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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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Theofilis P, Sagris M, Antonopoulos AS, Oikonomou E, Tsioufis K, Tousoulis D. Non-Invasive Modalities in the Assessment of Vulnerable Coronary Atherosclerotic Plaques. Tomography 2022; 8:1742-1758. [PMID: 35894012 PMCID: PMC9326642 DOI: 10.3390/tomography8040147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/26/2022] Open
Abstract
Coronary atherosclerosis is a complex, multistep process that may lead to critical complications upon progression, revolving around plaque disruption through either rupture or erosion. Several high-risk features are associated with plaque vulnerability and may add incremental prognostic information. Although invasive imaging modalities such as optical coherence tomography or intravascular ultrasound are considered to be the gold standard in the assessment of vulnerable coronary atherosclerotic plaques (VCAPs), contemporary evidence suggests a potential role for non-invasive methods in this context. Biomarkers associated with deleterious pathophysiologic pathways, including inflammation and extracellular matrix degradation, have been correlated with VCAP characteristics and adverse prognosis. However, coronary computed tomography (CT) angiography has been the most extensively investigated technique, significantly correlating with invasive method-derived VCAP features. The estimation of perivascular fat attenuation as well as radiomic-based approaches represent additional concepts that may add incremental information. Cardiac magnetic resonance imaging (MRI) has also been evaluated in clinical studies, with promising results through the various image sequences that have been tested. As far as nuclear cardiology is concerned, the implementation of positron emission tomography in the VCAP assessment currently faces several limitations with the myocardial uptake of the radiotracer in cases of fluorodeoxyglucose use, as well as with motion correction. Moreover, the search for the ideal radiotracer and the most adequate combination (CT or MRI) is still ongoing. With a look to the future, the possible combination of imaging and circulating inflammatory and extracellular matrix degradation biomarkers in diagnostic and prognostic algorithms may represent the essential next step for the assessment of high-risk individuals.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
- Correspondence:
| | - Marios Sagris
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
| | - Alexios S. Antonopoulos
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
| | - Evangelos Oikonomou
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
- 3rd Cardiology Department, Thoracic Diseases Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
| | - Dimitris Tousoulis
- 1st Cardiology Department, “Hippokration” General Hospital, Medical School, University of Athens, 11527 Athens, Greece; (M.S.); (A.S.A.); (E.O.); (K.T.); (D.T.)
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Cai Y, Li Z. Mathematical modeling of plaque progression and associated microenvironment: How far from predicting the fate of atherosclerosis? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106435. [PMID: 34619601 DOI: 10.1016/j.cmpb.2021.106435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Mathematical modeling contributes to pathophysiological research of atherosclerosis by helping to elucidate mechanisms and by providing quantitative predictions that can be validated. In turn, the complexity of atherosclerosis is well suited to quantitative approaches as it provides challenges and opportunities for new developments of modeling. In this review, we summarize the current 'state of the art' on the mathematical modeling of the effects of biomechanical factors and microenvironmental factors on the plaque progression, and its potential help in prediction of plaque development. We begin with models that describe the biomechanical environment inside and outside the plaque and its influence on its growth and rupture. We then discuss mathematical models that describe the dynamic evolution of plaque microenvironmental factors, such as lipid deposition, inflammation, smooth muscle cells migration and intraplaque hemorrhage, followed by studies on plaque growth and progression using these modelling approaches. Moreover, we present several key questions for future research. Mathematical models can complement experimental and clinical studies, but also challenge current paradigms, redefine our understanding of mechanisms driving plaque vulnerability and propose future potential direction in therapy for cardiovascular disease.
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Affiliation(s)
- Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Zhiyong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China; School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4001, Australia
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Vulnerable Plaque, Characteristics, Detection, and Potential Therapies. J Cardiovasc Dev Dis 2019; 6:jcdd6030026. [PMID: 31357630 PMCID: PMC6787609 DOI: 10.3390/jcdd6030026] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 12/16/2022] Open
Abstract
Plaque development and rupture are hallmarks of atherosclerotic vascular disease. Despite current therapeutic developments, there is an unmet necessity in the prevention of atherosclerotic vascular disease. It remains a challenge to determine at an early stage if atherosclerotic plaque will become unstable and vulnerable. The arrival of molecular imaging is receiving more attention, considering it allows for a better understanding of the biology of human plaque and vulnerabilities. Various plaque therapies with common goals have been tested in high-risk patients with cardiovascular disease. In this work, the process of plaque instability, along with current technologies for sensing and predicting high-risk plaques, is debated. Updates on potential novel therapeutic approaches are also summarized.
