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Fernandes M, Sousa LC, António CC, Silva S, Pinto SIS. A review of computational methodologies to predict the fractional flow reserve in coronary arteries with stenosis. J Biomech 2024:112299. [PMID: 39227297 DOI: 10.1016/j.jbiomech.2024.112299] [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: 02/01/2024] [Revised: 08/13/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024]
Abstract
Computational methodologies for predicting the fractional flow reserve (FFR) in coronary arteries with stenosis have gained significant attention due to their potential impact on healthcare outcomes. Coronary artery disease is a leading cause of mortality worldwide, prompting the need for accurate diagnostic and treatment approaches. The use of medical image-based anatomical vascular geometries in computational fluid dynamics (CFD) simulations to evaluate the hemodynamics has emerged as a promising tool in the medical field. This comprehensive review aims to explore the state-of-the-art computational methodologies focusing on the possible considerations. Key aspects include the rheology of blood, boundary conditions, fluid-structure interaction (FSI) between blood and the arterial wall, and multiscale modelling (MM) of stenosis. Through an in-depth analysis of the literature, the goal is to obtain an overview of the major achievements regarding non-invasive methods to compute FFR and to identify existing gaps and challenges that inform further advances in the field. This research has the major objective of improving the current diagnostic capabilities and enhancing patient care in the context of cardiovascular diseases.
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Affiliation(s)
- M Fernandes
- Faculty of Engineering of the University of Porto, FEUP, Rua Dr. Roberto Frias, s/n, 4200 - 465 Porto, Portugal; Institute of Science and Innovation in Mechanical and Industrial Engineering, LAETA-INEGI, Rua Dr. Roberto Frias, 400, 4200 - 465 Porto, Portugal.
| | - L C Sousa
- Faculty of Engineering of the University of Porto, FEUP, Rua Dr. Roberto Frias, s/n, 4200 - 465 Porto, Portugal; Institute of Science and Innovation in Mechanical and Industrial Engineering, LAETA-INEGI, Rua Dr. Roberto Frias, 400, 4200 - 465 Porto, Portugal.
| | - C C António
- Faculty of Engineering of the University of Porto, FEUP, Rua Dr. Roberto Frias, s/n, 4200 - 465 Porto, Portugal; Institute of Science and Innovation in Mechanical and Industrial Engineering, LAETA-INEGI, Rua Dr. Roberto Frias, 400, 4200 - 465 Porto, Portugal.
| | - S Silva
- University of Aveiro, UA, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal; Institute of Electronics and Informatics Engineering of Aveiro, IEETA, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.
| | - S I S Pinto
- Faculty of Engineering of the University of Porto, FEUP, Rua Dr. Roberto Frias, s/n, 4200 - 465 Porto, Portugal; Institute of Science and Innovation in Mechanical and Industrial Engineering, LAETA-INEGI, Rua Dr. Roberto Frias, 400, 4200 - 465 Porto, Portugal.
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Hwang D, Park SH, Nam CW, Doh JH, Kim HK, Kim Y, Chun EJ, Koo BK. Diagnostic Performance of On-Site Automatic Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve. Korean Circ J 2024; 54:382-394. [PMID: 38767442 PMCID: PMC11252635 DOI: 10.4070/kcj.2023.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/05/2024] [Accepted: 03/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Fractional flow reserve (FFR) is an invasive standard method to identify ischemia-causing coronary artery disease (CAD). With the advancement of technology, FFR can be noninvasively computed from coronary computed tomography angiography (CCTA). Recently, a novel simpler method has been developed to calculate on-site CCTA-derived FFR (CT-FFR) with a commercially available workstation. METHODS A total of 319 CAD patients who underwent CCTA, invasive coronary angiography, and FFR measurement were included. The primary outcome was the accuracy of CT-FFR for defining myocardial ischemia evaluated with an invasive FFR as a reference. The presence of ischemia was defined as FFR ≤0.80. Anatomical obstructive stenosis was defined as diameter stenosis on CCTA ≥50%, and the diagnostic performance of CT-FFR and CCTA stenosis for ischemia was compared. RESULTS Among participants (mean age 64.7±9.4 years, male 77.7%), mean FFR was 0.82±0.10, and 126 (39.5%) patients had an invasive FFR value of ≤0.80. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR were 80.6% (95% confidence interval [CI], 80.5-80.7%), 88.1% (95% CI, 82.4-93.7%), 75.6% (95% CI, 69.6-81.7%), 70.3% (95% CI, 63.1-77.4%), and 90.7% (95% CI, 86.2-95.2%), respectively. CT-FFR had higher diagnostic accuracy (80.6% vs. 59.1%, p<0.001) and discriminant ability (area under the curve from receiver operating characteristic curve 0.86 vs. 0.64, p<0.001), compared with anatomical obstructive stenosis on CCTA. CONCLUSIONS This novel CT-FFR obtained from an on-site workstation demonstrated clinically acceptable diagnostic performance and provided better diagnostic accuracy and discriminant ability for identifying hemodynamically significant lesions than CCTA alone.
