Wall vibrations induced by flow through simulated stenosis in models and arteries

Spectral Decomposition and Sound Source Localization of Highly Disturbed Flow through a Severe Arterial Stenosis

For the early detection of atherosclerosis, it is imperative to explore the capabilities of new, effective noninvasive diagnosis techniques to significantly reduce the associated treatment costs and mortality rates. In this study, a multifaceted comprehensive approach involving advanced computational fluid dynamics combined with signal processing techniques was exploited to investigate the highly turbulent fluctuating flow through arterial stenosis. The focus was on localizing high-energy mechano-acoustic source potential to transmit to the epidermal surface. The flow analysis results showed the existence of turbulent pressure fluctuations inside the stenosis and in the post-stenotic region. After analyzing the turbulent kinetic energy and pressure fluctuations on the flow centerline and the vessel wall, the point of maximum excitation in the flow was observed around two diameters downstream of the stenosis within the fluctuating zone. It was also found that the concentration of pressure fluctuation closer to the wall was higher inside the stenosis compared to the post-stenotic region. Additionally, the visualization of the most energetic proper orthogonal decomposition (POD) mode and spectral decomposition of the flow indicated that the break frequencies ranged from 80 to 220 Hz and were correlated to the eddies generated within these regions.

Numerical investigation of wall pressure fluctuations downstream of concentric and eccentric blunt stenosis models

Pressure fluctuations that cause acoustic radiation from vessel models with concentric and eccentric blunt stenoses are investigated. Large eddy simulations of non-pulsatile flow condition are performed using OpenFOAM. Calculated amplitude and spatial-spectral distribution of acoustic pressures at the post-stenotic region are compared with previous experimental and theoretical results. It is found that increasing the Reynolds number does not change the location of the maximum root mean square wall pressure, but causes a general increase in the spectrum level, although the change in the shape of the spectrum is not significant. On the contrary, compared to the concentric model at the same Reynolds number, eccentricity leads to an increase both at the distance of the location of the maximum root mean square wall pressure from the stenosis exit and the spectrum level. This effect becomes more distinct when radial eccentricity of the stenosis increases. Both the flow rate and the eccentricity of the stenosis shape are evaluated to be clinically important parameters in diagnosing stenosis.

Experimental and numerical investigation on soft tissue dynamic response due to turbulence-induced arterial vibration

Peripheral arterial occlusive disease is a serious cardiovascular disorder. The arterial occlusion leads to turbulent flow and arterial sound generation on the inner vessel wall. Stenosis-induced vibro-acoustic waves propagate through the surrounding soft tissues and reach the skin surface. In this study, the feasibility of noninvasive acoustic detection of the peripheral arterial stenosis is investigated using the vibration responses by means of experimental and computational models. Latex rubber tube is used to model the artery, and it is surrounded by a tissue mimicking phantom made of bovine gelatin. Vibration responses on phantom surface are measured using laser Doppler vibrometer, and computational results are obtained performing modal analysis. Experimental findings and computational results showed well agreement in terms of spectral content and vibration amplitudes. The effects of various stenosis severities, flow rates, and phantom thicknesses on the vibration responses are investigated from diagnostic perspective. Stenosis severities greater than 70% resulted in a considerable increase in vibration amplitudes. The structural mode shapes of the tissue phantom are dominant between 0 and 100 Hz, suppressing the signals generated by the stenosis. The optimum range of frequency for acoustic stenosis detection is concluded to be between 200 and 500 Hz, particularly around 300 Hz. Graphical abstract .

