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Vuong TNAM, Bartolf‐Kopp M, Andelovic K, Jungst T, Farbehi N, Wise SG, Hayward C, Stevens MC, Rnjak‐Kovacina J. Integrating Computational and Biological Hemodynamic Approaches to Improve Modeling of Atherosclerotic Arteries. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307627. [PMID: 38704690 PMCID: PMC11234431 DOI: 10.1002/advs.202307627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/12/2024] [Indexed: 05/07/2024]
Abstract
Atherosclerosis is the primary cause of cardiovascular disease, resulting in mortality, elevated healthcare costs, diminished productivity, and reduced quality of life for individuals and their communities. This is exacerbated by the limited understanding of its underlying causes and limitations in current therapeutic interventions, highlighting the need for sophisticated models of atherosclerosis. This review critically evaluates the computational and biological models of atherosclerosis, focusing on the study of hemodynamics in atherosclerotic coronary arteries. Computational models account for the geometrical complexities and hemodynamics of the blood vessels and stenoses, but they fail to capture the complex biological processes involved in atherosclerosis. Different in vitro and in vivo biological models can capture aspects of the biological complexity of healthy and stenosed vessels, but rarely mimic the human anatomy and physiological hemodynamics, and require significantly more time, cost, and resources. Therefore, emerging strategies are examined that integrate computational and biological models, and the potential of advances in imaging, biofabrication, and machine learning is explored in developing more effective models of atherosclerosis.
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Affiliation(s)
| | - Michael Bartolf‐Kopp
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
| | - Kristina Andelovic
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
| | - Tomasz Jungst
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
- Department of Orthopedics, Regenerative Medicine Center UtrechtUniversity Medical Center UtrechtUtrecht3584Netherlands
| | - Nona Farbehi
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydney2052Australia
- Tyree Institute of Health EngineeringUniversity of New South WalesSydneyNSW2052Australia
- Garvan Weizmann Center for Cellular GenomicsGarvan Institute of Medical ResearchSydneyNSW2010Australia
| | - Steven G. Wise
- School of Medical SciencesUniversity of SydneySydneyNSW2006Australia
| | - Christopher Hayward
- St Vincent's HospitalSydneyVictor Chang Cardiac Research InstituteSydney2010Australia
| | | | - Jelena Rnjak‐Kovacina
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydney2052Australia
- Tyree Institute of Health EngineeringUniversity of New South WalesSydneyNSW2052Australia
- Australian Centre for NanoMedicine (ACN)University of New South WalesSydneyNSW2052Australia
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Minderhoud SCS, van Montfoort R, Meijs TA, Korteland SA, Bruse JL, Kardys I, Wentzel JJ, Voskuil M, Hirsch A, Roos-Hesselink JW, van den Bosch AE. Aortic geometry and long-term outcome in patients with a repaired coarctation. Open Heart 2024; 11:e002642. [PMID: 38806222 PMCID: PMC11138275 DOI: 10.1136/openhrt-2024-002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE This study aims to compare aortic morphology between repaired coarctation patients and controls, and to identify aortic morphological risk factors for hypertension and cardiovascular events (CVEs) in coarctation patients. METHODS Repaired coarctation patients with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) were included, followed-up and compared with sex-matched and age-matched controls. Three-dimensional aortic shape was reconstructed using patients' CTA or MRA, or four-dimensional flow cardiovascular magnetic resonance in controls, and advanced geometrical characteristics were calculated and visualised using statistical shape modelling. In patients, we examined the association of geometrical characteristics with (1) baseline hypertension, using multivariable logistic regression; and (2) cardiovascular events (CVE, composite of aortic complications, coronary artery disease, ventricular arrhythmias, heart failure hospitalisation, stroke, transient ischaemic attacks and cardiovascular death), using multivariable Cox regression. The least absolute shrinkage and selection operator (LASSO) method selected the most informative multivariable model. RESULTS Sixty-five repaired coarctation patients (23 years (IQR 19-38)) were included, of which 44 (68%) patients were hypertensive at baseline. After a median follow-up of 8.7 years (IQR 4.8-15.4), 27 CVEs occurred in 20 patients. Aortic arch dimensions were smaller in patients compared with controls (diameter p<0.001, wall surface area p=0.026, volume p=0.007). Patients had more aortic arch torsion (p<0.001) and a higher curvature (p<0.001). No geometrical characteristics were associated with hypertension. LASSO selected left ventricular mass, male sex, tortuosity and age for the multivariable model. Left ventricular mass (p=0.014) was independently associated with CVE, and aortic tortuosity showed a trend towards significance (p=0.070). CONCLUSION Repaired coarctation patients have a smaller aortic arch and a more tortuous course of the aorta compared with controls. Besides left ventricular mass index, geometrical features might be of importance in long-term risk assessment in coarctation patients.
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Affiliation(s)
- Savine C S Minderhoud
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rick van Montfoort
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Timion A Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan L Bruse
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Fandaros M, Kwok C, Wolf Z, Labropoulos N, Yin W. Patient-Specific Numerical Simulations of Coronary Artery Hemodynamics and Biomechanics: A Pathway to Clinical Use. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00731-4. [PMID: 38710896 DOI: 10.1007/s13239-024-00731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Numerical models that simulate the behaviors of the coronary arteries have been greatly improved by the addition of fluid-structure interaction (FSI) methods. Although computationally demanding, FSI models account for the movement of the arterial wall and more adequately describe the biomechanical conditions at and within the arterial wall. This offers greater physiological relevance over Computational Fluid Dynamics (CFD) models, which assume the walls do not move or deform. Numerical simulations of patient-specific cases have been greatly bolstered by the use of imaging modalities such as Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI), Optical Coherence Tomography (OCT), and Intravascular Ultrasound (IVUS) to reconstruct accurate 2D and 3D representations of artery geometries. The goal of this study was to conduct a comprehensive review on CFD and FSI models on coronary arteries, and evaluate their translational potential. METHODS This paper reviewed recent work on patient-specific numerical simulations of coronary arteries that describe the biomechanical conditions associated with atherosclerosis using CFD and FSI models. Imaging modality for geometry collection and clinical applications were also discussed. RESULTS Numerical models using CFD and FSI approaches are commonly used to study biomechanics within the vasculature. At high temporal and spatial resolution (compared to most cardiac imaging modalities), these numerical models can generate large amount of biomechanics data. CONCLUSIONS Physiologically relevant FSI models can more accurately describe atherosclerosis pathogenesis, and help to translate biomechanical assessment to clinical evaluation.
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Affiliation(s)
- Marina Fandaros
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Chloe Kwok
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Zachary Wolf
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook Medicine, 11794, Stony Brook, NY, USA
| | - Wei Yin
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA.
