow Reserve Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Nobuo Tomizawa
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinichiro Fujimoto
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tomoya Mita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daigo Takahashi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yui Nozaki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ruiheng Fan
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ayako Kudo
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuko Kawaguchi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuhisa Takamura
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Makoto Hiki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Mika Kurita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kanako K. Kumamaru
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tohru Minamino
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Tomizawa N, Nozaki Y, Fujimoto S, Takahashi D, Kudo A, Kamo Y, Aoshima C, Kawaguchi Y, Takamura K, Hiki M, Dohi T, Okazaki S, Kumamaru KK, Minamino T, Aoki S. Coronary flow disturbance assessed by vorticity as a cause of functionally significant stenosis. Eur Radiol 2022; 32:6859-6867. [PMID: 35778509 DOI: 10.1007/s00330-022-08974-2] [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: 01/27/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Vorticity calculated using computational fluid dynamics (CFD) could assess the flow disturbance generated by coronary stenosis. The purpose of this study was to investigate whether vorticity would be an underlying cause of functionally significant stenosis assessed by invasive fractional flow reserve (FFR). METHODS This retrospective study included 113 patients who underwent coronary CT angiography showing intermediate stenosis and subsequent invasive FFR between December 2015 and March 2020. Vorticity at the stenosis site was calculated using a mesh-free CFD method. We also evaluated the minimum lumen area (MLA) and diameter stenosis (DS) of the lesion. Invasive FFR of ≤ 0.80 was considered functionally significant. Data were compared using Student's t-test and logistic regression analysis was performed. RESULTS Of the evaluated 144 vessels, 53 vessels (37%) showed FFR ≤ 0.80. Vorticity of significant stenosis was significantly higher than non-significant stenosis (569 ± 78 vs. 328 ± 34 s-1, p < 0.001). A significant negative relationship was present between vorticity and invasive FFR (R2 = 0.31, p < 0.001). Multivariate logistic regression analysis including MLA and DS showed that vorticity (per 100 s-1, odds ratio: 1.36, 95% confidence interval: 1.21-1.57, p < 0.001) was a statistically significant factor to detect functional significance. The area under the receiver operating characteristic curve statistically significantly increased when vorticity was combined with DS and MLA (0.76 vs. 0.87, p = 0.001). CONCLUSIONS Vorticity had a statistically significant negative relationship with invasive FFR independent of geometric stenosis. KEY POINTS • Flow disturbance caused by coronary stenosis could be evaluated by calculating vorticity which is defined as the norm of the rotation of the velocity vector. • Vorticity was statistically significantly higher in stenosis with functional significance than stenosis without. • Vorticity has an additive value to detect functionally significant stenosis over geometrical stenosis.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yui Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Kamo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Chihiro Aoshima
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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