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Liu H, Song J, Xu M, Wang K, Ma L, Hu D, Zhou W, Yu X, Wang L, Cai X, Chen R, Wang X. Hemodynamic Effects of Tortuosity and Stenosis in Superficial Temporal Artery-Middle Cerebral Artery Bypass for Moyamoya Disease. World Neurosurg 2024; 186:e316-e325. [PMID: 38548046 DOI: 10.1016/j.wneu.2024.03.128] [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: 12/04/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery has been widely adopted in treating moyamoya disease (MMD). Geometric variations including high tortuosity and stenosis exist in many cases, but the hemodynamic effects have not been comprehensively evaluated. We aim to evaluate the hemodynamic effects of bypass geometry variations based on patient-specific data. METHODS In total, 17 patients with MMD who underwent STA-MCA bypass surgery with highly tortuous bypass geometry were included. For each patient, the original 3-dimensional structure of STA-MCA bypass was reconstructed from clinical imaging data. The bypass structure was virtually improved by removing the tortuosity and stenosis. Computational fluid dynamics simulation was performed on both bypass structures under identical patient-specific condition. The simulated hemodynamic parameters of the bypass and its distal branches were compared between the original and virtually improved bypass geometries in all cases using paired t-test or Wilcoxon signed-rank test. The changes of hemodynamic parameters were compared between the cases with and without mild-to-moderate stenosis (44.0-70.3% in diameter) in the bypass using t-test or Mann-Whitney U test. RESULTS The virtual improvement of bypass geometry significantly increased the flow rate of the bypass and its distal branches (P < 0.05) and decreased the transcranial flow resistance (P < 0.05). The hemodynamic changes in cases with stenosis removal were significantly greater than those without stenosis (P < 0.05). CONCLUSIONS High tortuosity and stenosis can significantly change the hemodynamics of STA-MCA bypass, and the optimization of bypass geometry deserves further consideration.
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Affiliation(s)
- Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Jia Song
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengxi Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kexin Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linlin Ma
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Daoxi Hu
- Department of medical imaging, Army 75 Group Military Hospital, Dali, China
| | - Wei Zhou
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoli Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijian Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxiao Cai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rongliang Chen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Xinhong Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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2
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Taskin U, Mammadov G, Topaloglu C, Koyuncu I, Dogdus M. Evaluation of left atrial and left ventricular functions with 3D speckle-tracking echocardiography in patients with coronary artery tortuosity. Echocardiography 2023; 40:1237-1242. [PMID: 37817486 DOI: 10.1111/echo.15702] [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: 09/17/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Tortuosity in the coronary arteries is a very common entity encountered during angiography. The effect of coronary artery tortuosity (CAT) on the myocardium has not been completely investigated. The aim of the current study was to assess the effects of CAT on left atrial (LA) and left ventricular (LV) myocardial functions by 3D speckle-tracking echocardiography (3D-STE). METHODS Seventy-five patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms (CAG) were enrolled into the study. Following CAG, the 2D images were obtained first, and then 3D images were obtained for strain analysis. RESULTS The LAS-r, LAS-active, and LV-GLS were significantly depressed in the CAT (+) group (p < .001, p < .001, p = .012, respectively). The multivariate regression models demonstrated that LAS-r (p < .001), LAS-active (p = .009), and LV-GLS (p = .024) were found to be independent factors predicting CAT. CONCLUSION The current study is the first to focus on the assessing both LA and LV myocardial dynamics in CAT (+) patients by strain echocardiography. The results of our study support the patients with CAT may have subclinical LA and LV myocardial involvements.
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Affiliation(s)
- Ugur Taskin
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Ganbar Mammadov
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Caner Topaloglu
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
| | - Ilhan Koyuncu
- Bakircay University, Cigli Training and Research Hospital, Department of Cardiology, Izmir, Turkey
| | - Mustafa Dogdus
- Izmir University of Economics, Faculty of Medicine, Department of Cardiology, Izmir, Turkey
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Hemu M, Abbasi MA, Omer M, Sandoval Y. Treatment of Highly Angulated Lesions Using SuperCross Microcatheter. Curr Probl Cardiol 2023; 48:101690. [PMID: 36893967 DOI: 10.1016/j.cpcardiol.2023.101690] [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: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Unusually angulated coronary anatomy can decrease the success rate of coronary interventions by hindering successful wiring and equipment delivery. Additionally, due to the technical challenges involved, there is increased risk for complications such as perforations, dissections, stent loss, and equipment entrapment. In this case series, we illustrate the advantages of using angulated microcatheters to facilitate successful treatment of such patients in various clinical scenarios.