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Alegre-Martínez C, Choi KS, Tammisola O, McNally D. On the axial distribution of plaque stress: Influence of stenosis severity, lipid core stiffness, lipid core length and fibrous cap stiffness. Med Eng Phys 2019; 68:76-84. [DOI: 10.1016/j.medengphy.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
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Zareh M, Katul R, Mohammadi H. Mechanics of Atherosclerotic Plaques: Effect of Heart Rate. Cardiovasc Eng Technol 2019; 10:344-353. [PMID: 30949919 DOI: 10.1007/s13239-019-00413-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/28/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Atherosclerotic plaques are highly heterogeneous, nonlinear materials with uncharacteristic structural behaviors. It is well known that mechanics of atherosclerotic plaques significantly depend on plaque geometry, location, composition, and loading conditions. There is no question that atherosclerotic plaques are viscoelastic. Plaques are characterized as the buildup of low-density lipoprotein cholesterol, macrophages, monocytes, and foam cells at a place of inflammation inside arterial walls. Lipid core and fibrous cap are the two major ingredients that are frequently used for the identification of main constituting quantities of atherosclerotic plaques. The lipid core contains of debris from dead cells, esterified cholesterol and cholesterol crystals. The fibrous cap contains smooth muscle cells and collagen fibers. All these materials contribute to the viscoelastic properties of atherosclerotic plaques. Computational studies have shown great potential to characterize this mechanical behavior. Different types of plaque morphologies and mechanical properties have been used in a computational platform to estimate the stability of rupture-prone plaques and detect their locations. In this study for the first time to the best of authors' knowledge, we hypothesize that heart rate is also one of the major factors that should be taken into account while mechanics of plaques is studied. METHOD We propose a tunable viscoelastic constitutive material model for the fibrous cap tissue in order to calculate the peak cap stress in normal physiological (dynamic) conditions while heart rate changes from 60 bpm to 150 bpm in 2D plane stress models. A critical discussion on stress distribution in the fibrous cap area is made with respect to heart rate for the first time. RESULTS Results strongly suggest the viscoelastic properties of the fibrous cap tissue and heart rate together play a major role in the estimation of the pick cap stress values. CONCLUSIONS The results of current study may provide a better understanding on the mechanics of vulnerable atherosclerotic plaques and that any experimental methods assessing the viscoelasticity of plaque composition during progression are highly desirable.
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Affiliation(s)
- Mehrdad Zareh
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Ramsey Katul
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Hadi Mohammadi
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, V1V 1V7, Canada.
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Reconstruction of Intima and Adventitia Models into a State Undeformed by a Catheter by Using CT, IVUS, and Biplane X-Ray Angiogram Images. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:9807617. [PMID: 28154609 PMCID: PMC5244750 DOI: 10.1155/2017/9807617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022]
Abstract
The number of studies on blood flow analysis using fluid-structure interaction (FSI) analysis is increasing. Though a 3D blood vessel model that includes intima and adventitia is required for FSI analysis, there are difficulties in generating it using only one type of medical imaging. In this paper, we propose a 3D modeling method for accurate FSI analysis. An intravascular ultrasound (IVUS) image is used with biplane X-ray angiogram images to calculate the position and orientation of the blood vessel. However, these images show that the blood vessel is deformed by the catheter inserted into the blood vessel for IVUS imaging. To eliminate such deformation, a CT image was added and the two models were registered. First, a 3D model of the undeformed intima was generated using a CT image. In the second stage, a model of intima and adventitia deformed by the catheter was generated by combining the IVUS image and the X-ray angiogram images. A 3D model of intima and adventitia with the deformation caused by insertion of the catheter eliminated was generated by matching these 3D blood vessel models in different states. In addition, a 3D blood vessel model including bifurcation was generated using the proposed method.