Flow-induced vibration analysis of constricted artery models with surrounding soft tissue

Arterial stenosis is a vascular pathology which leads to serious cardiovascular diseases. Blood flow through a constriction generates sound and vibration due to fluctuating turbulent pressures. Generated vibro-acoustic waves propagate through surrounding soft tissues and reach the skin surface and may provide valuable insight for noninvasive diagnostic purposes. Motivated by the aforementioned phenomena, vibration of constricted arteries is investigated employing computational models. The flow-induced pressure field in an artery is modeled as broadband harmonic pressure loading based on previous studies in the literature and applied on the inner artery wall. Harmonic analysis is performed for determining radial velocity responses on the outer surface of the models. Results indicate that stenosis severities higher than 70% lead to significant increase in response amplitudes, especially at high frequencies between 250 and 600 Hz. The findings agree well with experimental and theoretical results in the literature considering bending mode frequencies, amplitude scales, and mainly excited frequency ranges. It is seen that artery vibration is sensitive to the phase behavior of pressure loading but its effect becomes less significant with the presence of surrounding tissue. As the surrounding tissue thickness increases, radial velocity response amplitudes decrease but the effect of changes in tissue elastic modulus is more pronounced.

Effect of Varying Hemodynamic and Vascular Conditions on Fractional Flow Reserve: An In Vitro Study

Background

The aim of this study was to investigate the impact of varying hemodynamic conditions on fractional flow reserve (ratio of pressure distal [P_d] and proximal [P_a] to stenosis under hyperemia) in an in vitro setting. Failure to achieve maximal hyperemia and the choice of hyperemic agents may have differential effects on coronary hemodynamics and, consequently, on the determination of fractional flow reserve.

Methods and Results

An in vitro flow system was developed to experimentally model the physiological coronary circulation as flow‐dependent stenosis resistance in series with variable downstream resistance. Five idealized models with 30% to 70% diameter stenosis severity were fabricated using VeroClear rigid material in an Objet260 Connex printer. Mean aortic pressure was maintained at 7 levels (60–140 mm Hg) from hypotension to hypertension using a needle valve that mimicked adjustable microcirculatory resistance. A range of physiological flow rates was applied by a steady flow pump and titrated by a flow sensor. The pressure drop and the pressure ratio (P_d/P_a) were assessed for the 7 levels of aortic pressure and differing flow rates. The in vitro experimental data were coupled with pressure–flow relationships from clinical data for populations with and without myocardial infarction, respectively, to evaluate fractional flow reserve. The curve for pressure ratio and flow rate demonstrated a quadratic relationship with a decreasing slope. The absolute decrease in fractional flow reserve in the group without myocardial infarction (with myocardial infarction) was on the order of 0.03 (0.02), 0.05 (0.02), 0.07 (0.05), 0.17 (0.13) and 0.20 (0.24), respectively, for 30%, 40%, 50%, 60%, and 70% diameter stenosis, for an increase in aortic pressure from 60 to 140 mm Hg.

Conclusions

The fractional flow reserve value, an index of physiological stenosis significance, was observed to decrease with increasing aortic pressure for a given stenosis in this idealized in vitro experiment for vascular groups with and without myocardial infarction.

Transthoracic coronary Doppler vibrometry in the evaluation of normal volunteers and patients with coronary artery stenosis

Coronary artery vibrometry is a new transthoracic Doppler ultrasound method for the detection of coronary artery stenosis. It detects audio-frequency vibrations generated by coronary artery luminal diameter reduction. We studied 31 patients with known or suspected stenosis using coronary artery vibrometry and quantitative coronary angiography and 83 normal volunteers. A tissue vibration difference index (TVDI) was calculated from the left anterior descending, circumflex, left main and right coronary arteries. Accuracy for coronary artery stenosis detection using TVDI was assessed. Sensitivity for detecting coronary stenosis equal or greater than 25% diameter reduction was 89% in the left anterior descending coronary artery (16/18, 95% confidence interval [CI] = 64%-98%), 87% in the right coronary artery (13/15, 95% CI = 58%-98%), 83% in the circumflex coronary artery (5/6, 95% CI = 36%-99%) and 100% in the left main artery (3/3, 95% CI = 31%-100%). The median TVDI increased with severity of stenosis, suggesting that this measure might be used to track progression/regression of coronary artery stenosis.