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Affiliation(s)
- Mohamad Hemu
- Department of Cardiology, Mayo Clinic, Rochester, MN
| | | | - Mohamed Omer
- Department of Cardiology, Mayo Clinic, Rochester, MN
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4
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Li D, Wang J, Zhao J, Wang T, Zeng X, Zheng T, Yuan D. Identification of high-risk patients for development of type B aortic dissection based on novel morphological parameters. Front Physiol 2023; 14:1065805. [PMID: 36818449 PMCID: PMC9932022 DOI: 10.3389/fphys.2023.1065805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Background: Predicting the development of sporadic type B aortic dissection (TBAD) always remains a difficult issue. This study aimed to identify high-risk patients for development of TBAD based on morphological parameters. Methods: This propensity-score-matched case-control study collected and reconstructed the computed tomography angiography of acute TBAD patients and hospital-based control participants without aortic dissection from January 2013 to December 2016. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). Discriminant and reclassification abilities were compared between our model and a previously established model. Results: Our study included 76 acute TBAD patients and 79 control patients (48 cases and 48 controls after propensity-score matching). The degree of question mark (aOR 1.07, 95% CI 1.04-1.11), brachiocephalic trunk diameter (aOR 1.49, 95% CI 1.20-1.85), brachiocephalic trunk angle (aOR 0.97, 95% CI 0.94-0.99), aortic root diameter (aOR 1.31, 95% CI 1.15-1.48), and aortic width (aOR 1.12, 95% CI 1.07-1.17) were associated with a significantly increased risk of TBAD formation. Similar findings were observed in the propensity-score matching and sensitivity analysis only including hyperacute TBAD patients. A novel prediction model was established based on the aforementioned parameters. The new model showed significantly improved discriminant ability compared with the previously established model (c-index 0.78 [95% CI 0.71-0.85] vs. 0.67 [95% CI 0.58-0.75], p = .03), driven by increased reclassification ability in identifying TBAD patients (NRI for events 0.16, 95% CI 0.02-0.30, p = .02). Conclusion: Morphological predictors, including the degree of question mark, aortic width, aortic root diameter, brachiocephalic trunk angle, and brachiocephalic trunk diameter, may be used to identify patients at high risk of TBAD.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, Chengdu, China,Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Jiarong Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tiehao Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangguo Zeng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China,Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China,Med-X center for informatics, Sichuan University, Chengdu, China,*Correspondence: Tinghui Zheng, ; Ding Yuan,
| | - Ding Yuan
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China,Med-X center for informatics, Sichuan University, Chengdu, China,*Correspondence: Tinghui Zheng, ; Ding Yuan,
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5
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Estrada A, Sousa AS, Mesquita CT, Villacorta H. Coronary Tortuosity as a New Phenotype for Ischemia without Coronary Artery Disease. Arq Bras Cardiol 2022; 119:883-890. [PMID: 36169451 DOI: 10.36660/abc.20210787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/15/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Coronary arteries tend to be more tortuous than other arteries and follow the repeated flexion and relaxation movements that occur during the cardiac cycle. Coronary tortuosity (CorT) leads to changes in coronary flow with a reduction in distal perfusion pressure, which could cause myocardial ischemia. OBJECTIVE To assess the association between CorT and myocardial ischemia. METHODS Between January 2015 and December 2017, 57 patients with angina and nonobstructive coronary artery disease detected by invasive coronary angiography (ICA) were retrospectively enrolled. Angiographic variables were analyzed to assess the presence and degree of tortuosity and correlated with their respective vascular territories on stress myocardial perfusion imaging (MPI). CorT was defined as coronary arteries with three or more bend angles ≤90°, measured during diastole. Statistical significance was determined at the 5% level. RESULTS A total of 17 men and 40 women were enrolled (mean age 58.3 years). CorT was observed in 16 patients (28%) and in 24 of 171 arteries. There was a significant association between CorT and ischemia when analyzed per artery (p<0.0001). The angiographic factor most associated with ischemia was the number of bend angles in an epicardial artery measured at systole (p=0.021). CONCLUSION This study showed an association of CorT and myocardial ischemia in patients with unobstructed coronary arteries and angina. An increased number of coronary bend angles measured by angiography during systole was related to ischemia.
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Affiliation(s)
- André Estrada
- Universidade Federal Fluminense Hospital Universitário Antônio Pedro , Niterói , RJ - Brasil
| | - André Silveira Sousa
- Universidade Federal Fluminense Hospital Universitário Antônio Pedro , Niterói , RJ - Brasil.,Hospital Pró-Cardíaco , Rio de Janeiro , RJ - Brasil
| | - Claudio Tinoco Mesquita
- Universidade Federal Fluminense Faculdade de Medicina - Departamento de Radiologia , Niterói , RJ - Brasil
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Kumar S, Rai SK, Kumar BVR, Shankar O. The pulsatile 3D-Hemodynamics in a doubly afflicted human descending abdominal artery with iliac branching. Comput Methods Biomech Biomed Engin 2022; 26:680-699. [PMID: 35727024 DOI: 10.1080/10255842.2022.2082839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The study of patient-specific human arterial flow dynamics is well known to face challenges like a) apt geometric modelling, b) bifurcation zone meshing, and c) capturing the hemodynamic prone to variations with multiple disease complications. Due to aneurysms and stenosis in the same arterial network, the blood flow dynamics get affected, which needs to be explored. This study develops a new protocol for accurate geometric modelling, bifurcation zone meshing and numerically investigates the arterial network with abdominal aortic aneurysms (AAA) and right internal iliac stenosis (RIIAS). A realistic arterial model is reconstructed from the computed tomography (CT) data of a human subject. To understand the combined effect of the aneurysm and aortoiliac occlusive diseases in a patient, an arterial network with AAA, RIIAS, multiple branches tapering, and curvature has been considered. Clinically significant pulsatile blood flow simulations have been carried out to trace the alteration in the flow dynamics with multiple pathological complications under consideration. The transient blood flow dynamics are investigated via wall shear stress, wall pressure, velocity contour, streamlines, vorticity, and swirling strength. During the systolic deceleration phase, the rhythmic nested rapid secondary oscillatory WSS, adverse pressure gradients, high WSS, and high WP bands are noticed. Also, the above studies will help researchers, clinicians, and doctors understand the influence of morphological changes on hemodynamics in cardiovascular studies.