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Huang X, Yang C, Zheng J, Bach R, Muccigrosso D, Woodard PK, Tang D. 3D MRI-based multicomponent thin layer structure only plaque models for atherosclerotic plaques. J Biomech 2016; 49:2726-2733. [PMID: 27344199 DOI: 10.1016/j.jbiomech.2016.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/22/2016] [Accepted: 06/01/2016] [Indexed: 01/13/2023]
Abstract
MRI-based fluid-structure interactions (FSI) models for atherosclerotic plaques have been developed to perform mechanical analysis to investigate the association of plaque wall stress (PWS) with cardiovascular disease. However, the time consuming 3D FSI model construction process is a great hinder for its clinical implementations. In this study, a 3D thin-layer structure only (TLS) plaque model was proposed as an approximation with much less computational cost to 3D FSI models for better clinical implementation potential. 192 TLS models were constructed based on 192 ex vivo MRI Images of 12 human coronary atherosclerotic plaques. Plaque stresses were extracted from all lumen nodal points. The maximum value of Plaque wall stress (MPWS) and average value of plaque wall stress (APWS) of each slice were used to compare with those from corresponding FSI models. The relative errors for MPWS and APWS were 9.76% and 9.89%, respectively. Both MPWS and APWS values obtained from TLS models showed very good correlation with those from 3D FSI models. Correlation results from TLS models were in consistent with FSI models. Our results indicated that the proposed 3D TLS plaque models may be used as a good approximation to 3D FSI models with much less computational cost. With further validation, 3D TLS models may be possibly used to replace FSI models to save time and perform mechanical analysis for atherosclerotic plaques for clinical implementation.
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Affiliation(s)
- Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, China; Fujian Provincial Key Laboratory of Mathematical Modeling and High-Performance Scientific Computation, Xiamen University, Xiamen, Fujian 361005 China; Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA.
| | - Chun Yang
- Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA; Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing, China
| | - Jie Zheng
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Richard Bach
- Cardiovascular Division, Washington University, St. Louis, MO 63110, USA
| | - David Muccigrosso
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Dalin Tang
- Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA; School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
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Teng Z, Yuan J, Feng J, Zhang Y, Brown AJ, Wang S, Lu Q, Gillard JH. The influence of constitutive law choice used to characterise atherosclerotic tissue material properties on computing stress values in human carotid plaques. J Biomech 2015; 48:3912-21. [PMID: 26472305 PMCID: PMC4655867 DOI: 10.1016/j.jbiomech.2015.09.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/16/2015] [Accepted: 09/24/2015] [Indexed: 01/01/2023]
Abstract
Calculating high stress concentration within carotid atherosclerotic plaques has been shown to be complementary to anatomical features in assessing vulnerability. Reliability of stress calculation may depend on the constitutive laws/strain energy density functions (SEDFs) used to characterize tissue material properties. Different SEDFs, including neo-Hookean, one-/two-term Ogden, Yeoh, 5-parameter Mooney–Rivlin, Demiray and modified Mooney–Rivlin, have been used to describe atherosclerotic tissue behavior. However, the capacity of SEDFs to fit experimental data and the difference in the stress calculation remains unexplored. In this study, seven SEDFs were used to fit the stress–stretch data points of media, fibrous cap, lipid and intraplaque hemorrhage/thrombus obtained from 21 human carotid plaques. Semi-analytic solution, 2D structure-only and 3D fully coupled fluid-structure interaction (FSI) analyses were used to quantify stress using different SEDFs and the related material stability examined. Results show that, except for neo-Hookean, all other six SEDFs fitted the experimental points well, with vessel stress distribution in the circumferential and radial directions being similar. 2D structural-only analysis was successful for all seven SEDFs, but 3D FSI were only possible with neo-Hookean, Demiray and modified Mooney–Rivlin models. Stresses calculated using Demiray and modified Mooney–Rivlin models were nearly identical. Further analyses indicated that the energy contours of one-/two-term Ogden and 5-parameter Mooney–Rivlin models were not strictly convex and the material stability indictors under homogeneous deformations were not always positive. In conclusion, considering the capacity in characterizing material properties and stabilities, Demiray and modified Mooney–Rivlin SEDF appear practical choices for mechanical analyses to predict the critical mechanical conditions within carotid atherosclerotic plaques.
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Affiliation(s)
- Zhongzhao Teng
- Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Jianmin Yuan
- Department of Radiology, University of Cambridge, UK
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Yongxue Zhang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, UK
| | - Shuo Wang
- Department of Radiology, University of Cambridge, UK
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
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Pagiatakis C, Galaz R, Tardif JC, Mongrain R. A comparison between the principal stress direction and collagen fiber orientation in coronary atherosclerotic plaque fibrous caps. Med Biol Eng Comput 2015; 53:545-55. [DOI: 10.1007/s11517-015-1257-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/18/2015] [Indexed: 01/18/2023]
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