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Xie Y, Zhu Y, Shi Y, Zhao Y, Zhang H, Li F, Song H, Chen L, Guo W. Impact of Cross-Limb Stent-Graft Configuration on Hemodynamics in Abdominal Aortic Aneurysm Interventional Therapy. Cardiovasc Eng Technol 2024; 15:137-146. [PMID: 37985614 DOI: 10.1007/s13239-023-00702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The cross-limb (CL) technique is a commonly used endovascular treatment for addressing unfavorable anatomical features in patients with abdominal aortic aneurysm (AAA). The configuration of CL stent-graft plays a critical role in determining the postoperative hemodynamic properties and physiological behaviors, which ultimately impact the efficacy and safety of endovascular AAA treatment. This study aims to investigate the relationship between hemodynamics and CL stent-graft configuration from a hemodynamic perspective. METHODS Five distinct geometric models of cross-limb (CL) stent-graft configurations were constructed by optimizing the real clinical computed tomography angiography (CTA) data. These models varied in main body lengths and cross angles and were used to perform numerical simulations to analyze various hemodynamic parameters. Flow pattern, distribution of wall shear stress (WSS)-related parameters, localized normalized helicity (LNH), pressure drop, and the displacement force of all models were examined in this paper. RESULTS In patient-specific cases, helical flow and WSS increase with the main body. However, it also generated secondary flow in localized areas, leading to increased oscillation in the WSS direction. Notably, increasing the stent graft's main body length or decreasing the cross angle reduced the displacement force exerted on the stent-graft. Reducing the cross angle did not significantly alter the hemodynamic characteristics. CONCLUSION In the clinical practice of CL deployment, it is crucial to carefully consider the stent-graft configuration and the patient specific to achieve optimal postoperative outcomes. This study provides valuable insights for guiding stent selection and treatment planning in patients with abdominal aortic aneurysm undergoing CL techniques, from a hemodynamic perspective.
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Affiliation(s)
- Yanqing Xie
- Department of Cardiology, The First Affiliated Hospital of Ningbo University, Ningbo, 315020, China
| | - Yating Zhu
- Department of Vascular Surgery, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yike Shi
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Yawei Zhao
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Hongpeng Zhang
- Department of Vascular Surgery, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fen Li
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, 79 West Yingze Street, Taiyuan, 030024, China.
| | - Hui Song
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, 79 West Yingze Street, Taiyuan, 030024, China
| | - Lingfeng Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Wei Guo
- Department of Vascular Surgery, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Kwak D, Im Y, Nam H, Nam U, Kim S, Kim W, Kim HJ, Park J, Jeon JS. Analyzing the effects of helical flow in blood vessels using acoustofluidic-based dynamic flow generator. Acta Biomater 2024; 177:216-227. [PMID: 38253303 DOI: 10.1016/j.actbio.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
The effects of helical flow in a blood vessel are investigated in a dynamic flow generator using surface acoustic wave (SAW) in the microfluidic device. The SAW, generated by an interdigital transducer (IDT), induces acoustic streaming, resulting in a stable and consistent helical flow pattern in microscale channels. This approach allows rapid development of helical flow within the channel without directly contacting the medium. The precise design of the window enables the creation of distinct unidirectional vortices, which can be controlled by adjusting the amplitude of the SAW. Within this device, optimal operational parameters of the dynamic flow generator to preserve the integrity of endothelial cells are found, and in such settings, the actin filaments within the cells are aligned to the desired state. Our findings reveal that intracellular Ca2+ concentrations vary in response to flow conditions. Specifically, comparable maximum intensity and graphical patterns were observed between low-flow rate helical flow and high-flow rate Hagen-Poiseuille flow. These suggest that the cells respond to the helical flow through mechanosensitive ion channels. Finally, adherence of monocytes is effectively reduced under helical flow conditions in an inflammatory environment, highlighting the atheroprotective role of helical flow. STATEMENT OF SIGNIFICANCE: Helical flow in blood vessels is well known to prevent atherosclerosis. However, despite efforts to replicate helical flow in microscale channels, there is still a lack of in vitro models which can generate helical flow for analyzing its effects on the vascular system. In this study, we developed a method for generating steady and constant helical flow in microfluidic channel using acoustofluidic techniques. By utilizing this dynamic flow generator, we were able to observe the atheroprotective aspects of helical flow in vitro, including the enhancement of calcium ion flux and reduction of monocyte adhesion. This study paves the way for an in vitro model of dynamic cell culture and offers advanced investigation into helical flow in our circulatory system.
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Affiliation(s)
- Daesik Kwak
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Yongtaek Im
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Hyeono Nam
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Ungsig Nam
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Seunggyu Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Woohyuk Kim
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Hyun Jin Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Jinsoo Park
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jessie S Jeon
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea.
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De Nisco G, Hartman EMJ, Torta E, Daemen J, Chiastra C, Gallo D, Morbiducci U, Wentzel JJ. Predicting Lipid-Rich Plaque Progression in Coronary Arteries Using Multimodal Imaging and Wall Shear Stress Signatures. Arterioscler Thromb Vasc Biol 2024; 44:976-986. [PMID: 38328935 DOI: 10.1161/atvbaha.123.320337] [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: 10/27/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Plaque composition and wall shear stress (WSS) magnitude act as well-established players in coronary plaque progression. However, WSS magnitude per se does not completely capture the mechanical stimulus to which the endothelium is subjected, since endothelial cells experience changes in the WSS spatiotemporal configuration on the luminal surface. This study explores WSS profile and lipid content signatures of plaque progression to identify novel biomarkers of coronary atherosclerosis. METHODS Thirty-seven patients with acute coronary syndrome underwent coronary computed tomography angiography, near-infrared spectroscopy intravascular ultrasound, and optical coherence tomography of at least 1 nonculprit vessel at baseline and 1-year follow-up. Baseline coronary artery geometries were reconstructed from intravascular ultrasound and coronary computed tomography angiography and combined with flow information to perform computational fluid dynamics simulations to assess the timeaveraged WSS magnitude (TAWSS) and the variability in the contraction/expansion action exerted by WSS on the endothelium, which can be assessed by the topological shear variation index (TSVI). Plaque progression was measured as intravascular ultrasound-derived percentage atheroma volume change at 1-year follow-up (Δplaque atheroma volume). Plaque composition information was extracted from near-infrared spectroscopy and optical coherence tomography. RESULTS Exposure to high TSVI and low TAWSS was associated with higher plaque progression (4.00±0.69% and 3.60±0.62%, respectively). Plaque composition acted synergistically with TSVI or TAWSS, resulting in the highest plaque progression (≥5.90%) at locations where lipid-rich content is exposed to high TSVI or low TAWSS. CONCLUSIONS Luminal exposure to high TSVI, solely or combined with a lipid-rich plaque phenotype, is associated with enhanced plaque progression at 1-year follow-up. Where plaque progression occurred, low TAWSS was also observed. These findings suggest TSVI, in addition to low TAWSS, as a potential biomechanical predictor for plaque progression, showing promise for clinical translation to improve patient prognosis.