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Affiliation(s)
- Sumit Kumar
- School of Biomedical Engineering, Indian Institute of Technology (BHU), Varanasi, Uttar Pradesh, India
| | - S K Rai
- School of Biomedical Engineering, Indian Institute of Technology (BHU), Varanasi, Uttar Pradesh, India
| | - B V Rathish Kumar
- Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, Uttar Pradesh, India
| | - Om Shankar
- Department of Cardiology, Institute of Medical Science, BHU, Varanasi, Uttar Pradesh, India
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7
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van Zandwijk JK, Tuncay V, Vliegenthart R, Pelgrim GJ, Slump CH, Oudkerk M, van Ooijen PMA. Assessment of Dynamic Change of Coronary Artery Geometry and Its Relationship to Coronary Artery Disease, Based on Coronary CT Angiography. J Digit Imaging 2021; 33:480-489. [PMID: 31745678 PMCID: PMC7165136 DOI: 10.1007/s10278-019-00300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate the relationship between dynamic changes of coronary artery geometry and coronary artery disease (CAD) using computed tomography (CT). Seventy-one patients underwent coronary CT angiography with retrospective electrocardiographic gating. End-systolic (ES) and end-diastolic (ED) phases were automatically determined by dedicated software. Centerlines were extracted for the right and left coronary artery. Differences between ES and ED curvature and tortuosity were determined. Associations of change in geometrical parameters with plaque types and degree of stenosis were investigated using linear mixed models. The differences in number of inflection points were analyzed using Wilcoxon signed-rank tests. Tests were done on artery and segment level. One hundred thirty-seven arteries (64.3%) and 456 (71.4%) segments were included. Curvature was significantly higher in ES than in ED phase for arteries (p = 0.002) and segments (p < 0.001). The difference was significant only at segment level for tortuosity (p = 0.005). Number of inflection points was significantly higher in ES phase on both artery and segment level (p < 0.001). No significant relationships were found between degree of stenosis and plaque types and dynamic change in geometrical parameters. Non-invasive imaging by cardiac CT can quantify change in geometrical parameters of the coronary arteries during the cardiac cycle. Dynamic change of vessel geometry through the cardiac cycle was not found to be related to the presence of CAD.
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Affiliation(s)
- Jordy K van Zandwijk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Volkan Tuncay
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Gert Jan Pelgrim
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Matthijs Oudkerk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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8
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Konigstein M, Ben-Yehuda O, Redfors B, Mintz GS, Madhavan MV, Golomb M, McAndrew T, Zhang Z, Kandzari DE, Hermiller JB, Leon MB, Stone GW. Impact of Coronary Artery Tortuosity on Outcomes Following Stenting: A Pooled Analysis From 6 Trials. JACC Cardiovasc Interv 2021; 14:1009-1018. [PMID: 33640388 DOI: 10.1016/j.jcin.2020.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The authors sought to determine whether coronary artery tortuosity negatively affects clinical outcomes after stent implantation. BACKGROUND Coronary artery tortuosity is a common angiographic finding and has been associated with increased rates of early and late major adverse events after balloon angioplasty. METHODS Individual patient data from 6 prospective, randomized stent trials were pooled. Outcomes at 30 days and 5 years following percutaneous coronary intervention of a single coronary lesion were analyzed according to the presence or absence of moderate/severe vessel tortuosity, as determined by an angiographic core laboratory. The primary endpoint was target vessel failure (TVF) (composite of cardiac death, target vessel-related myocardial infarction [TV-MI], or ischemia-driven target vessel revascularization [ID-TVR]). RESULTS A total of 6,951 patients were included, 729 of whom (10.5%) underwent percutaneous coronary intervention in vessels with moderate/severe tortuosity. At 30 days, TVF was more frequent in patients with versus without moderate/severe tortuosity (3.8% vs. 2.4%; hazard ratio [HR]: 1.64; 95% confidence interval [CI]: 1.09 to 2.46; p = 0.02), a difference driven by a higher rate of TV-MI. At 5 years, TVF remained increased in patients with moderate/severe tortuosity (p = 0.003), driven by higher rates of TV-MI (p = 0.003) and ID-TVR (p = 0.01). Definite stent thrombosis was also greater in patients with versus without moderate/severe tortuosity (1.9% vs. 1.0%; HR: 1.86; 95% CI: 1.02 to 3.39; p = 0.04). After adjustment for baseline covariates, moderate/severe vessel tortuosity was independently associated with TV-MI and ID-TVR at 5 years (p = 0.04 for both). CONCLUSIONS Stent implantation in vessels with moderate/severe coronary artery tortuosity is associated with increased rates of TVF due to greater rates of TV-MI and ID-TVR.