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hyeon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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Ali S, Ho CY, Yang CC, Chou SH, Chen ZY, Huang WC, Shih TC. Computational fluid dynamics modeling of coronary artery blood flow using OpenFOAM: Validation with the food and drug administration benchmark nozzle model. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:1121-1136. [PMID: 38788116 DOI: 10.3233/xst-230239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Cardiovascular disease (CVD), a global health concern, particularly coronary artery disease (CAD), poses a significant threat to well-being. Seeking safer and cost-effective diagnostic alternatives to invasive coronary angiography, noninvasive coronary computed tomography angiography (CCTA) gains prominence. This study employed OpenFOAM, an open-source Computational Fluid Dynamics (CFD) software, to analyze hemodynamic parameters in coronary arteries with serial stenoses. Patient-specific three-dimensional (3D) models from CCTA images offer insights into hemodynamic changes. OpenFOAM breaks away from traditional commercial software, validated against the FDA benchmark nozzle model for reliability. Applying this refined methodology to seventeen coronary arteries across nine patients, the study evaluates parameters like fractional flow reserve computed tomography simulation (FFRCTS), fluid velocity, and wall shear stress (WSS) over time. Findings include FFRCTS values exceeding 0.8 for grade 0 stenosis and falling below 0.5 for grade 5 stenosis. Central velocity remains nearly constant for grade 1 stenosis but increases 3.4-fold for grade 5 stenosis. This research innovates by utilizing OpenFOAM, departing from previous reliance on commercial software. Combining qualitative stenosis grading with quantitative FFRCTS and velocity measurements offers a more comprehensive assessment of coronary artery conditions. The study introduces 3D renderings of wall shear stress distribution across stenosis grades, providing an intuitive visualization of hemodynamic changes for valuable insights into coronary stenosis diagnosis.
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Affiliation(s)
- Sajid Ali
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chien-Yi Ho
- Department of Family Medicine, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chen-Chia Yang
- Department of Internal Medicine, Division of Cardiovascular Medicine, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Szu-Hsien Chou
- Department of Radiology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Zhen-Ye Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Wei-Chien Huang
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Center for Molecular Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
| | - Tzu-Ching Shih
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
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Jung EC, Lee GH, Shim EB, Ha H. Assessing the impact of turbulent kinetic energy boundary conditions on turbulent flow simulations using computational fluid dynamics. Sci Rep 2023; 13:14638. [PMID: 37670027 PMCID: PMC10480182 DOI: 10.1038/s41598-023-41324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023] Open
Abstract
Computational fluid dynamics has been widely used to study hemodynamics, but accurately determining boundary conditions for turbulent blood flow remains challenging. This study aims to investigate the effect of patient-specific turbulence boundary conditions on the accuracy of turbulent flow simulation. Using a stenosis model with 50% severity in diameter, the post-stenosis turbulence flow region was simulated with different planes to obtain inlet boundary conditions and simulate downstream flows. The errors of simulated flow fields obtained with turbulence kinetic energy (TKE) boundary data and arbitrary turbulence intensity were compared. Additionally, the study tested various TKE data resolutions and noise levels to simulate experimental environments. The mean absolute error of velocity and TKE was investigated with various turbulence intensities and TKE mapping. While voxel size and signal-to-noise ratio of the TKE data affected the results, simulation with SNR > 5 and voxel size < 10% resulted in better accuracy than simulations with turbulence intensities. The simulation with appropriate TKE boundary data resulted in a more accurate velocity and turbulence field than those with arbitrary turbulence intensity boundary conditions. The study demonstrated the potential improvement of turbulent blood flow simulation with patient-specific turbulence boundary conditions, which can be obtained from recent measurement techniques.
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Affiliation(s)
- Eui Cheol Jung
- Kangwon Institute of Inclusive Technology, Kangwon National University, 1, Kangwondaehak-Gil, Chuncheon, 24341, Republic of Korea
| | - Gyu-Han Lee
- Institute of Medical Devices, Kangwon National University, 1, Kangwondaehak-Gil, Chuncheon, 24341, Republic of Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, 1, Kangwondaehak-Gil, Chuncheon, 24341, Republic of Korea
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, 1, Kangwondaehak-Gil, Chuncheon, 24341, Republic of Korea.
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Kang SH, Kim SH, Kim SH, Chun EJ, Chung WY, Yoon CH, Park SD, Nam CW, Kwon KH, Doh JH, Byun YS, Bae JW, Youn TJ, Chae IH. Performance of a Novel CT-Derived Fractional Flow Reserve Measurement to Detect Hemodynamically Significant Coronary Stenosis. J Korean Med Sci 2023; 38:e254. [PMID: 37582501 PMCID: PMC10427209 DOI: 10.3346/jkms.2023.38.e254] [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: 11/09/2022] [Accepted: 07/03/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Fractional flow reserve (FFR) based on computed tomography (CT) has been shown to better identify ischemia-causing coronary stenosis. However, this current technology requires high computational power, which inhibits its widespread implementation in clinical practice. This prospective, multicenter study aimed at validating the diagnostic performance of a novel simple CT based fractional flow reserve (CT-FFR) calculation method in patients with coronary artery disease. METHODS Patients who underwent coronary CT angiography (CCTA) within 90 days and invasive coronary angiography (ICA) were prospectively enrolled. A hemodynamically significant lesion was defined as an FFR ≤ 0.80, and the area under the receiver operating characteristic curve (AUC) was the primary measure. After the planned analysis for the initial algorithm A, we performed another set of exploratory analyses for an improved algorithm B. RESULTS Of 184 patients who agreed to participate in the study, 151 were finally analyzed. Hemodynamically significant lesions were observed in 79 patients (52.3%). The AUC was 0.71 (95% confidence interval [CI], 0.63-0.80) for CCTA, 0.65 (95% CI, 0.56-0.74) for CT-FFR algorithm A (P = 0.866), and 0.78 (95% CI, 0.70-0.86) for algorithm B (P = 0.112). Diagnostic accuracy was 0.63 (0.55-0.71) for CCTA alone, 0.66 (0.58-0.74) for algorithm A, and 0.76 (0.68-0.82) for algorithm B. CONCLUSION This study suggests the feasibility of automated CT-FFR, which can be performed on-site within several hours. However, the diagnostic performance of the current algorithm does not meet the a priori criteria for superiority. Future research is required to improve the accuracy.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun-Hwa Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ki-Hwan Kwon