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Affiliation(s)
- Giuseppe De Nisco
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Eline M J Hartman
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (E.M.J.H., J.D., J.J.W.)
| | - Elena Torta
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Joost Daemen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (E.M.J.H., J.D., J.J.W.)
| | - Claudio Chiastra
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Diego Gallo
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Umberto Morbiducci
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (E.M.J.H., J.D., J.J.W.)
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Lodi Rizzini M, Candreva A, Mazzi V, Pagnoni M, Chiastra C, Aben JP, Fournier S, Cook S, Muller O, De Bruyne B, Mizukami T, Collet C, Gallo D, Morbiducci U. Blood Flow Energy Identifies Coronary Lesions Culprit of Future Myocardial Infarction. Ann Biomed Eng 2024; 52:226-238. [PMID: 37733110 DOI: 10.1007/s10439-023-03362-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
The present study establishes a link between blood flow energy transformations in coronary atherosclerotic lesions and clinical outcomes. The predictive capacity for future myocardial infarction (MI) was compared with that of established quantitative coronary angiography (QCA)-derived predictors. Angiography-based computational fluid dynamics (CFD) simulations were performed on 80 human coronary lesions culprit of MI within 5 years and 108 non-culprit lesions for future MI. Blood flow energy transformations were assessed in the converging flow segment of the lesion as ratios of kinetic and rotational energy values (KER and RER, respectively) at the QCA-identified minimum lumen area and proximal lesion sections. The anatomical and functional lesion severity were evaluated with QCA to derive percentage area stenosis (%AS), vessel fractional flow reserve (vFFR), and translesional vFFR (ΔvFFR). Wall shear stress profiles were investigated in terms of topological shear variation index (TSVI). KER and RER predicted MI at 5 years (AUC = 0.73, 95% CI 0.65-0.80, and AUC = 0.76, 95% CI 0.70-0.83, respectively; p < 0.0001 for both). The predictive capacity for future MI of KER and RER was significantly stronger than vFFR (p = 0.0391 and p = 0.0045, respectively). RER predictive capacity was significantly stronger than %AS and ΔvFFR (p = 0.0041 and p = 0.0059, respectively). The predictive capacity for future MI of KER and RER did not differ significantly from TSVI. Blood flow kinetic and rotational energy transformations were significant predictors for MI at 5 years (p < 0.0001). The findings of this study support the hypothesis of a biomechanical contribution to the process of plaque destabilization/rupture leading to MI.
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Affiliation(s)
- Maurizio Lodi Rizzini
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Alessandro Candreva
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
- Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
| | - Valentina Mazzi
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Mattia Pagnoni
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudio Chiastra
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | | | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Stephane Cook
- Department of Cardiology, HFR Fribourg, Fribourg, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy.
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De Nisco G, Lodi Rizzini M, Verardi R, Chiastra C, Candreva A, De Ferrari G, D'Ascenzo F, Gallo D, Morbiducci U. Modelling blood flow in coronary arteries: Newtonian or shear-thinning non-Newtonian rheology? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107823. [PMID: 37757568 DOI: 10.1016/j.cmpb.2023.107823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The combination of medical imaging and computational hemodynamics is a promising technology to diagnose/prognose coronary artery disease (CAD). However, the clinical translation of in silico hemodynamic models is still hampered by assumptions/idealizations that must be introduced in model-based strategies and that necessarily imply uncertainty. This study aims to provide a definite answer to the open question of how to properly model blood rheological properties in computational fluid dynamics (CFD) simulations of coronary hemodynamics. METHODS The geometry of the right coronary artery (RCA) of 144 hemodynamically stable patients with different stenosis degree were reconstructed from angiography. On them, unsteady-state CFD simulations were carried out. On each reconstructed RCA two different simulation strategies were applied to account for blood rheological properties, implementing (i) a Newtonian (N) and (ii) a shear-thinning non-Newtonian (non-N) rheological model. Their impact was evaluated in terms of wall shear stress (WSS magnitude, multidirectionality, topological skeleton) and helical flow (strength, topology) profiles. Additionally, luminal surface areas (SAs) exposed to shear disturbances were identified and the co-localization of paired N and non-N SAs was quantified in terms of similarity index (SI). RESULTS The comparison between paired N vs. shear-thinning non-N simulations revealed remarkably similar profiles of WSS-based and helicity-based quantities, independent of the adopted blood rheology model and of the degree of stenosis of the vessel. Statistically, for each paired N and non-N hemodynamic quantity emerged negligible bias from Bland-Altman plots, and strong positive linear correlation (r > 0.94 for almost all the WSS-based quantities, r > 0.99 for helicity-based quantities). Moreover, a remarkable co-localization of N vs. non-N luminal SAs exposed to disturbed shear clearly emerged (SI distribution 0.95 [0.93, 0.97]). Helical flow topology resulted to be unaffected by blood rheological properties. CONCLUSIONS This study, performed on 288 angio-based CFD simulations on 144 RCA models presenting with different degrees of stenosis, suggests that the assumptions on blood rheology have negligible impact both on WSS and helical flow profiles associated with CAD, thus definitively answering to the question "is Newtonian assumption for blood rheology adequate in coronary hemodynamics simulations?".
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Affiliation(s)
- Giuseppe De Nisco
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio Lodi Rizzini
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Roberto Verardi
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudio Chiastra
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Alessandro Candreva
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Gaetano De Ferrari
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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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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10
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Ha H, Park JY, Lee CH, Son D, Chung SW, Baek S, Lee K, Lee KS, Yi SW, Kang M, Kim D, Sung H. Vascular Cast to Program Antistenotic Hemodynamics and Remodeling of Vein Graft. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2204993. [PMID: 36727829 PMCID: PMC10074125 DOI: 10.1002/advs.202204993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/28/2022] [Indexed: 05/31/2023]
Abstract
The structural stability of medical devices is established by managing stress distribution in response to organ movement. Veins abruptly dilate upon arterial grafting due to the mismatched tissue property, resulting in flow disturbances and consequently stenosis. Vascular cast is designed to wrap the vein-artery grafts, thereby adjusting the diameter and property mismatches by relying on the elastic fixity. Here, a small bridge connection in the cast structure serves as an essential element to prevent stress concentrations due to the improved elastic fixity. Consequently, the vein dilation is efficiently suppressed, healthy (laminar and helical) flow is induced effectively, and the heathy functions of vein grafting are promoted, as indicated by the flow directional alignment of endothelial cells with arterialization, muscle expansion, and improved contractility. Finally, collaborative effects of the bridge drastically suppress stenosis with patency improvement. As a key technical point, the advantages of the bridge addition are validated via the computational modeling of fluid-structure interaction, followed by a customized ex vivo set-up and analyses. The calculated effects are verified using a series of cell, rat, and canine models towards translation. The bridge acted like "Little Dutch boy" who saved the big mass using one finger by supporting the cast function.