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Affiliation(s)
- Maayan Konigstein
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Division of Cardiology, University of California - San Diego, San Diego, California, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mahesh V Madhavan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mordechai Golomb
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | | | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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9
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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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10
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Li Y, Zhang X, Dai Q, Ma G. Coronary flow reserve and microcirculatory resistance in patients with coronary tortuosity and without atherosclerosis. J Int Med Res 2020; 48:300060520955060. [PMID: 32954929 PMCID: PMC7509742 DOI: 10.1177/0300060520955060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective Coronary tortuosity may affect epicardial coronary arterial blood flow. This study aimed to investigate the effect of coronary tortuosity on coronary flow reserve and the coronary microcirculation in patients without apparent coronary atherosclerosis. Methods Prospective patients (n = 8, 3 men, mean age: 58 ± 6.0 years) with coronary tortuosity and without apparent coronary atherosclerosis were enrolled. Coronary tortuosity was defined by the finding of ≥three bends (defined as a ≥45° change in vessel direction) along the main trunk of the left anterior descending artery or left circumflex artery. Coronary flow reserve and the index of microcirculatory resistance were measured by the thermodilution technique. Results A total of eight coronary arteries with coronary tortuosity were analyzed. The mean fractional flow reserve was 0.98 ± 0.007. The mean coronary flow reserve was 1.5 ± 0.3, which is much lower than that in the normal coronary artery as reported in the literature. The mean index of microcirculatory resistance was 26.7 ± 2.3, which is much higher than that in the normal coronary artery. Conclusions Coronary tortuosity is associated with decreased coronary flow reserve and an increased index of microcirculatory resistance. Trial registration: This study is registered at the Chinese Clinical Trial Registry, NCT No: ChiCTR2000033671
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Affiliation(s)
- Yang Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qiming Dai
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Esenboga K, Baskovski E, Sahin E, Ozyuncu N, Tan TS, Candemir B, Turhan S, Tutar E. Assessment of Myocardial Perfusion by Angiographic Methods in Tortuous Coronary Arteries. Angiology 2020; 71:616-620. [PMID: 32314591 DOI: 10.1177/0003319720919325] [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] [Indexed: 11/16/2022]
Abstract
The relationship between coronary tortuosity (CorT) and tissue-level myocardial perfusion is not clear. We investigated tissue perfusion in myocardial territories supplied by tortuous coronary arteries. Among patients who had undergone coronary angiography, patients with reported CorT, those with ≥1 coronary artery were included in the study group (100 patients). The control group included patients with normal coronary arteries (100 patients). Thrombolysis In Myocardial Infarction frame count (TFC) and myocardial blush grade (MBG) were calculated for each coronary artery. Mean TFC was significantly higher in tortuous right coronary artery (RCA), left anterior descending (LAD) artery, and circumflex (Cx) artery compared to their non-tortuous counterparts (28.81 ± 6.463 vs 21.94 ± 3.328, P = .009; 43.28 ± 5.698 vs 36.17 ± 3.875, P = .006; 29.35 ± 4.111 vs 23.821 ± 2.639; P < .001, respectively). Mean MBG was also significantly lower in tortuous RCA, LAD, and Cx, compared to their normal counterparts (2.78 ± 0.417 vs 2.98 ± 0.155, P < .001; 2.74 ± 0.483 vs 2.97 ± 0.164, P < .001; 2.92 ± 0.277 vs 2.99 ± 0.110, P < .001, respectively). For each tortuous coronary artery, TFC was similar for every MBG category. Tortuous coronary arteries have higher TFC and lower MBG, suggesting impaired epicardial and microvascular coronary flow, when compared to normal coronary arteries.
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Affiliation(s)
- Kerim Esenboga
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Emir Baskovski
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Ebru Sahin
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Nil Ozyuncu
- Ankara University, Cardiology Department, Ankara, Turkey
| | | | - Basar Candemir
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Sibel Turhan
- Ankara University, Cardiology Department, Ankara, Turkey
| | - Eralp Tutar
- Ankara University, Cardiology Department, Ankara, Turkey
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12
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A parametric model for studying the aorta hemodynamics by means of the computational fluid dynamics. J Biomech 2020; 103:109691. [PMID: 32147240 DOI: 10.1016/j.jbiomech.2020.109691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 11/23/2022]
Abstract
Perturbed aorta hemodynamics, as for the carotid and the coronary artery, has been identified as potential predicting factor for cardiovascular diseases. In this study, we propose a parametric study based on the computational fluid dynamics with the aim of providing information regarding aortic disease. In particular, the blood flow inside a parametrized aortic arch is computed as a function of morphological changes of baseline aorta geometry. Flow patterns, wall shear stress, time average wall shear stress and oscillatory shear index were calculated during the cardiac cycle. The influence of geometrical changes on the hemodynamics and on these variables was evaluated. The results suggest that the distance between inflow and aortic arch and the angle between aortic arch and descending trunk are the most influencing parameters regarding the WSS-related indices while the effect of the inlet diameter seems limited. In particular, an increase of the aforementioned distance produces a reduction of the spatial distribution of the higher values of the time average wall shear stress and of the oscillatory shear index independently on the other two parameters while an increase of the angle produce an opposite effect. Moreover, as expected, the analysis of the wall shear stress descriptors suggests that the inlet diameter influences only the flow intensity. As conclusion, the proposed parametric study can be used to evaluate the aorta hemodynamics and could be also applied in the future, for analyzing pathological cases and virtual situations, such as pre- and/or post-operative cardiovascular surgical states that present enhanced changes in the aorta morphology yet promoting important variations on the considered indexes.