- Division of Cardiology, Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Joon-Hyung Doh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young-Sup Byun
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Lesage R, Van Oudheusden M, Schievano S, Van Hoyweghen I, Geris L, Capelli C. Mapping the use of computational modelling and simulation in clinics: A survey. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1125524. [PMID: 37138727 PMCID: PMC10150234 DOI: 10.3389/fmedt.2023.1125524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
In silico medicine describes the application of computational modelling and simulation (CM&S) to the study, diagnosis, treatment or prevention of a disease. Tremendous research advances have been achieved to facilitate the use of CM&S in clinical applications. Nevertheless, the uptake of CM&S in clinical practice is not always timely and accurately reflected in the literature. A clear view on the current awareness, actual usage and opinions from the clinicians is needed to identify barriers and opportunities for the future of in silico medicine. The aim of this study was capturing the state of CM&S in clinics by means of a survey toward the clinical community. Responses were collected online using the Virtual Physiological Human institute communication channels, engagement with clinical societies, hospitals and individual contacts, between 2020 and 2021. Statistical analyses were done with R. Participants (n = 163) responded from all over the world. Clinicians were mostly aged between 35 and 64 years-old, with heterogeneous levels of experience and areas of expertise (i.e., 48% cardiology, 13% musculoskeletal, 8% general surgery, 5% paediatrics). The CM&S terms "Personalised medicine" and "Patient-specific modelling" were the most well-known within the respondents. "In silico clinical trials" and "Digital Twin" were the least known. The familiarity with different methods depended on the medical specialty. CM&S was used in clinics mostly to plan interventions. To date, the usage frequency is still scarce. A well-recognized benefit associated to CM&S is the increased trust in planning procedures. Overall, the recorded level of trust for CM&S is high and not proportional to awareness level. The main barriers appear to be access to computing resources, perception that CM&S is slow. Importantly, clinicians see a role for CM&S expertise in their team in the future. This survey offers a snapshot of the current situation of CM&S in clinics. Although the sample size and representativity could be increased, the results provide the community with actionable data to build a responsible strategy for accelerating a positive uptake of in silico medicine. New iterations and follow-up activities will track the evolution of responses over time and contribute to strengthen the engagement with the medical community.
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Affiliation(s)
| | - Michiel Van Oudheusden
- Centre for Sociological Research, Life Sciences and Society Lab, KU Leuven, Leuven, Belgium
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ine Van Hoyweghen
- Centre for Sociological Research, Life Sciences and Society Lab, KU Leuven, Leuven, Belgium
| | - Liesbet Geris
- Virtual Physiological Human Institute, Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium
- Biomechanics Section, KU Leuven, Leuven, Belgium
- Biomechanics Research Unit, GIGA in Silico Medicine, University of Liège, Liège, Belgium
| | - Claudio Capelli
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Ahres A, Simon J, Jablonkai B, Nagybaczoni B, Baranyai T, Apor A, Kolossvary M, Merkely B, Maurovich-Horvat P, Szilveszter B, Andrassy P. Diagnostic Performance of On-Site Computed Tomography Derived Fractional Flow Reserve on Non-Culprit Coronary Lesions in Patients with Acute Coronary Syndrome. Life (Basel) 2022; 12:life12111820. [PMID: 36362974 PMCID: PMC9698642 DOI: 10.3390/life12111820] [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: 10/08/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
The role of coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) in the assessment of non-culprit lesions (NCL) in patients with acute coronary syndrome (ACS) is debated. In this prospective clinical study, a total of 68 ACS patients with 89 moderate (30−70% diameter stenosis) NCLs were enrolled to evaluate the diagnostic accuracy of on-site CT-FFR compared to invasive fractional flow reserve (FFRi) and dobutamine stress echocardiography (DSE) as reference standards. CT-FFR and FFRi values ≤0.80, as well as new or worsening wall motion abnormality in ≥2 contiguous segments on the supplying area of an NCL on DSE, were considered positive for ischemia. Sensitivity, specificity, positive, and negative predictive value of CT-FFR relative to FFRi and DSE were 51%, 89%, 75%, and 74% and 37%, 77%, 42%, and 74%, respectively. CT-FFR value (β = 0.334, p < 0.001) and CT-FFR drop from proximal to distal measuring point [(CT-FFR drop), β = −0.289, p = 0.002)] were independent predictors of FFRi value in multivariate linear regression analysis. Based on comparing their receiver operating characteristics area under the curve (AUC) values, CT-FFR value and CT-FFR drop provided better discriminatory power than CCTA-based minimal lumen diameter stenosis to distinguish between an NCL with positive and negative FFRi [0.77 (95% Confidence Intervals, CI: 0.67−0.86) and 0.77 (CI: 0.67−0.86) vs. 0.63 (CI: 0.52−0.73), p = 0.029 and p = 0.043, respectively]. Neither CT-FFR value nor CT-FFR drop was predictive of regional wall motion score index at peak stress (β = −0.440, p = 0.441 and β = 0.403, p = 0.494) or was able to confirm ischemia on the territory of an NCL revealed by DSE (AUC = 0.54, CI: 0.43−0.64 and AUC = 0.55, CI: 0.44−0.65, respectively). In conclusion, on-site CT-FFR is superior to conventional CCTA-based anatomical analysis in the assessment of moderate NCLs; however, its diagnostic capacity is not sufficient to make it a gatekeeper to invasive functional evaluation. Moreover, based on its comparison with DSE, CT-FFR might not yield any information on the microvascular dysfunction in the territory of an NCL.