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Affiliation(s)
- Hyunsu Ha
- Department of Medical EngineeringYonsei University College of Medicine50–1 Yonsei‐roSeodaemun‐guSeoul03722Republic of Korea
| | - Ju Young Park
- TMD LAB Co. Ltd.6th floor, 31, Gwangnaru‐ro 8‐gil, Seongdong‐guSeoul03722Republic of Korea
| | - Chan Hee Lee
- Department of Medical EngineeringYonsei University College of Medicine50–1 Yonsei‐roSeodaemun‐guSeoul03722Republic of Korea
| | - Deok‐Hyeon Son
- Department of Medical EngineeringYonsei University College of Medicine50–1 Yonsei‐roSeodaemun‐guSeoul03722Republic of Korea
| | - Soon Won Chung
- Department of Plastic SurgeryKorea University Guro HospitalKorea University College of MedicineGurodong‐ro 28‐gilGuro‐guSeoul08308Republic of Korea
| | - Sewoom Baek
- Department of Brain Korea 21 FOUR Project for Medical Science and Medical EngineeringYonsei University College of Medicine50–1 Yonsei‐roSeodaemun‐guSeoul03722Republic of Korea
| | - Kyubae Lee
- Department of Medical EngineeringYonsei University College of Medicine50–1 Yonsei‐roSeodaemun‐guSeoul03722Republic of Korea
| | - Kang Suk Lee
- TMD LAB Co. Ltd.6th floor, 31, Gwangnaru‐ro 8‐gil, Seongdong‐guSeoul03722Republic of Korea
| | - Se Won Yi
- TMD LAB Co. Ltd.6th floor, 31, Gwangnaru‐ro 8‐gil, Seongdong‐guSeoul03722Republic of Korea
| | - Mi‐Lan Kang
- TMD LAB Co. Ltd.6th floor, 31, Gwangnaru‐ro 8‐gil, Seongdong‐guSeoul03722Republic of Korea
| | - Dae‐Hyun Kim
- Department of Veterinary SurgeryChungnam National University College of Veterinary Medicine99, Daehak‐roYuseong‐guDaejeon34134Republic of Korea
| | - Hak‐Joon Sung
- Department of Medical EngineeringYonsei University College of Medicine50–1 Yonsei‐roSeodaemun‐guSeoul03722Republic of Korea
- TMD LAB Co. Ltd.6th floor, 31, Gwangnaru‐ro 8‐gil, Seongdong‐guSeoul03722Republic of Korea
- Department of Brain Korea 21 FOUR Project for Medical Science and Medical EngineeringYonsei University College of Medicine50–1 Yonsei‐roSeodaemun‐guSeoul03722Republic of Korea
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11
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Wajihah SA, Sankar DS. A review on non-Newtonian fluid models for multi-layered blood rheology in constricted arteries. ARCHIVE OF APPLIED MECHANICS = INGENIEUR-ARCHIV 2023; 93:1771-1796. [PMID: 36743075 PMCID: PMC9886544 DOI: 10.1007/s00419-023-02368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Haemodynamics is a branch of fluid mechanics which investigates the features of blood when it flows not only via blood vessels of smaller/larger diameter, but also under normal as well as abnormal flow states, such as in the presence of stenosis, aneurysm, and thrombosis. This review aims to discuss the rheological properties of blood, geometry of constrictions, dilations and the emergence of single-layered fluid to four-layered fluid models. To discuss further the influence of the aforesaid parameters on the physiologically important flow quantities, the mathematical formulation and solution methodology of the two-layered and four layered arterial blood flow problems studied by the authors (Afiqah and Sankar in ARPN J Eng Appl Sci 15:1129--1143, 2020, Comput Methods Programs Biomed 199:105907, 2021. 10.1016/j.cmpb.2020.105907) are recalled. It should be pointed out that the increasing resistive impedance to flow in three distinct states encompassing healthy, anaemic, and diabetic demonstrates that the greater the restriction in the artery, very few blood is carried to the pathetic organs, leading to subjects' death. It is also discovered that the pulsatile nature of blood movement produces a dynamic environment that poses a slew of intriguing and unstable fluid mechanical state. It is hoped that the intriguing results gathered from this literature survey and review conducted may help the medical practitioners to forecast blood behaviour mobility in stenotic arteries. Furthermore, the physiological information gathered from the available clinical data from the literature on patients diagnosed with diabetes and anaemia may be beneficial to doctors in deciding the therapeutic procedure for treating some particular cardiovascular disease.
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Affiliation(s)
- S. Afiqah Wajihah
- Applied Mathematics and Economics Programme Area, School of Applied Sciences and Mathematics, Universiti Teknologi Brunei, Jalan Tungku Link, Gadong, Bandar Seri Begawan, BE1410 Brunei Darussalam
| | - D. S. Sankar
- Applied Mathematics and Economics Programme Area, School of Applied Sciences and Mathematics, Universiti Teknologi Brunei, Jalan Tungku Link, Gadong, Bandar Seri Begawan, BE1410 Brunei Darussalam
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12
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Computational Study of Hemodynamic Field of an Occluded Artery Model with Anastomosis. Bioengineering (Basel) 2023; 10:bioengineering10020146. [PMID: 36829640 PMCID: PMC9952429 DOI: 10.3390/bioengineering10020146] [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: 01/04/2023] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
In this research work, the hemodynamic field of an occluded artery with anastomosis by means of computational simulation has been studied. The main objective of the current study is the investigation of 3D flow field phenomena in the by-pass region and the effect of the bypass graft to stenosis volume flow ratio on their formation. The anastomosis type was end-to-side with a 45° angle, while stenosis imposed a 75% area blockage of the aorta vessel and the total volume flow was 220 lt/h. The computational study of the flow field was utilized via a laminar flow model and three turbulence models (k-ε RNG, standard k-ω, and k-ω SST). Numerical results were compared qualitatively with experimental visualizations carried out under four different flow conditions, varying according to the flow ratio between the stenosis and the anastomotic graft. Comparison between computational results and experimental visualization findings exhibited a good agreement. Results showed that SST k-ω turbulence models reproduce better visually obtained flow patterns. Furthermore, cross-sectional velocity distributions demonstrated two distinct flow patterns down the bypass graft, depending on the flow ratio. Low values of flow ratio are characterized by fluid rolling up, whereas for high values fluid volume twisting was observed. Finally, areas with low wall shear stresses were mapped, as these are more prone to postoperative degradation of the bypass graft due to the development of subendothelial hyperplasia.