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Coronary tortuosity affects left ventricular myocardial functions: a 3D-speckle tracking echocardiography study. Int J Cardiovasc Imaging 2020; 36:627-632. [PMID: 31916067 DOI: 10.1007/s10554-019-01760-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
Coronary artery tortuosity (CAT) is a common finding in coronary angiography, and is defined as three fixed bends during both systole and diastole in at least one epicardial coronary artery, with each bend showing a 45° change in vessel direction. The impact of CAT on the myocardial deformation has not been completely evaluated using 3D-STE. As a result of this, we aimed to assess the effects of CAT on LV functions using 3D-STE in the present study. Eighty-two patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms were enrolled into the study. 3D-STE was performed and LV-GLS, LV-GCS, LV-GAS, and LV-GRS were obtained for every patient after coronary angiography. The LV-GLS was significantly depressed in the CAT ( +) group than in the control group (p = 0.001). ROC analysis was performed to find out ideal LV-GLS cut off value to predict the presence of CAT. A LV-GLS value of > - 17 has 81.3% sensitivity, 56.7% specificity to detect the presence of CAT. The present study is the first to focus on the assessing LV myocardial functions in patients with CAT by 3D-STE. CAT has a considerable negative effect on LV myocardial longitudinal deformation as evaluated by 3D strain parameters. Our results support that patients with CAT may have subclinical LV longitudinal deformation abnormalities even though they are apparently healthy.
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16
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Coronary plaque erosion developing in an area of high endothelial shear stress: insights from serial optical coherence tomography imaging. Coron Artery Dis 2019; 30:74-75. [PMID: 30407208 DOI: 10.1097/mca.0000000000000673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hassan AK, Abd–El Rahman H, Hassan SG, Ahmed TA, Youssef AAA. Validity of tortuosity severity index in chest pain patients with abnormal exercise test and normal coronary angiography. Egypt Heart J 2018; 70:381-387. [PMID: 30591760 PMCID: PMC6303525 DOI: 10.1016/j.ehj.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Coronary tortuosity (CT) had different definitions and scores in literature with unclear pathophysiological impact. OBJECTIVES To study degree of CT and it's relation to ischemic changes in patients with angina but normal coronary angiography (CA). METHODS We conducted a prospective study at University hospitals between May 2016 and January 2017. We included 200 consecutive patients who underwent CA due to chest pain assumed to be of cardiac origin, and their CA was normal (no diameter stenosis >30%, nor myocardial bridging). Patients were prospectively divided into 2 groups based on the presence (n = 113) or absence (n = 87) of ischemic changes during stress study and compared for clinical, echocardiographic and CA characteristics. A newly proposed Tortuosity Severity Index (TSI) was developed into significant (mild/moderate CT with more than 4 curvatures in total, or severe/extreme CT with any number of curvatures) or not significant TSI (mild CT with curvatures less than or equal to 4 curvatures in total). RESULTS Patients with ischemic changes had the highest rate of CT (76.5 vs 18%, p = 0.004) compared to those without. CT mostly affects the left anterior descending (LAD) coronary artery in mid and distal segments. Females, elderly, and hypertensives with left ventricular hypertrophy were strongly related to CT. Multivariate logistic regression analysis identified CT with significant TSI as the only predictor of ischemic changes in these patients (OR = 6.2, CI = 2.5-15.3, P = <0.001). CONCLUSIONS Coronary tortuosity is a strong predictor of anginal pain among patients with normal CA, despite positive stress study. This finding is more pronounced among elderly, hypertensive female patients.
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Affiliation(s)
- Ayman K.M. Hassan
- Department of Cardiology, Faculty of Medicine, Assiut University, Egypt
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Li Y, Feng Y, Ma G, Shen C, Liu N. Coronary tortuosity is negatively correlated with coronary atherosclerosis. J Int Med Res 2018; 46:5205-5209. [PMID: 30304979 PMCID: PMC6300977 DOI: 10.1177/0300060518804723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective The impact of coronary tortuosity on coronary atherosclerosis remains unclear. This study was performed to determine to the relationship between coronary tortuosity and the presence of coronary atherosclerosis. Methods Tortuosity and the presence of coronary atherosclerosis in the main coronary arteries were evaluated. The coronary artery was divided into non-tortuous and tortuous segments. The incidence of coronary atherosclerosis between the two segments was compared. Results The prevalence of coronary atherosclerotic stenosis was significantly lower in the tortuous than non-tortuous segment. Conclusion The prevalence of coronary atherosclerotic stenosis is lower in the coronary tortuous than non-tortuous segment, indicating that coronary tortuosity might be considered a protective factor for atherosclerosis.