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Affiliation(s)
- Abdelkrim Ahres
- Department of Cardiology, Bajcsy-Zsilinszky Hospital, Maglodi Rd. 89-91., H-1106 Budapest, Hungary
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68., H-1222 Budapest, Hungary
- Medical Imaging Center, Semmelweis University, Ulloi Rd. 78a., H-1082 Budapest, Hungary
| | - Balazs Jablonkai
- Department of Cardiology, Bajcsy-Zsilinszky Hospital, Maglodi Rd. 89-91., H-1106 Budapest, Hungary
| | - Bela Nagybaczoni
- Department of Cardiology, Bajcsy-Zsilinszky Hospital, Maglodi Rd. 89-91., H-1106 Budapest, Hungary
| | - Tamas Baranyai
- Department of Cardiology, Bajcsy-Zsilinszky Hospital, Maglodi Rd. 89-91., H-1106 Budapest, Hungary
| | - Astrid Apor
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68., H-1222 Budapest, Hungary
| | - Marton Kolossvary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68., H-1222 Budapest, Hungary
| | - Bela Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68., H-1222 Budapest, Hungary
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68., H-1222 Budapest, Hungary
- Medical Imaging Center, Semmelweis University, Ulloi Rd. 78a., H-1082 Budapest, Hungary
| | - Balint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68., H-1222 Budapest, Hungary
| | - Peter Andrassy
- Department of Cardiology, Bajcsy-Zsilinszky Hospital, Maglodi Rd. 89-91., H-1106 Budapest, Hungary
- Correspondence: ; Tel.: +36-1-432-7644; Fax: +36-1-432-7501
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LI NA, LIU JINCHENG, LI BAO, BAI LAN, FENG YILI, LIU JIAN, ZHANG LIYUAN, YANG HAISHENG, LIU YOUJUN. PERSONALIZED FLOW DIVISION METHOD BASED ON THE LEFT-RIGHT CORONARY CROSS-SECTIONAL AREA. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This paper proposes a personalized method to estimate blood flow distribution based on the cross-sectional area of the left-right coronary artery openings. According to the cross-sectional area of the left-right coronary artery in 30 cases, a personalized flow distribution model was derived. A 0D/3D geometric multiscale model was used for the numerical simulation of FFR. To evaluate the accuracy of the cross-sectional area method, invasive FFR was used as the standard. The diagnostic efficiency of the proposed method was verified through the simulation results of the volume and the fixed ratio methods. The flow of the left-right coronary artery was proportional to the 3/4 power of the cross-sectional area. The 95% LOA between the cross-sectional area method, volume method, fixed ratio method and FFR were [Formula: see text]0.06 ([[Formula: see text]0.22, 0.10]), [Formula: see text]0.03 ([[Formula: see text]0.35, 0.28]), and [Formula: see text]0.05 ([[Formula: see text]0.30, 0.20]), the accuracy values were 94.44%, 77.78%, and 77.78%, respectively. Flow distribution based on the cross-sectional area represents the supply and demand relationship of the myocardium. The flow of the left-right coronary arteries is proportional to the 3/4 exponent of the cross-sectional area, which affects the accuracy of FFRCT by affecting the exit boundary conditions of the 0D/3D model.
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Affiliation(s)
- NA LI
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - JINCHENG LIU
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - BAO LI
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - LAN BAI
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - YILI FENG
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - JIAN LIU
- Peking University People’s Hospital, Beijing P. R. China
| | - LIYUAN ZHANG
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - HAISHENG YANG
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - YOUJUN LIU
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
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Hwang M, Hwang SB, Yu H, Kim J, Kim D, Hong W, Ryu AJ, Cho HY, Zhang J, Koo BK, Shim EB. A Simple Method for Automatic 3D Reconstruction of Coronary Arteries From X-Ray Angiography. Front Physiol 2021; 12:724216. [PMID: 34557111 PMCID: PMC8452945 DOI: 10.3389/fphys.2021.724216] [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] [Received: 06/12/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
Automatic three-dimensional (3-D) reconstruction of the coronary arteries (CA) from medical imaging modalities is still a challenging task. In this study, we present a deep learning-based method of automatic identification of the two ends of the vessel from X-ray coronary angiography (XCA). We also present a method of using template models of CA in matching the two-dimensional segmented vessels from two different angles of XCA. For the deep learning network, we used a U-net consisting of an encoder (Resnet) and a decoder. The two ends of the vessel were manually labeled to generate training images. The network was trained with 2,342, 1,907, and 1,523 labeled images for the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), respectively. For template models of CA, ten reconstructed 3-D models were averaged for each artery. The accuracy of correspondence using template models was compared with that of manual matching. The deep learning network pointed the proximal region (20% of the total length) in 97.7, 97.5, and 96.4% of 315, 201, and 167 test images for LAD, LCX, and RCA, respectively. The success rates in pointing the distal region were 94.9, 89.8, and 94.6%, respectively. The average distances between the projected points from the reconstructed 3-D model to the detector and the points on the segmented vessels were not statistically different between the template and manual matchings. The computed FFR was not significantly different between the two matchings either. Deep learning methodology is feasible in identifying the two ends of the vessel in XCA, and the accuracy of using template models is comparable to that of manual correspondence in matching the segmented vessels from two angles.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jinlong Zhang
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Bon Kwon Koo
- Department of Cardiology, Seoul National University and Seoul National University Hospital, Seoul, South Korea
| | - Eun Bo Shim
- AI Medic Inc., Seoul, South Korea.,Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
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10
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Jonášová A, Vimmr J. On the relevance of boundary conditions and viscosity models in blood flow simulations in patient-specific aorto-coronary bypass models. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3439. [PMID: 33464717 DOI: 10.1002/cnm.3439] [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: 09/08/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Physiologically realistic results are the aim of every blood flow simulation. This is not different in aorto-coronary bypasses where the properties of the coronary circulation may significantly affect the relevance of the performed simulations. By considering three patient-specific bypass geometries, the present article focuses on two aspects of the coronary blood flow - its phasic flow pattern and its behaviour affected by blood rheology. For the phasic flow property, a multiscale modelling approach is chosen as a means to assess the ability of five different types of coronary boundary conditions (mean arterial pressure, Windkessel model and three lumped parameter models) to attain realistic coronary haemodynamics. From the analysed variants of boundary conditions, the best option in terms of physiological characteristics and its potential for use in patient-based simulations, is utilised to account for the effect of shear-dependent viscosity on the resulting haemodynamics and wall shear stress stimulation. Aside from the Newtonian model, the blood rheology is approximated by two non-Newtonian models in order to determine whether the choice of a viscosity model is important in simulations involving coronary circulation. A comprehensive analysis of obtained results demonstrated notable superiority of all lumped parameter models, especially in comparison to the constant outlet pressure, which regardless of bypass type gave overestimated and physiologically misleading results. In terms of rheology, it was noted that blood in undamaged coronary arteries behaves as a Newtonian fluid, whereas in vessels with atypical lumen geometry, such as that of anastomosis or stenosis, its shear-thinning behaviour should not be ignored.