Doppler vibrometry: assessment of arterial stenosis by using perivascular tissue vibrations without lumen visualization

PURPOSE

To correlate vibration frequency and duration at Doppler vibrometry with stenosis severity determined at catheter angiography.

MATERIALS AND METHODS

Sixteen patients (eight women) scheduled to undergo abdominal or pelvic angiography were recruited after providing informed consent. An ultrasonography (US) scanner was customized to acquire raw echo data before conventional Doppler processing. Data were acquired from perivascular tissue regions proximal to stenoses, close to the most narrow lumen, and distal to stenoses in the renal, hepatic, common iliac, and superior mesenteric arteries. The data were processed to quantify vibration frequency and duration. The minimum lumen diameter and the pre- and poststenotic lumen diameters were quantified from angiograms. One patient with a hepatic artery stenosis did not yield measurable vibrometry data due to significant bowel gas.

RESULTS

Stenoses (diameter reduction, 43%-91%) were angiographically measured in the six renal arteries, four hepatic arteries, three iliac arteries, and one superior mesenteric artery yielding vibrometry data. Three iliac arteries were normal (<30% diameter reduction at angiography). For these 17 arteries, the vibration frequency was higher with a greater percentage of stenosis [Pearson r = .75; P < .001) and a smaller minimum lumen diameter (r = .72; P < .001). The vibration duration increased with a greater percentage of stenosis (r = .7; P < .001).

CONCLUSIONS

Preliminary results indicate that the vibration frequency and duration can be used to quantitatively estimate stenosis severity. Doppler vibrometry is complementary to duplex US and does not require lumen visualization.

Ultrasonic interrogation of tissue vibrations in arterial and organ injuries: preliminary in vivo results

Soft tissues surrounding vascular injuries are known to vibrate at audible and palpable frequencies, producing bruits and thrills. We report the results of a feasibility study where Doppler ultrasound (US) was used to quantitatively estimate the tissue vibrations after induced trauma in an animal model. A software-programmable US system was used to acquire quadrature-demodulated ensembles of received US echoes bypassing clutter filtering and other conventional Doppler processing stages. The waveforms of tissue velocity surrounding the injury site were then estimated from the clutter data using autocorrelation and analyzed to determine vibration characteristics. Six New Zealand white rabbits and two juvenile pigs were used for the study. The femoral artery of the anesthetized animal was punctured with an 18-gauge needle to model a peripheral arterial trauma, and the liver was surgically exposed and incised to model organ trauma. Two types of oscillatory tissue motion were observed: "vibrations" with high frequency (>50 Hz) and low peak-peak amplitude (<1 microm) and "flutter" with low frequency (<50 Hz) and high peak-peak amplitude (>1 microm). Active bleeding in femoral artery punctures produced tissue vibrations at the frequency of 323 +/- 214 Hz (mean +/- standard deviation, pooled for both rabbits and pigs) and the amplitude of 0.24 +/- 0.15 microm. Active bleeding in liver incisions produced vibrations at the frequency of 120 +/- 47 Hz and the amplitude of 0.33 +/- 0.25 microm. Flutter was observed in punctured arteries at the frequency of 28 +/- 13 Hz the amplitude of 2.92 +/- 1.75 microm, and in incised livers at the frequency of 26 +/- 6 Hz and the amplitude of 1.53 +/- 0.76 microm. In a punctured artery, the vibration frequency and phase of tissue surrounding the artery were highly correlated between neighboring locations in tissue (correlation coefficient = 0.98), and with the flow oscillations in the lumen (correlation coefficient = 0.96). This preliminary study indicates that tissue vibrations could provide additional physiologic information for detecting, localizing and monitoring internal bleeding using US.