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13
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Shen C, Gharleghi R, Li DD, Beier S. Helical Flow in Healthy and Diseased Patient-specific Coronary Bifurcations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3977-3980. [PMID: 36086059 DOI: 10.1109/embc48229.2022.9871374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Helical flow (HF) exists in healthy and diseased coronary bifurcations and was found to have a protective atherosclerotic vascular effect in other vessels. However, the role of HF in patient-specific human coronary arteries still needs further study, and is therefore the objective of this study in both healthy and diseased bifurcations. Computational studies were conducted on 16 patient-specific coronary bifurcations, including eight healthy and eight identical cases with idealized narrowing to represent disease. In general, higher HF intensity may have a favorable effect as it corelated to the reduction of the percentage vessel area exposed to adverse time averaged wall shear stress (TAWSS%) in both healthy and diseased models. The HF intensity and distribution of each model varies due to the complex shape of patient-specific models. The presence of disease appears to have an important impact on the downstream HF patterns and the TAWSS distributions. Clinical Relevance- By understanding the relationship between HF and hemodynamics, HF may be used as a predictor for the formation and progression of atherosclerotic plaque in coronary arteries instead of near-wall WSS measures, which can be determined with higher accuracy in vivo.
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14
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Li X, Liu X, Liang Y, Deng X, Fan Y. Spatiotemporal changes of local hemodynamics and plaque components during atherosclerotic progression in rabbit. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 220:106814. [PMID: 35523025 DOI: 10.1016/j.cmpb.2022.106814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/22/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Recent evidence demonstrates that the atherogenic process is discontinuous. Our goal is to study changes of plaque components and local hemodynamics during atherosclerotic progression. METHODS The histological and immunohistochemical staining of high-fat diet rabbit aorta were evaluated at 0, 8, 10 and 12 weeks, respectively. In addition, the blood flow and LDL transport were simulated at the above four time points. RESULTS The plaque thickness at different characteristic regions increased at different rates. The collagen continued to increase, while the elastin, fibronectin, macrophages and smooth muscle cells increased first and then decreased. The relative surface LDL concentration decreased at 8 weeks, and then it increased first and decreased slightly. Meanwhile, the hemodynamic environment became better firstly at 8 weeks, then got slightly worse and lastly improved again. CONCLUSIONS The local hemodynamics and plaque components vary nonlinearly during atherosclerotic progression in rabbit aorta.
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Affiliation(s)
- Xiaoyin Li
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Xiao Liu
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China.
| | - Ye Liang
- State Key Laboratory of Membrane Biology, School of Life Sciences, Peking University, Beijing, China
| | - Xiaoyan Deng
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Yubo Fan
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China; School of Engineering Medicine, Beihang University, Beijing, China.
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15
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Lodi Rizzini M, Candreva A, Chiastra C, Gallinoro E, Calò K, D'Ascenzo F, De Bruyne B, Mizukami T, Collet C, Gallo D, Morbiducci U. Modelling coronary flows: impact of differently measured inflow boundary conditions on vessel-specific computational hemodynamic profiles. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106882. [PMID: 35597205 DOI: 10.1016/j.cmpb.2022.106882] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The translation of hemodynamic quantities based on wall shear stress (WSS) or intravascular helical flow into clinical biomarkers of coronary atherosclerotic disease is still hampered by the assumptions/idealizations required by the computational fluid dynamics (CFD) simulations of the coronary hemodynamics. In the resulting budget of uncertainty, inflow boundary conditions (BCs) play a primary role. Accordingly, in this study we investigated the impact of the approach adopted for in vivo coronary artery blood flow rate assessment on personalized CFD simulations where blood flow rate is used as inflow BC. METHODS CFD simulations were carried out on coronary angiograms by applying personalized inflow BCs derived from four different techniques assessing in vivo surrogates of flow rate: continuous thermodilution, intravascular Doppler, frame count-based 3D contrast velocity, and diameter-based scaling law. The impact of inflow BCs on coronary hemodynamics was evaluated in terms of WSS- and helicity-based quantities. RESULTS As main findings, we report that: (i) coronary flow rate values may differ based on the applied flow derivation technique, as continuous thermodilution provided higher flow rate values than intravascular Doppler and diameter-based scaling law (p = 0.0014 and p = 0.0023, respectively); (ii) such intrasubject differences in flow rate values lead to different surface-averaged values of WSS magnitude and helical blood flow intensity (p<0.0020); (iii) luminal surface areas exposed to low WSS and helical flow topological features showed robustness to the flow rate values. CONCLUSIONS Although the absence of a clinically applicable gold standard approach prevents a general recommendation for one coronary blood flow rate derivation technique, our findings indicate that the inflow BC may impact computational hemodynamic results, suggesting that a standardization would be desirable to provide comparable results among personalized CFD simulations of the coronary hemodynamics.
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Affiliation(s)
- Maurizio Lodi Rizzini
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Alessandro Candreva
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy; Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
| | - Claudio Chiastra
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | | | - Karol Calò
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
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16
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Shen C, Gharleghi R, Li DD, Stevens M, Dokos S, Beier S. Secondary flow in bifurcations - Important effects of curvature, bifurcation angle and stents. J Biomech 2021; 129:110755. [PMID: 34601214 DOI: 10.1016/j.jbiomech.2021.110755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
Coronary bifurcations have complex flow patterns including secondary flow zones and helical flow, which directly affect pathophysiological mechanisms such as the development of atherosclerosis. The objective of this study was to generate insights into the effects of curvature, bifurcation angle and the presence of stents on flow patterns and resulting haemodynamics in coronary left main bifurcations. The blood flow and associated metrics were modelled in both idealised and patient-specific bifurcations with varying curvature and bifurcation angles with and without stents, resulting in a total of 128 geometries considered. The results showed that larger curvature of bifurcating vessels has a significant influence on secondary flow, especially with distance to the bifurcation region, causing a skew, spin and asymmetry of Dean vortices, an increase in helical flow intensity with symmetry loss, and a decrease in adversely low time-average wall shear stress (TAWSS). Generally, asymmetric flow patterns coincided with adversely low TAWSS regions. In identical stented geometries, the presence of the stents induced local recirculation immediately adjacent to the stent struts, thus generating adversely low TAWSS in these areas, with some effect on the overall secondary flow. Overall, the effect of stents outweighed the effect of curvature and BA. This new knowledge contributes to a better understanding of the joint effects of curvature, bifurcation angle, and stents on flow patterns and haemodynamics in coronary bifurcations.