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Affiliation(s)
- Alena Jonášová
- NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Plzeň, Czech Republic
- Department of Mechanics, Faculty of Applied Sciences, University of West Bohemia, Plzeň, Czech Republic
| | - Jan Vimmr
- NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Plzeň, Czech Republic
- Department of Mechanics, Faculty of Applied Sciences, University of West Bohemia, Plzeň, Czech Republic
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11
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Kim SH, Kang SH, Chung WY, Yoon CH, Park SD, Nam CW, Kwon KH, Doh JH, Byun YS, Bae JW, Youn TJ, Chae IH. Validation of the diagnostic performance of 'HeartMedi V.1.0', a novel CT-derived fractional flow reserve measurement, for patients with coronary artery disease: a study protocol. BMJ Open 2020; 10:e037780. [PMID: 32690748 PMCID: PMC7375628 DOI: 10.1136/bmjopen-2020-037780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/12/2020] [Accepted: 06/05/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Coronary CT angiography (CCTA) is widely used for non-invasive coronary artery evaluation, but it is limited in identifying the nature of functional characteristics that cause ischaemia. Recent computational fluid dynamic (CFD) techniques applied to CCTA images permit non-invasive computation of fractional flow reserve (FFR), a measure of lesion-specific ischaemia. However, this technology has limitations, such as long computational time and the need for expensive equipment, which hinder widespread use. METHODS AND ANALYSIS This study is a prospective, multicentre, comparative and confirmatory trial designed to evaluate the diagnostic performance of HeartMedi V.1.0, a novel CT-derived FFR measurement for the detection of haemodynamically significant coronary artery stenoses identified by CCTA, based on invasive FFR as a reference standard. The invasive FFR values ≤0.80 will be considered haemodynamically significant. The study will enrol 184 patients who underwent CCTA, invasive coronary angiography and invasive FFR. Computational FFR (c-FFR) will be analysed by CFD techniques using a lumped parameter model based on vessel length method. Blinded core laboratory interpretation will be performed for CCTA, invasive coronary angiography, invasive FFR and c-FFR. The primary objective of the study is to compare the area under the receiver-operator characteristic curve between c-FFR and CCTA to non-invasively detect the presence of haemodynamically significant coronary stenosis. The secondary endpoints include diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and correlation of c-FFR with invasive FFR. ETHICS AND DISSEMINATION The study has ethic approval from the ethics committee of Seoul National University Bundang Hospital (E-1709/420-001) and informed consent will be obtained for all enrolled patients. The result will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER KCT0002725; Pre-results.
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Affiliation(s)
- Soo-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, The Republic of Korea
| | - Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, The Republic of Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Seoul Metropolitan Boramae Hospital, Dongjak-gu, Seoul, The Republic of Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, The Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, The Republic of Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, The Republic of Korea
| | - Ki-Hwan Kwon
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, The Republic of Korea
| | - Joon-Hyung Doh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, The Republic of Korea
| | - Young-Sup Byun
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, The Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, The Republic of Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, The Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, The Republic of Korea
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12
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Diagnostic performance of a vessel-length-based method to compute the instantaneous wave-free ratio in coronary arteries. Sci Rep 2020; 10:1132. [PMID: 31980645 PMCID: PMC6981213 DOI: 10.1038/s41598-020-57424-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/20/2019] [Indexed: 01/10/2023] Open
Abstract
The instantaneous wave-free ratio (iFR) is a recently introduced vasodilator-free index to assess the functional severity of coronary stenosis in the resting state, while fractional flow reserve (FFR) is the gold standard index in hyperemia. The computed instantaneous wave-free ratio (CT-iFR) is a noninvasive method to estimate iFR using computer simulations. Here, we developed a vessel-length-based CT-iFR method in patient-specific models of coronary arteries. This method was implemented by coupling a three-dimensional computational fluid dynamics model with a lumped parameter model (LPM) of coronary circulation in a non-hyperemic resting state. A time-varying resistance in the LPM was used for the iFR simulation. In total, 50 coronary vessels of 32 patients were computed, and their CT-iFR values were compared with clinically measured iFRs to evaluate the diagnostic performance of the present CT-iFR method. The area under the receiver operating characteristics curve of CT-iFR validation was 0.93. In diagnostic performances of CT-iFR, accuracy, sensitivity, and specificity were 86%, 83.3%, and 86.8%, respectively. These results indicate that this CT-iFR method can be used as a pre-operative aid to establish a percutaneous coronary intervention strategy as a noninvasive alternative to iFR.