Acoustic radiation from a fluid-filled, subsurface vascular tube with internal turbulent flow due to a constriction

The vibration of a thin-walled cylindrical, compliant viscoelastic tube with internal turbulent flow due to an axisymmetric constriction is studied theoretically and experimentally. Vibration of the tube is considered with internal fluid coupling only, and with coupling to internal-flowing fluid and external stagnant fluid or external tissue-like viscoelastic material. The theoretical analysis includes the adaptation of a model for turbulence in the internal fluid and its vibratory excitation of and interaction with the tube wall and surrounding viscoelastic medium. Analytical predictions are compared with experimental measurements conducted on a flow model system using laser Doppler vibrometry to measure tube vibration and the vibration of the surrounding viscoelastic medium. Fluid pressure within the tube was measured with miniature hydrophones. Discrepancies between theory and experiment, as well as the coupled nature of the fluid-structure interaction, are described. This study is relevant to and may lead to further insight into the patency and mechanisms of vascular failure, as well as diagnostic techniques utilizing noninvasive acoustic measurements.

Ultrasonic vibration dectection with wavelets: preliminary results

Several arterial disorders are known to cause systolic audio vibrations in tissue: they include stenoses, vasospasm, aneurysms, bleeds and arteriovenous fistulas. High-amplitude vibrations can be discovered with conventional Doppler ultrasound (US) instruments; however, differentiating brief, low-amplitude vibrations from other nonstationary echo sources is difficult. Further, characterizing the frequency and amplitude of vibrations is not feasible with conventional Doppler US. The automated detection and estimation of both the frequency and amplitude of vibrations with durations less than 100 ms and amplitudes of a micrometer or less have remained a signal-processing challenge. These vibrations may be associated with both nonstationary colored noise and strong low-frequency clutter. The normalized continuous Morlet wavelet power-spectrum analysis of quadrature Doppler echoes, followed by a binary hypothesis test for noise, results in simulated detection rates above 99.9%, with 0.1% false alarms for signal-on signal-to-noise ratios (SNRs) as low as one. Two clinical examples are included.

Computerised analysis of auscultatory sounds associated with vascular patency of haemodialysis access

Vascular access for renal dialysis is a lifeline for about 120 000 individuals in the United States. Stethoscope auscultation of vascular sounds has some utility in the assessment of access patency, yet can be highly skill-dependent. The objective of the study was to identify acoustic parameters that are related to changes in vascular access patency. The underlying hypothesis is that stenoses of haemodialysis access vessels or grafts cause vascular sound changes that are detectable using computerised data acquisition and analysis. Eleven patients participated in the study. Their vascular sounds were recorded before and after angiography, which was accompanied by angioplasty in most patients. The sounds were acquired using two electronic stethoscopes and then digitised and analysed on a personal computer. Vessel stenosis changes were found to be associated with changes in acoustic amplitude and/or spectral energy distribution. Certain acoustic parameters correlated well (correlation coefficient = 0.98, p < 0.0001) with the change in the degree of stenosis, suggesting that stenosis severity may be predictable from these parameters. Parameters also appeared to be sensitive to modest diameter changes (> 20%), (p < 0.005, Wilcoxon rank sum test). These results suggest that computerised analysis of vascular sounds may be useful in vessel patency surveillance. Further testing using longitudinal studies may be warranted.

Ultrasonic technique for imaging tissue vibrations: preliminary results

We propose an ultrasound (US)-based technique for imaging vibrations in the blood vessel walls and surrounding tissue caused by eddies produced during flow through narrowed or punctured arteries. Our approach is to utilize the clutter signal, normally suppressed in conventional color flow imaging, to detect and characterize local tissue vibrations. We demonstrate the feasibility of visualizing the origin and extent of vibrations relative to the underlying anatomy and blood flow in real-time and their quantitative assessment, including measurements of the amplitude, frequency and spatial distribution. We present two signal-processing algorithms, one based on phase decomposition and the other based on spectral estimation using eigen decomposition for isolating vibrations from clutter, blood flow and noise using an ensemble of US echoes. In simulation studies, the computationally efficient phase-decomposition method achieved 96% sensitivity and 98% specificity for vibration detection and was robust to broadband vibrations. Somewhat higher sensitivity (98%) and specificity (99%) could be achieved using the more computationally intensive eigen decomposition-based algorithm. Vibration amplitudes as low as 1 mum were measured accurately in phantom experiments. Real-time tissue vibration imaging at typical color-flow frame rates was implemented on a software-programmable US system. Vibrations were studied in vivo in a stenosed femoral bypass vein graft in a human subject and in a punctured femoral artery and incised spleen in an animal model.