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Affiliation(s)
- Yang Li
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yi Feng
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Genshan Ma
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chengxing Shen
- 2 Department of Cardiology, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Naifeng Liu
- 1 Department & Institute of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Khosravani-Rudpishi M, Akhavan-Khaleghi N, Hosseinsabet A. Two-dimensional speckle-tracking echocardiographic evaluation of the longitudinal deformation of the left ventricular myocardium in patients with severe coronary artery tortuosity. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:467-474. [PMID: 29683198 DOI: 10.1002/jcu.22597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/15/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Coronary artery tortuosity (CAT) is an anatomical condition in which epicardial coronary arteries have abnormal curves or spiral courses. Although correlated with higher rates of positive stress test, its effects on the myocardial function remain to be clearly defined. METHODS We included in this cross-sectional study and evaluated with 2D speckle-tracking echocardiography 40 consecutive patients admitted to our hospital for selective coronary angiography which showed severe CAT without significant epicardial coronary artery stenosis, and 40 consecutive subjects matched for age, hypertension, and diabetes in whom selective coronary angiography showed neither CAT nor significant epicardial coronary artery stenosis. RESULTS Systolic strain, strain rate, and early and late diastolic strain rates were not significantly different between the 2 groups, even after adjustment for potential confounding variables. CONCLUSION The 2D speckle-tracking echocardiography-derived indices of longitudinal deformation of the left ventricular myocardium were not significantly different between the patients with severe CAT and controls.
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Affiliation(s)
| | | | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R., Iran
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20
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Li Y, Qadir Nawabi A, Feng Y, Ma G, Tong J, Shen C, Liu N. Coronary tortuosity is associated with an elevated high-sensitivity C-reactive protein concentration and increased risk of ischemic stroke in hypertensive patients. J Int Med Res 2018; 46:1579-1584. [PMID: 29436255 PMCID: PMC6091816 DOI: 10.1177/0300060517748527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective The clinical implication of coronary tortuosity is unclear. The present study was conducted to determine the relationships between coronary tortuosity and the high-sensitivity C-reactive protein (hs-CRP) concentration and between coronary tortuosity and cerebrovascular accident in hypertensive patients without coronary artery disease. Methods In total, 236 patients with normal coronary angiography findings were categorized into 3 different groups: control participants (n = 58), who had neither hypertension nor coronary tortuosity; patients with hypertension but no coronary tortuosity (H-NCT group, n = 93); and patients with both hypertension and coronary tortuosity (H-CT group, n = 85). The hs-CRP concentration was measured in every patient, and 168 hypertensive patients were followed up for at least 2 years to check for the development of cerebrovascular accident. Results The hs-CRP concentration was significantly higher in the H-CT group than in the control and H-NCT groups (4.33 ± 3.15 vs. 1.52 ± 1.31 and 2.31 ± 2.09 mg/L, respectively). The incidence of lacunar infarction was higher in the H-CT than H-NCT group during the follow-up. Conclusions Hypertensive patients with coronary tortuosity have a higher serum hs-CRP level concentration and have a higher incidence of lacunar infarction than hypertensive patients without coronary tortuosity.
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Affiliation(s)
- Yang Li
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Abdul Qadir Nawabi
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yi Feng
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Genshan Ma
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jiayi Tong
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chengxing Shen
- 2 Department of Cardiology, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Naifeng Liu
- 1 Department of Cardiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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21
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Kagan HJ, Belekdanian VD, Chen J, Backeris P, Hammoudi N, Turnbull IC, Costa KD, Hajjar RJ. Coronary capillary blood flow in a rat model of congestive heart failure. J Appl Physiol (1985) 2017; 124:632-640. [PMID: 29051335 DOI: 10.1152/japplphysiol.00741.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to explore the role of abnormal coronary microvasculature morphology and hemodynamics in the development of congestive heart failure (CHF). CHF was induced in rats by aortic banding, followed by ischemia-reperfusion and later aortic debanding. Polymerized casts of coronary vasculature were imaged under a scanning electron microscope (SEM). Matrix Laboratory (MATLAB) software was used to calculate capillary structure index (CSI), a measure of structural alignment also called mean vector length (MVL), for 93 SEM images of coronary capillaries (CSI→1 perfect linearity; CSI→0 circular disarray). CSI was incorporated as a constant to represent tortuosity and nonlaminar flow in Poiseuille's equation to estimate the differences in capillary blood flow rate, velocity, and resistance for CHF vs. CONTROL The morphology of CHF capillaries is significantly disordered and tortuous compared with control (CSI: 0.35 ± 0.02 for 61 images from 7 CHF rats; 0.58 ± 0.02 for 32 images from 7 control rats; P < 0.01). Estimated capillary resistance in CHF is elevated by 173% relative to control, while blood flow rate and blood velocity are 56 and 43% slower than control. Capillary resistance increased 67% due to the significantly narrower capillary diameter in CHF, while it increased an additional 105% due to tortuosity. The significant structural abnormalities of CHF coronary capillaries may drastically stagnate hemodynamics in myocardium and increase resistance to blood flow. This could play a role in the development of CHF. NEW & NOTEWORTHY In the present study, coronary capillary tortuosity was measured by applying Matrix Laboratory software to scanning electron microscope images of capillaries in a rat model of congestive heart failure. Stagnant blood flow in coronary capillaries may play a role in the development of congestive heart failure. The application of computer modeling to histological and physiological data to characterize the hemodynamics of coronary microcirculation is a new area of study.