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13
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Integrating Patient-Specific Electrocardiogram Signals and Image-Based Computational Fluid Dynamics Method to Analyze Coronary Blood Flow in Patients during Cardiac Arrhythmias. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose
The aim of this study was to use the computational fluid dynamics (CFD) method, patient-specific electrocardiogram (ECG) signals, and computed tomography three-dimensional image reconstruction technique to investigate the blood flow in coronary arteries during cardiac arrhythmia.
Methods
Two patients with premature ventricular contraction-type cardiac arrhythmia and one with atrial fibrillation-type cardiac arrhythmia were investigated. The inlet velocity of the coronary artery in simulation was applied with the measured velocity profile of the left ventricular outflow tract (LVOT) from the Doppler echocardiography. The measured patient central aortic blood pressure waveform was employed for the coronary artery outlet in simulation. The no-slip boundary condition was applied to the arterial wall.
Results
For the patient with irregular cardiac rhythms (Case I), the coronary blood flow rate under the shortened and lengthened cardiac rhythms were 0.66 and 0.96 mL/s, respectively. In Case II, the maximum velocity at the LVOT under a normal heartbeat was found to be 101 cm/s, whereas the average value was 73 cm/s. In Case III, the patient was also diagnosed with a congenital stenosis problem at the myocardial bridge (MCB) at the LAD. The measured blood flow rate at the MCB of the LAD for the three heartbeats in Case III was found to be 0.68, 1.08, and 1.14 mL/s.
Conclusion
The integration of patient-specific ECG signals and image-based CFD methods can clearly analyze hemodynamic information for patients during cardiac arrhythmia. The cardiac arrhythmia can reduce the blood flow in the coronary arteries.
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14
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Lee KE, Shin SW, Kim GT, Choi JH, Shim EB. Prediction of Plaque Progression in Coronary Arteries Based on a Novel Hemodynamic Index Calculated From Virtual Stenosis Method. Front Physiol 2019; 10:400. [PMID: 31133862 PMCID: PMC6526757 DOI: 10.3389/fphys.2019.00400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/22/2019] [Indexed: 01/07/2023] Open
Abstract
Rationale Predicting the sites in coronary arteries that are susceptible to plaque deposition is essential for the development of clinical treatment strategies and prevention. However, to date, no physiological biomarkers for this purpose have been developed. We hypothesized that the possibility of plaque deposition at a specific site in the coronary artery is associated with wall shear stress (WSS) and fractional flow reserve (FFR). Background and Objective We proposed a new biomarker called the stenosis susceptibility index (SSI) using the FFR and WSS derived using virtual stenosis method. To validate the clinical efficacy of this index, we applied the method to actual pilot clinical cases. This index non-invasively quantifies the vasodilation effects of vascular endothelial cells relative to FFR variation at a specific coronary artery site. Methods and Results Using virtual stenosis method, we computed maximum WSS and FFR according to the variation in stenotic severity at each potential stenotic site and then plotted the variations of maximum WSS (y-axis) and FFR (x-axis). The slope of the graph indicated a site-specific SSI value. Then we determined the most susceptible sites for plaque deposition by comparing SSI values between the potential sites. Applying this method to seven patients revealed 71.4% in per-patient basis analysis 77.8% accuracy in per-vessel basis analysis in percutaneous coronary intervention (PCI) site prediction. Conclusion The SSI index can be used as a predictive biomarker to identify plaque deposition sites. Patients with relatively smaller SSI values also had a higher tendency for myocardial infarction. In conclusion, sites susceptible to plaque deposition can be identified using the SSI index.
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Affiliation(s)
- Kyung Eun Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea.,Bio-Convergence Technology Group, Korea Institute of Industrial Technology, Jeju, South Korea
| | - Sung Woong Shin
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
| | | | - Jin Ho Choi
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea
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15
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Shim EB, Heldt T. Fluid-structure Interaction in the Cerebral Venous Transverse Sinus. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:4544-4547. [PMID: 30441362 DOI: 10.1109/embc.2018.8513150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The biomechanics of the cerebral venous system plays an important role in determining blood flow to the brain. Computational approaches to help elucidate the role of the cerebral venous system in health and disease have largely focused on lumped-parameter models and one-dimensional computational fluid dynamics simulations. To expand upon the prior work, and to investigate the possible role of cerebral venous collapse in normal physiology and pathological conditions, we developed a fluid-structure interaction (FSI) model of the cerebral venous transverse sinus (TS), coupled to a lumpedparameter representation of the upstream cerebral circulation to provide boundary conditions for the FSI simulation. We simulated the effects of local venous hemodynamics on the TS distention and investigated TS vascular collapse under increased intracranial pressure, as has been hypothesized in the pathogenesis of idiopathic intracranial hypertension. Our baseline simulations reproduced pressures and flows in the cerebral venous system that compared favorably with what has been reported in the literature. The FSI simulations under increased intracranial pressure showed a decreased venous flow through and progressive collapse of the TS veins. Our simulations captured the dynamic behavior of the vascular collapse and may help shed light on the interactions between the cerebrovascular and cerebrospinal fluid spaces in health and disease.