In vivo ultrasonic measurement of tissue vibration at a stenosis: a case study

It is known that bruits often can be heard downstream from stenoses. They are thought to be produced by disturbed blood flow and vessel wall vibrations. Our understanding of bruits has been limited, though, to analysis of sounds heard at the level of the skin. For direct measurements from the stenosis site, we developed an ultrasonic pulse-echo multigate system using quadrature phase demodulation. The system simultaneously measures tissue displacements and blood velocities at multiple depths. This paper presents a case study of a severe stenosis in a human infrainguinal vein bypass graft. During systole, nearly sinusoidal vessel wall vibrations were detected. Solid tissue vibration amplitudes measured up to 2 microm, with temporal durations of 100 ms and frequencies of roughly 145 Hz and its harmonics. Cross-axial oscillations were also found in the lumen that correlate with the wall vibrations, suggesting coupling between wall vibration and blood velocity oscillation.

Simulation of coronary artery revascularization

Simulation of the commonly constructed geometries of aorto-coronary bypass anastomoses was carried out using especially fabricated distensible tubes and a pulsatile pump. The system pressure was maintained between 80 and 120 mmHg. The total mean flow was set at 250 ml min-1 (Reynolds number of 200) and the pulsatile frequency was varied from 0 to 2 Hz. A water-glycerine mixture having a density and viscosity similar to that of blood was used throughout. A 16 mm film of the front of black dye injected proximal to the anastomosis was made as the dye approached and passed through the anastomosis. Anastomotic geometries consisted of: end to side, parallel, 45 degree angle, and 90 degree angle. Stenoses, located in the tube representing the coronary artery, were simulated using a bevelled insert which represented an 80-85% area reduction. Flow visualization revealed that distensible tubes gave more realistic flow patterns than rigid tubes, a result particularly evident when a stenosis was present. Pulsatile flow demonstrated considerably more mixing than steady flow. The use of pulsatile flow in distensible tubing with a partial stenosis showed retrograde flow through the stenosis which was not evident for either steady flow or for flow in rigid tubing. The flow at the anastomatic site of the graft having an angle of 0 degrees showed a jetting action with a zone of recirculating fluid being present whereas for a 90 degree graft a distinct helical flow was formed distal to the anastomosis.

Effects of surrounding tissue on the sound spectrum of arterial bruits in vivo

Turbulent flow distal to arterial stenoses producers bruits with a characteristic sound spectrum, analysis of which has permitted accurate non-invasive assessment of the residual lumen diameter of the stenosis in the case of the human carotid artery. In contrast, investigators working with in vitro elastic models of arteries or with excised vessels have reported finding mainly resonant spectra of bruits recorded distal to stenoses. We have studied the effects of turbulent flow on the sound spectrum produced at the arterial wall and the influence of surrounding tissue on this spectrum. Aortic, carotid, and femoral stenoses were produced in dogs by external banding of the arteries with 5mm wide Teflon bands. Recordings of bruits made directly on the vessel wall had a sound spectrum made up of 2 components, one due to turbulent flow, and the second to a superimposed resonant spectrum from arterial wall vibration. This was true of 3 kinds of vessels studied. The effects of surrounding tissue on the sound spectrum of arterial bruits was shown by comparing the spectra o bruits recorded directly on the vessel wall, on the freshly closed wound and on the healed wound. The sound properties of the artery in situ are very different from those of exposed or excised vessels or elastic tubes. Although intravascular turbulence may be accurately appreciated at the skin surface, arterial wall resonance in the intact animal is extensively damped by the normal coupling of the artery to its surrounding tissue.