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Affiliation(s)
- C Shen
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia.
| | - R Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - D D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - M Stevens
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
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17
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The definition of low wall shear stress and its effect on plaque progression estimation in human coronary arteries. Sci Rep 2021; 11:22086. [PMID: 34764316 PMCID: PMC8586146 DOI: 10.1038/s41598-021-01232-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
Wall shear stress (WSS), the frictional force of the blood on the vessel wall, plays a crucial role in atherosclerotic plaque development. Low WSS has been associated with plaque growth, however previous research used different approaches to define low WSS to investigate its effect on plaque progression. In this study, we used four methodologies to allocate low, mid and high WSS in one dataset of human coronary arteries and investigated the predictive power of low WSS for plaque progression. Coronary reconstructions were based on multimodality imaging, using intravascular ultrasound and CT-imaging. Vessel-specific flow was measured using Doppler wire and computational fluid dynamics was performed to calculate WSS. The absolute WSS range varied greatly between the coronary arteries. On the population level, the established pattern of most plaque progression at low WSS was apparent in all methodologies defining the WSS categories. However, for the individual patient, when using measured flow to determine WSS, the absolute WSS values range so widely, that the use of absolute thresholds to determine low WSS was not appropriate to identify regions at high risk for plaque progression.
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18
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Hossain T, Anan N, Arafat MT. The effects of plaque morphological characteristics on the post-stenotic flow in left main coronary artery bifurcation. Biomed Phys Eng Express 2021; 7. [PMID: 34425569 DOI: 10.1088/2057-1976/ac202c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Abstract
Local post-stenotic hemodynamics has critical influence in the atherosclerotic plaque progression occurring in susceptible arterial sites, in particular the left main coronary artery (LMCA) bifurcation. Understanding the effects of plaque morphological characteristics: stenosis severity (SS), eccentricity index (EI) and lesion length (LL) on the post-stenotic flow behavior can significantly improve treatment planning. In order to investigate these effects, we have employed computational fluid dynamics (CFD) simulations in twenty computer-generated and five patient-specific LMCA models and the hemodynamic parameters: velocity, pressure (P), wall pressure gradient (WPG), wall shear stress (WSS), time averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT) and helicity intensity (h2) were analyzed. Our results revealed that the effect of stenosis eccentricity varied significantly for different values of stenosis severity and lesion length. Regions with low WSS, low TAWSS and high RRT were more prominent in models having higher stenosis severity. For smaller lesion length, at low and moderate stenosis severity, surface area with low TAWSS and high RRT decreased with increasing eccentricity index, whereas for high stenosis severity models, low TAWSS region and average RRT values increased with eccentricity. However, for models with longer lesion length, regions with high OSI and RRT overall increased gradually with eccentricity. The helicity intensity (h2) of all models remained very low except at the most eccentric model with longer lesion length. The presence of very high helical flow in this model suggests the possibility of atheroprotective flow. It can be concluded that all plaque morphological characteristics covered under this investigation play an important role in plaque progression.
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Affiliation(s)
- Tahura Hossain
- Department of Biomedical Engineering, Military Institute of Science and Technology (MIST), Dhaka-1216, Bangladesh
| | - Noushin Anan
- Department of Biomedical Engineering, Military Institute of Science and Technology (MIST), Dhaka-1216, Bangladesh
| | - M Tarik Arafat
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka-1205, Bangladesh
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19
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De Nisco G, Chiastra C, Hartman EMJ, Hoogendoorn A, Daemen J, Calò K, Gallo D, Morbiducci U, Wentzel JJ. Comparison of Swine and Human Computational Hemodynamics Models for the Study of Coronary Atherosclerosis. Front Bioeng Biotechnol 2021; 9:731924. [PMID: 34409022 PMCID: PMC8365882 DOI: 10.3389/fbioe.2021.731924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Coronary atherosclerosis is a leading cause of illness and death in Western World and its mechanisms are still non completely understood. Several animal models have been used to 1) study coronary atherosclerosis natural history and 2) propose predictive tools for this disease, that is asymptomatic for a long time, aiming for a direct translation of their findings to human coronary arteries. Among them, swine models are largely used due to the observed anatomical and pathophysiological similarities to humans. However, a direct comparison between swine and human models in terms of coronary hemodynamics, known to influence atherosclerotic onset/development, is still lacking. In this context, we performed a detailed comparative analysis between swine- and human-specific computational hemodynamic models of coronary arteries. The analysis involved several near-wall and intravascular flow descriptors, previously emerged as markers of coronary atherosclerosis initiation/progression, as well as anatomical features. To do that, non-culprit coronary arteries (18 right–RCA, 18 left anterior descending–LAD, 13 left circumflex–LCX coronary artery) from patients presenting with acute coronary syndrome were imaged by intravascular ultrasound and coronary computed tomography angiography. Similarly, the three main coronary arteries of ten adult mini-pigs were also imaged (10 RCA, 10 LAD, 10 LCX). The geometries of the imaged coronary arteries were reconstructed (49 human, 30 swine), and computational fluid dynamic simulations were performed by imposing individualized boundary conditions. Overall, no relevant differences in 1) wall shear stress-based quantities, 2) intravascular hemodynamics (in terms of helical flow features), and 3) anatomical features emerged between human- and swine-specific models. The findings of this study strongly support the use of swine-specific computational models to study and characterize the hemodynamic features linked to coronary atherosclerosis, sustaining the reliability of their translation to human vascular disease.
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Affiliation(s)
- Giuseppe De Nisco
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Eline M J Hartman
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Ayla Hoogendoorn
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Joost Daemen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Karol Calò
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - 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
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
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20
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Carpenter HJ, Gholipour A, Ghayesh MH, Zander AC, Psaltis PJ. In Vivo Based Fluid-Structure Interaction Biomechanics of the Left Anterior Descending Coronary Artery. J Biomech Eng 2021; 143:1104434. [PMID: 33729476 DOI: 10.1115/1.4050540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Indexed: 12/25/2022]
Abstract
A fluid-structure interaction-based biomechanical model of the entire left anterior descending coronary artery is developed from in vivo imaging via the finite element method in this paper. Included in this investigation is ventricle contraction, three-dimensional motion, all angiographically visible side branches, hyper/viscoelastic artery layers, non-Newtonian and pulsatile blood flow, and the out-of-phase nature of blood velocity and pressure. The fluid-structure interaction model is based on in vivo angiography of an elite athlete's entire left anterior descending coronary artery where the influence of including all alternating side branches and the dynamical contraction of the ventricle is investigated for the first time. Results show the omission of side branches result in a 350% increase in peak wall shear stress and a 54% decrease in von Mises stress. Peak von Mises stress is underestimated by up to 80% when excluding ventricle contraction and further alterations in oscillatory shear indices are seen, which provide an indication of flow reversal and has been linked to atherosclerosis localization. Animations of key results are also provided within a video abstract. We anticipate that this model and results can be used as a basis for our understanding of the interaction between coronary and myocardium biomechanics. It is hoped that further investigations could include the passive and active components of the myocardium to further replicate in vivo mechanics and lead to an understanding of the influence of cardiac abnormalities, such as arrythmia, on coronary biomechanical responses.