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16
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Liu H, Gong Y, Leng X, Xia L, Wong KS, Ou S, Leung TW, Wang D, Shi L. Estimating current and long-term risks of coronary artery in silico by fractional flow reserve, wall shear stress and low-density lipoprotein filtration rate. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aa9a09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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A numerical study of the hemodynamic effect of the aortic valve on coronary flow. Biomech Model Mechanobiol 2017; 17:319-338. [DOI: 10.1007/s10237-017-0962-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
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18
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Chung JH, Lee KE, Nam CW, Doh JH, Kim HI, Kwon SS, Shim EB, Shin ES. Diagnostic Performance of a Novel Method for Fractional Flow Reserve Computed from Noninvasive Computed Tomography Angiography (NOVEL-FLOW Study). Am J Cardiol 2017; 120:362-368. [PMID: 28595860 DOI: 10.1016/j.amjcard.2017.04.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
Coronary computed tomography angiography (CCTA)-derived fractional flow reserve from computed tomography (CT-FFR) may provide better diagnostic performance over CCTA alone, but the complexity of its method limits the use in clinical environment. The aim of the present study is to validate a newly developed vessel-length based computational fluid dynamics scheme for the computation of FFR based on CCTA data, compare them with invasively measured FFR, and evaluate its diagnostic performance with that of CCTA. One hundred seventeen patients from 4 medical institutions who had clinically indicated invasive coronary angiography for suspected coronary artery disease (CAD) were enrolled. Invasive FFR measurement was performed in 218 vessels and these measurements were regarded as the reference standard. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR on a per-vessel basis were 85.8%, 86.2%, 85.5%, 79.8%, and 90.3%, respectively, for CT-FFR ≤0.80, and 66.1%, 75.9%, 59.5%, 55.5%, and 78.8%, respectively, for CCTA ≥50%. A higher area under the receiver operating characteristic curve for CT-FFR was observed compared with CCTA (0.93 vs 0.74, p <0.0001). The CT-FFR and FFR correlated well (r = 0.76, p <0.001) with slight underestimation by CT-FFR (0.014 ± 0.077, p = 0.007). With a novel method of vessel-length based computational fluid dynamics scheme, CT-FFR can be performed at a personal computer enhancing its applicability in clinical situation. The diagnostic accuracy of CT-FFR for the detection of functionally significant CAD was good and was superior to that of CCTA within a population of suspected CAD.
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19
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Lee KE, Lee SH, Shin ES, Shim EB. A vessel length-based method to compute coronary fractional flow reserve from optical coherence tomography images. Biomed Eng Online 2017. [PMID: 28651585 PMCID: PMC5485716 DOI: 10.1186/s12938-017-0365-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Hemodynamic simulation for quantifying fractional flow reserve (FFR) is often performed in a patient-specific geometry of coronary arteries reconstructed from the images from various imaging modalities. Because optical coherence tomography (OCT) images can provide more precise vascular lumen geometry, regardless of stenotic severity, hemodynamic simulation based on OCT images may be effective. The aim of this study is to perform OCT–FFR simulations by coupling a 3D CFD model from geometrically correct OCT images with a LPM based on vessel lengths extracted from CAG data with clinical validations for the present method. Methods To simulate coronary hemodynamics, we developed a fast and accurate method that combined a computational fluid dynamics (CFD) model of an OCT-based region of interest (ROI) with a lumped parameter model (LPM) of the coronary microvasculature and veins. Here, the LPM was based on vessel lengths extracted from coronary X-ray angiography (CAG) images. Based on a vessel length-based approach, we describe a theoretical formulation for the total resistance of the LPM from a three-dimensional (3D) CFD model of the ROI. Results To show the utility of this method, we present calculated examples of FFR from OCT images. To validate the OCT-based FFR calculation (OCT–FFR) clinically, we compared the computed OCT–FFR values for 17 vessels of 13 patients with clinically measured FFR (M-FFR) values. Conclusion A novel formulation for the total resistance of LPM is introduced to accurately simulate a 3D CFD model of the ROI. The simulated FFR values compared well with clinically measured ones, showing the accuracy of the method. Moreover, the present method is fast in terms of computational time, enabling clinicians to provide solutions handled within the hospital.
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Affiliation(s)
- Kyung Eun Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea
| | - Seo Ho Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea.
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Lee KE, Ryu AJ, Shin ES, Shim EB. Physiome approach for the analysis of vascular flow reserve in the heart and brain. Pflugers Arch 2017; 469:613-628. [PMID: 28353154 DOI: 10.1007/s00424-017-1961-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/02/2017] [Accepted: 02/20/2017] [Indexed: 01/10/2023]
Abstract
This work reviews the key aspects of coronary and neurovascular flow reserves with an emphasis on physiomic modeling characteristics by the use of a variety of numerical approaches. First, we explain the definition of fractional flow reserve (FFR) in coronary artery and introduce its clinical significance. Then, computational researches for obtaining FFR are reviewed, and their clinical outcomes are compared. In the case of cerebrovascular reserve (CVR), in spite of substantial progress in the simulation of cerebral hemodynamics, only a few computational studies exist. Thus, we discuss the limitations of CVR simulation study and suggest the challenging issue to overcome these. Also, the future direction of physiomic researches for the flow reserves in coronary arteries and cerebral arteries is described. Also, we introduce a machine learning algorithm trained by the existing physiomic simulation data of flow reserve and suggest a prospective research direction related to this.
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Affiliation(s)
- Kyung Eun Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea
| | - Ah-Jin Ryu
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea.