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Affiliation(s)
- Heather J Kagan
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Varujan D Belekdanian
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jiqiu Chen
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Peter Backeris
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Nadjib Hammoudi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Irene C Turnbull
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Kevin D Costa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
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Chiha J, Mitchell P, Gopinath B, Burlutsky G, Kovoor P, Thiagalingam A. Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease. IJC HEART & VASCULATURE 2017; 14:23-27. [PMID: 28616559 PMCID: PMC5454180 DOI: 10.1016/j.ijcha.2016.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/19/2016] [Indexed: 12/04/2022]
Abstract
Background Little is known about the significance of severe coronary tortuosity (SCT) despite it being a relatively common finding on coronary angiography. We examined whether the presence of tortuosity was influenced by gender or cardiac risk factors. Methods and results We examined 870 patients (Men = 589, Women = 281) who presented to Westmead Hospital, Sydney, Australia for invasive coronary angiography for the assessment of chest pain due to suspected CAD. Female gender and age were significantly associated with SCT (p < 0.001 for age) with 45.2% of women having SCT as opposed to 19.7% of men (p < 0.001). Men with SCT had lower Extent scores only compared than those without tortuosity (22.4 vs. 32.4, p = 0.003). However, women with SCT had less severe coronary artery disease than those with no SCT as measured by both the Extent score (12.4 vs. 19.1, p = 0.03) and Gensini score (10.4 vs. 15.5, p = 0.02). Conclusion There is a significant relationship between coronary artery tortuosity and gender. Women with severe tortuosity are more likely to have normal coronary arteries or less severe disease than men despite presenting with chest pain.
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Affiliation(s)
- Joseph Chiha
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Bamini Gopinath
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Pramesh Kovoor
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia
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Liu X, Zhang H, Ren L, Xiong H, Gao Z, Xu P, Huang W, Wu W. Functional assessment of the stenotic carotid artery by CFD-based pressure gradient evaluation. Am J Physiol Heart Circ Physiol 2016; 311:H645-53. [PMID: 27371686 DOI: 10.1152/ajpheart.00888.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/24/2016] [Indexed: 11/22/2022]
Abstract
The functional assessment of a hemodynamic significant stenosis base on blood pressure variation has been applied for evaluation of the myocardial ischemic event. This functional assessment shows great potential for improving the accuracy of the classification of the severity of carotid stenosis. To explore the value of grading the stenosis using a pressure gradient (PG)-we had reconstructed patient-specific carotid geometries based on MRI images-computational fluid dynamics were performed to analyze the PG in their stenotic arteries. Doppler ultrasound image data and the corresponding MRI image data of 19 patients with carotid stenosis were collected. Based on these, 31 stenotic carotid arterial geometries were reconstructed. A combinatorial boundary condition method was implemented for steady-state computer fluid dynamics simulations. Anatomic parameters, including tortuosity (T), the angle of bifurcation, and the cross-sectional area of the remaining lumen, were collected to investigate the effect on the pressure distribution. The PG is highly correlated with the severe stenosis (r = 0.902), whereas generally, the T and the angle of the bifurcation negatively correlate to the pressure drop of the internal carotid artery stenosis. The calculation required <10 min/case, which made it prepared for the fast diagnosis of the severe stenosis. According to the results, we had proposed a potential threshold value for distinguishing severe stenosis from mild-moderate stenosis (PG = 0.88). In conclusion, the PG could serve as the additional factor for improving the accuracy of grading the severity of the stenosis.
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Affiliation(s)
- Xin Liu
- Institute of Clinical Anatomy, Southern Medical University, Guangzhou, China
| | - Heye Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Lijie Ren
- Neurology Department, Shenzhen Second People's Hospital, Shenzhen, Guangdon, China
| | - Huahua Xiong
- Department of Ultrasound, Shenzhen Second People's Hospital, Shenzhen, Guangdon, China; and
| | - Zhifan Gao
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Pengcheng Xu
- Institute of Clinical Anatomy, Southern Medical University, Guangzhou, China
| | - Wenhua Huang
- Institute of Clinical Anatomy, Southern Medical University, Guangzhou, China
| | - Wanqing Wu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Effects of Vessel Tortuosity on Coronary Hemodynamics: An Idealized and Patient-Specific Computational Study. Ann Biomed Eng 2015; 44:2228-39. [PMID: 26498931 DOI: 10.1007/s10439-015-1492-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
Abstract
Although coronary tortuosity can influence the hemodynamics of coronary arteries, the relationship between tortuosity and flow has not been thoroughly investigated partly due to the absence of a widely accepted definition of tortuosity and the lack of patient-specific studies that analyze complete coronary trees. Using a computational approach we investigated the effects of tortuosity on coronary flow parameters including pressure drop, wall shear stress, and helical flow strength as measured by helicity intensity. Our analysis considered idealized and patient-specific geometries. Overall results indicate that perfusion pressure decreases with increased tortuosity, but the patient-specific results show that more tortuous vessels have higher physiological wall shear stress values. Differences between the idealized and patient-specific results reveal that an accurate representation of coronary tortuosity must account for all relevant geometric aspects, including curvature imposed by the heart shape. The patient-specific results exhibit a strong correlation between tortuosity and helicity intensity, and the corresponding helical flow contributes directly to the observed increase in wall shear stress. Therefore, helicity intensity may prove helpful in developing a universal parameter to describe tortuosity and assess its impact on patient health. Our data suggest that increased tortuosity could have a deleterious impact via a reduction in coronary perfusion pressure, but the attendant increase in wall shear stress could afford protection against atherosclerosis.