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Affiliation(s)
- Harry J Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Alireza Gholipour
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Mergen H Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Anthony C Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia
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21
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Mazzi V, De Nisco G, Hoogendoorn A, Calò K, Chiastra C, Gallo D, Steinman DA, Wentzel JJ, Morbiducci U. Early Atherosclerotic Changes in Coronary Arteries are Associated with Endothelium Shear Stress Contraction/Expansion Variability. Ann Biomed Eng 2021; 49:2606-2621. [PMID: 34324092 PMCID: PMC8455396 DOI: 10.1007/s10439-021-02829-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although unphysiological wall shear stress (WSS) has become the consensus hemodynamic mechanism for coronary atherosclerosis, the complex biomechanical stimulus affecting atherosclerosis evolution is still undetermined. This has motivated the interest on the contraction/expansion action exerted by WSS on the endothelium, obtained through the WSS topological skeleton analysis. This study tests the ability of this WSS feature, alone or combined with WSS magnitude, to predict coronary wall thickness (WT) longitudinal changes. Nine coronary arteries of hypercholesterolemic minipigs underwent imaging with local WT measurement at three time points: baseline (T1), after 5.6 ± 0.9 (T2), and 7.6 ± 2.5 (T3) months. Individualized computational hemodynamic simulations were performed at T1 and T2. The variability of the WSS contraction/expansion action along the cardiac cycle was quantified using the WSS topological shear variation index (TSVI). Alone or combined, high TSVI and low WSS significantly co-localized with high WT at the same time points and were significant predictors of thickening at later time points. TSVI and WSS magnitude values in a physiological range appeared to play an atheroprotective role. Both the variability of the WSS contraction/expansion action and WSS magnitude, accounting for different hemodynamic effects on the endothelium, (1) are linked to WT changes and (2) concur to identify WSS features leading to coronary atherosclerosis.
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Affiliation(s)
- Valentina Mazzi
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129, Turin, Italy
| | - Giuseppe De Nisco
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129, Turin, Italy
| | - Ayla Hoogendoorn
- Department of Cardiology, Biomedical Engineering, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | - Karol Calò
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129, Turin, Italy
| | - Claudio Chiastra
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129, Turin, Italy
| | - Diego Gallo
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129, Turin, Italy
| | - David A Steinman
- Biomedical Simulation Laboratory, Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Canada
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | - Umberto Morbiducci
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129, Turin, Italy.
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22
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Shinge SAU, Zhang D, Achu Muluh T, Nie Y, Yu F. Mechanosensitive Piezo1 Channel Evoked-Mechanical Signals in Atherosclerosis. J Inflamm Res 2021; 14:3621-3636. [PMID: 34349540 PMCID: PMC8328000 DOI: 10.2147/jir.s319789] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/03/2021] [Indexed: 12/18/2022] Open
Abstract
Recently, more and more works have focused and used extensive resources on atherosclerosis research, which is one of the major causes of death globally. Alongside traditional risk factors, such as hyperlipidemia, smoking, hypertension, obesity, and diabetes, mechanical forces, including shear stress, pressure and stretches exerted on endothelial cells by flow, is proved to be crucial in atherosclerosis development. Studies have recognized the mechanosensitive Piezo1 channel as a special sensor and transducer of various mechanical forces into biochemical signals, and recent studies report its role in atherosclerosis through different mechanical forces in pressure, stretching and turbulent shear stress. Based on our expertise in this field and considering the recent advancement of atherosclerosis research, we will be focusing on the function of Piezo1 and its involvement in various cellular mechanisms and consequent involvement in the development of atherosclerosis in this review. Also, we will discuss various functions of Piezo1 involvement in atherosclerosis and come up with new mechanistic insight for future research. Based on the recent findings, we suggest Piezo1 as a valid candidate for novel therapeutic innovations, in which deep exploration and translating its findings into the clinic will be a new therapeutic strategy for cardiovascular diseases, particularly atherosclerosis.
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Affiliation(s)
- Shafiu A Umar Shinge
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Daifang Zhang
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Clinical Research Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Tobias Achu Muluh
- Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Yongmei Nie
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Fengxu Yu
- Cardiovascular Surgery Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
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23
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Zuin M, Rigatelli G, Zuliani G, Roncon L. Helical flow as a new determinant of coronary plaque vulnerability: a glimpse into the future. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:643. [PMID: 33775590 DOI: 10.1016/j.rec.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
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24
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Zuin M, Rigatelli G, Zuliani G, Roncon L. El flujo helicoidal como determinante de placa vulnerable: una mirada al futuro. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Ahmadpour-B M, Nooraeen A, Tafazzoli-Shadpour M, Taghizadeh H. Contribution of atherosclerotic plaque location and severity to the near-wall hemodynamics of the carotid bifurcation: an experimental study and FSI modeling. Biomech Model Mechanobiol 2021; 20:1069-1085. [PMID: 33609192 DOI: 10.1007/s10237-021-01431-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/03/2021] [Indexed: 01/22/2023]
Abstract
Atherosclerosis is initiated by endothelial injury that is related to abnormal values of hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI) and stress phase angle (SPA), which are more common in arterial bifurcations due to the complex structure. An experimental model of human carotid bifurcation with accurate geometrical and mechanical features was set up, and using realistic pulsatile flow rates, the inlet and outlet pressure pulses were measured for normal and stenosed models with 40% and 80% severities at common carotid (CCA), internal carotid (ICA) and external carotid (ECA) arteries. Based on the obtained experimental data, fluid-structure models were developed to obtain WSS, OSI, and SPA and evaluate pathological consequences at different locations. Mild severity had minor impact, however, inducing severe 80% stenosis in each branch led to considerable localized changes of hemodynamic parameters both in the stenosis site and other locations. This included sharp increases in WSS values accompanied by very low values close to zero before and after the peaks. Severe stenosis not only caused significant changes in the local artery, but also in other branches. OSI and SPA were less sensitive to stenosis, although high peaks were observed on bifurcation site for the stenosis at ECA. The interconnection of arteries at carotid bifurcation results in altered pressure/flow patterns in all branches when a stenosis is applied in any site. Such effect confirms pathological findings that atherosclerotic plaques are observed simultaneously in different carotid branches, although with different degrees of plaque growth and severity.