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Lin KY, Shih TC, Chou SH, Chen ZY, Hsu CH, Ho CY. Computational fluid dynamics with application of different theoretical flow models for the evaluation of coronary artery stenosis on CT angiography: comparison with invasive fractional flow reserve. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/6/065011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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A patient-specific virtual stenotic model of the coronary artery to analyze the relationship between fractional flow reserve and wall shear stress. Int J Cardiol 2016; 222:799-805. [DOI: 10.1016/j.ijcard.2016.07.153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/24/2016] [Indexed: 11/18/2022]
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23
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Peng C, Wang X, Xian Z, Liu X, Huang W, Xu P, Wang J. The Impact of the Geometric Characteristics on the Hemodynamics in the Stenotic Coronary Artery. PLoS One 2016; 11:e0157490. [PMID: 27310014 PMCID: PMC4911169 DOI: 10.1371/journal.pone.0157490] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/30/2016] [Indexed: 01/15/2023] Open
Abstract
The alterations of the hemodynamics in the coronary arteries, which result from patient-specific geometric significances are complex. The effect of the stenosis on the blood flow alteration had been wildly reported, but the combinational contribution from geometric factors required a comprehensive investigation to provide patient-specific information for diagnosis and assisting in the decision on the further treatment strategies. In the present study, we investigated the correlation between hemodynamic parameters and individual geometric factors in the patient-specific coronary arteries. Computational fluid dynamic simulations were performed on 22 patient-specific 3-dimensional coronary artery models that were reconstructed based on computed tomography angiography images. Our results showed that the increasing severity of the stenosis is associated with the increased maximum wall shear stress at the stenosis region (r = 0.752, P < 0.001). In contrast, the length of the recirculation zone has a moderate association with the curvature of the lesion segment (r = 0.505, P = 0.019) and the length of the lesions (r = 0.527, P = 0.064). Moreover, bifurcation in the coronary arteries is significantly correlated with the occurrence of recirculation, whereas the severity of distal stenosis demonstrated an effect on the alteration of the flow in the upstream bifurcation. These findings could serve as an indication for treatment planning and assist in prognosis evaluation.
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Affiliation(s)
- Changnong Peng
- Department of Cardiology, Shenzhen Sun Yat-Sen cardiovascular hospital, Shenzhen 518112, China
| | - Xiaoqing Wang
- Department of Cardiology, Shenzhen Sun Yat-Sen cardiovascular hospital, Shenzhen 518112, China
| | - Zhanchao Xian
- Department of Cardiology, Shenzhen Sun Yat-Sen cardiovascular hospital, Shenzhen 518112, China
| | - Xin Liu
- Research center for biomedical information technology, Shenzhen institute of advance technology, Chinese academic of science, Shenzhen 518055, China
- * E-mail: (XL); (WH)
| | - Wenhua Huang
- Institutes of Clinical Anatomy, Southern Medical University, Guangzhou 510515, China
- * E-mail: (XL); (WH)
| | - Pengcheng Xu
- Institutes of Clinical Anatomy, Southern Medical University, Guangzhou 510515, China
| | - Jinyang Wang
- Institutes of Clinical Anatomy, Southern Medical University, Guangzhou 510515, China
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Estimation of the flow resistances exerted in coronary arteries using a vessel length-based method. Pflugers Arch 2016; 468:1449-58. [DOI: 10.1007/s00424-016-1831-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/02/2016] [Accepted: 04/22/2016] [Indexed: 11/25/2022]
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25
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Hwang D, Lee JM, Koo BK. Physiologic Assessment of Coronary Artery Disease: Focus on Fractional Flow Reserve. Korean J Radiol 2016; 17:307-20. [PMID: 27134520 PMCID: PMC4842851 DOI: 10.3348/kjr.2016.17.3.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/29/2016] [Indexed: 01/10/2023] Open
Abstract
The presence of myocardial ischemia is the most important prognostic factor in patients with ischemic heart disease. Fractional flow reserve (FFR) is a gold standard invasive method used to detect the stenosis-specific myocardial ischemia. FFR-guided revascularization strategy is superior to angiography-guided strategy. The recently developed hyperemia-free index, instantaneous wave free ratio is being actively investigated. A non-invasive FFR derived from coronary CT angiography is now used in clinical practice. Due to rapid expansion of invasive and non-invasive physiologic assessment, comprehensive understanding of the role and potential pitfalls of each modality are required for its application. In this review, we focus on the basic and clinical aspects of physiologic assessment in ischemic heart disease.
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Korea
| | - Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Aging, Seoul National University, Seoul 03087, Korea
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Calderan J, Mao W, Sirois E, Sun W. Development of an In Vitro Model to Characterize the Effects of Transcatheter Aortic Valve on Coronary Artery Flow. Artif Organs 2015; 40:612-9. [PMID: 26510926 DOI: 10.1111/aor.12589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Impairment of coronary artery flow, in either acute or chronic conditions, is a severe complication of transcatheter aortic valve (TAV) implantation, which can arise due to improper TAV positioning. However, little work has been done to quantify the effects of the TAV positioning on the coronary flow. In this study, a realistic in vitro model of coronary artery flow was developed and used to investigate the impact of TAV deployed orientations on coronary flow. The coronary hemodynamics was first replicated mathematically using a lumped parameter model with time-varying myocardial resistance. Based on the analytical model, two stepper motor controlled stopcock valves were integrated in a left heart simulator to represent the variable myocardial resistance in the experimental setup. The coronary flow and pressure waveforms obtained from the in vitro system were consistent with published data. With a TAV deployed in different orientations, the measured results demonstrated that TAV orientation does not have a significant impact on the coronary flow. The developed in vitro model can be further utilized to simulate coronary flow under various pathological conditions.
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Affiliation(s)
- Joseph Calderan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wenbin Mao
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Eric Sirois
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wei Sun
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Tu S, Bourantas CV, Nørgaard BL, Kassab GS, Koo BK, Reiber JH. Image-based assessment of fractional flow reserve. EUROINTERVENTION 2015; 11 Suppl V:V50-4. [DOI: 10.4244/eijv11sva11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Special issue on "Toward physiome based therapeutics". PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 116:1-2. [PMID: 25454286 DOI: 10.1016/j.pbiomolbio.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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