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Alfonso F, Bastante T. Spontaneous coronary artery dissection: novel diagnostic insights from large series of patients. Circ Cardiovasc Interv 2015; 7:638-41. [PMID: 25336602 DOI: 10.1161/circinterventions.114.001984] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Fernando Alfonso
- From the Cardiac Department, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Teresa Bastante
- From the Cardiac Department, Hospital Universitario de La Princesa, Madrid, Spain
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XIE XINZHOU, WANG YUANYUAN, ZHU HONGMIN, ZHOU JINGMIN. SHEAR-INDUCED PLATELET ACTIVATION IN TORTUOUS CORONARY ARTERY: A NUMERICAL STUDY. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415500311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High fluid shear stresses (FSSs) were observed in tortuous coronary arteries, especially during the strenuous exercise condition. Whether these high FSSs would enhance the shear-induced platelet activation is still unknown. A computational fluid dynamics (CFD) study was conducted to evaluate the impact of coronary tortuosity (CT) on the shear-induced platelet activation during various conditions. A patient-specific left anterior descending (LAD) coronary artery model (CT model) and the corresponding non tortuous model (nCT model) were reconstructed to perform three-dimensional CFD analysis. Lagrangian particle analysis was performed to further obtain the platelet activation state (PAS) of the platelet-like particles. No significant difference was observed between CT and nCT models on the PAS values reached by the platelet-like particles at all simulated conditions. PAS values for particles within both CT and nCT models were decreased during exercise conditions, as compared to those during the rest condition. These results confirmed that CT could not enhance the platelet activation even with extreme high FSSs existing at bend sections during the strenuous exercise condition, and the results also implied that high FSSs might not be the critical factor leading to the platelet activation during the strenuous exercise for persons without the coronary obstructive.
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Affiliation(s)
- XINZHOU XIE
- Department of Electronic Engineering, Fudan University, Shanghai, P. R. China
| | - YUANYUAN WANG
- Department of Electronic Engineering, Fudan University, Shanghai, P. R. China
- Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, P. R. China
| | - HONGMIN ZHU
- Department of Cardiology, Sixth People's Hospital, Jiao Tong University, Shanghai, P. R. China
| | - JINGMIN ZHOU
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
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Alexanderson-Rosas E, Berríos-Bárcenas E, Meave A, de la Fuente-Mancera JC, Oropeza-Aguilar M, Barrero-Mier A, Monroy-González ADG, Cruz-Mendoza R, Guinto-Nishimura GY. Novel contributions of multimodality imaging in hypertension: A narrative review. World J Hypertens 2015; 5:28-40. [DOI: 10.5494/wjh.v5.i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/05/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.
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Xie X, Wang Y, Zhu H, Zhou J. Computation of Hemodynamics in Tortuous Left Coronary Artery: A Morphological Parametric Study. J Biomech Eng 2014; 136:101006. [PMID: 25048524 DOI: 10.1115/1.4028052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/22/2014] [Indexed: 12/13/2022]
Abstract
Coronary tortuosity (CT) would alter the local wall shear stress (WSS) and may become a risk factor for atherosclerosis. Here we performed a systematic computational study to relate CT morphological parameters to abnormal WSS, which is a predisposing factor to the formation of atherosclerotic lesions. Several idealized left coronary artery (LCA) models were created to conduct a series of morphological parametric studies, in which we concentrate on three specific morphological parameters, the center line radius (CLR), the bend angle (BA), and the length between two adjust bends (LBB). The time averaged WSS (TAWSS), the oscillatory shear index (OSI), and the time averaged WSS gradient (WSSGnd) were explored by using the computational fluid dynamics (CFD) method, in order to determine susceptible sites for the onset of early atherosclerosis. In addition, two realistic LCA models were reconstructed to further validate the finding's credibility. The CLR and LBB had great impact on the distributions of WSS-derived parameters, while the BA had minor impact on the hemodynamic of the tortuous arteries. Abnormal regions with low TAWSS (TAWSS < 0.5 Pa), high OSI (OSI > 0.1) and high WSSGnd (WSSGnd > 8) were observed at the inner wall of bend sections in the models with small CLR or small LBB. These findings were also confirmed in the realistic models. Severe CT with small CLR or LBB would lead to the formation of abnormal WSS regions at the bend sections and providing these regions with favorable conditions for the onset and/or progression of atherosclerosis.
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Affiliation(s)
- Xinzhou Xie
- Department of Electronic Engineering, Fudan University, Shanghai 200433, China e-mail:
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University, Shanghai 200433, China
- Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai 200433, China e-mail:
| | - Hongmin Zhu
- Department of Cardiology, Sixth People's Hospital, Jiao Tong University, Shanghai 200233, China e-mail:
| | - Jingmin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China e-mail:
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