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Affiliation(s)
- Mahyar Ahmadpour-B
- Cardiovascular Engineering Lab, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ahmad Nooraeen
- Tissue Mechanics Lab, Faculty of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran
| | - Mohammad Tafazzoli-Shadpour
- Cardiovascular Engineering Lab, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
| | - Hadi Taghizadeh
- Tissue Mechanics Lab, Faculty of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran.
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26
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Abstract
Atherosclerosis is one of the main causes of cardiovascular events, namely, myocardium infarction and cerebral stroke, responsible for a great number of deaths every year worldwide. This pathology is caused by the progressive accumulation of low-density lipoproteins, cholesterol, and other substances on the arterial wall, narrowing its lumen. To date, many hemodynamic studies have been conducted experimentally and/or numerically; however, this disease is not yet fully understood. For this reason, the research of this pathology is still ongoing, mainly, resorting to computational methods. These have been increasingly used in biomedical research of atherosclerosis because of their high-performance hardware and software. Taking into account the attempts that have been made in computational techniques to simulate realistic conditions of blood flow in both diseased and healthy arteries, the present review aims to give an overview of the most recent numerical studies focused on coronary arteries, by addressing the blood viscosity models, and applied physiological flow conditions. In general, regardless of the boundary conditions, numerical studies have been contributed to a better understanding of the development of this disease, its diagnosis, and its treatment.
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27
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Numerical study on flow topology and hemodynamics in tortuous coronary artery with symmetrical and asymmetrical stenosis. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2020.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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28
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Deciphering ascending thoracic aortic aneurysm hemodynamics in relation to biomechanical properties. Med Eng Phys 2020; 82:119-129. [DOI: 10.1016/j.medengphy.2020.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/19/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
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29
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Won KB, Lee BK, Park HB, Heo R, Lee SE, Rizvi A, Lin FY, Kumar A, Hadamitzky M, Kim YJ, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, de Araújo Gonçalves P, Leipsic JA, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Raff GL, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, Chang HJ. Quantitative assessment of coronary plaque volume change related to triglyceride glucose index: The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. Cardiovasc Diabetol 2020; 19:113. [PMID: 32682451 PMCID: PMC7368987 DOI: 10.1186/s12933-020-01081-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 01/06/2023] Open
Abstract
Background The association between triglyceride glucose (TyG) index and coronary atherosclerotic change remains unclear. We aimed to evaluate the association between TyG index and coronary plaque progression (PP) using serial coronary computed tomography angiography (CCTA). Methods A total of 1143 subjects (aged 60.7 ± 9.3 years, 54.6% male) who underwent serial CCTA with available data on TyG index and diabetic status were analyzed from The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. PP was defined as plaque volume (PV) (mm3) at follow-up minus PV at index > 0. Annual change of PV (mm3/year) was defined as PV change divided by inter-scan period. Rapid PP was defined as the progression of percent atheroma volume (PV divided by vessel volume multiplied by 100) ≥ 1.0%/year. Results The median inter-scan period was 3.2 (range 2.6–4.4) years. All participants were stratified into three groups based on TyG index tertiles. The overall incidence of PP was 77.3%. Baseline total PV (group I [lowest]: 30.8 (0.0–117.7), group II: 47.2 (6.2–160.4), and group III [highest]: 57.5 (8.4–154.3); P < 0.001) and the annual change of total PV (group I: 5.7 (0.0–20.2), group II: 7.6 (0.5–23.5), and group III: 9.4 (1.4–27.7); P = 0.010) were different among all groups. The risk of PP (odds ratio [OR] 1.648; 95% confidence interval [CI] 1.167–2.327; P = 0.005) and rapid PP (OR 1.777; 95% CI 1.288–2.451; P < 0.001) was increased in group III compared to that in group I. TyG index had a positive and significant association with an increased risk of PP and rapid PP after adjusting for confounding factors. Conclusion TyG index is an independent predictive marker for the progression of coronary atherosclerosis. Clinical registration ClinicalTrials.gov NCT02803411
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Affiliation(s)
- Ki-Bum Won
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.,Department of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Bok Park
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Ran Heo
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Sang-Eun Lee
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Department of Cardiology, Ewha Womans University Medical Center, Seoul, South Korea
| | - Asim Rizvi
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Amit Kumar
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Department of Cardiology, Seoul National University Hospital, Seoul, South Korea
| | - Ji Min Sung
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR, Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
| | | | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sanghoon Shin
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Busan University Hospital, Busan, South Korea
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Peter H Stone
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, USA.,Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Hyuk-Jae Chang
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. .,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
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30
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Lodi Rizzini M, Gallo D, De Nisco G, D'Ascenzo F, Chiastra C, Bocchino PP, Piroli F, De Ferrari GM, Morbiducci U. Does the inflow velocity profile influence physiologically relevant flow patterns in computational hemodynamic models of left anterior descending coronary artery? Med Eng Phys 2020; 82:58-69. [PMID: 32709266 DOI: 10.1016/j.medengphy.2020.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/03/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Patient-specific computational fluid dynamics is a powerful tool for investigating the hemodynamic risk in coronary arteries. Proper setting of flow boundary conditions in computational hemodynamic models of coronary arteries is one of the sources of uncertainty weakening the findings of in silico experiments, in consequence of the challenging task of obtaining in vivo 3D flow measurements within the clinical framework. Accordingly, in this study we evaluated the influence of assumptions on inflow velocity profile shape on coronary artery hemodynamics. To do that, (1) ten left anterior descending coronary artery (LAD) geometries were reconstructed from clinical angiography, and (2) eleven velocity profiles with realistic 3D features such as eccentricity and differently shaped (single- and double-vortex) secondary flows were generated analytically and imposed as inflow boundary conditions. Wall shear stress and helicity-based descriptors obtained prescribing the commonly used parabolic velocity profile were compared with those obtained with the other velocity profiles. Our findings indicated that the imposition of idealized velocity profiles as inflow boundary condition is acceptable as long the results of the proximal vessel segment are not considered, in LAD coronary arteries. As a pragmatic rule of thumb, a conservative estimation of the length of influence of the shape of the inflow velocity profile on LAD local hemodynamics can be given by the theoretical entrance length for cylindrical conduits in laminar flow conditions.
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Affiliation(s)
- Maurizio Lodi Rizzini
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Giuseppe De Nisco
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Pier Paolo Bocchino
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Piroli
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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31
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Helical flow: A means to identify unstable plaques and a new direction for the design of vascular grafts and stents. Atherosclerosis 2020; 300:34-36. [PMID: 32216972 DOI: 10.1016/j.atherosclerosis.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 12/25/2022]
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