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Tomizawa N, Fujimoto S, Mita T, Takahashi D, Nozaki Y, Fan R, Kudo A, Kawaguchi Y, Takamura K, Hiki M, Kurita M, Kumamaru KK, Watada H, Minamino T, Aoki S. Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus. Radiol Cardiothorac Imaging 2023; 5:e230016. [PMID: 37693191 PMCID: PMC10483244 DOI: 10.1148/ryct.230016] [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: 01/17/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023]
Abstract
Purpose To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus. Materials and Methods This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis. Results Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec-1; IQR: 730-1253 vs 443 sec-1; IQR: 295-602; P < .001) than vessels without progression. The area under the receiver operating characteristic curve of vorticity (0.91; 95% CI: 0.84, 0.97) was higher than that of HRP and LL (0.69; 95% CI: 0.56, 0.82; P < .01). Diagnostic accuracy of vorticity (85%; 80 of 94 vessels; 95% CI: 76, 92) was higher than that of HRP and LL (72%; 68 of 94 vessels; 95% CI: 62, 81; P = .004). Conclusion In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL.Keywords: Coronary Artery, Vorticity, Functional Plaque Progression, Type 2 Diabetes, Vasculature, CT Angiography, Computational Fluid Dynamics, Fractional Flow Reserve Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Nobuo Tomizawa
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinichiro Fujimoto
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tomoya Mita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daigo Takahashi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yui Nozaki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ruiheng Fan
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ayako Kudo
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuko Kawaguchi
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kazuhisa Takamura
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Makoto Hiki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Mika Kurita
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kanako K. Kumamaru
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tohru Minamino
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- From the Department of Radiology (N.T., R.F., K.K.K., S.A.),
Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K.,
K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and
Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of
Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Zhou M, Yu Y, Chen R, Liu X, Hu Y, Ma Z, Gao L, Jian W, Wang L. Wall shear stress and its role in atherosclerosis. Front Cardiovasc Med 2023; 10:1083547. [PMID: 37077735 PMCID: PMC10106633 DOI: 10.3389/fcvm.2023.1083547] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Atherosclerosis (AS) is the major form of cardiovascular disease and the leading cause of morbidity and mortality in countries around the world. Atherosclerosis combines the interactions of systemic risk factors, haemodynamic factors, and biological factors, in which biomechanical and biochemical cues strongly regulate the process of atherosclerosis. The development of atherosclerosis is directly related to hemodynamic disorders and is the most important parameter in the biomechanics of atherosclerosis. The complex blood flow in arteries forms rich WSS vectorial features, including the newly proposed WSS topological skeleton to identify and classify the WSS fixed points and manifolds in complex vascular geometries. The onset of plaque usually occurs in the low WSS area, and the plaque development alters the local WSS topography. low WSS promotes atherosclerosis, while high WSS prevents atherosclerosis. Upon further progression of plaques, high WSS is associated with the formation of vulnerable plaque phenotype. Different types of shear stress can lead to focal differences in plaque composition and to spatial variations in the susceptibility to plaque rupture, atherosclerosis progression and thrombus formation. WSS can potentially gain insight into the initial lesions of AS and the vulnerable phenotype that gradually develops over time. The characteristics of WSS are studied through computational fluid dynamics (CFD) modeling. With the continuous improvement of computer performance-cost ratio, WSS as one of the effective parameters for early diagnosis of atherosclerosis has become a reality and will be worth actively promoting in clinical practice. The research on the pathogenesis of atherosclerosis based on WSS is gradually an academic consensus. This article will comprehensively review the systemic risk factors, hemodynamics and biological factors involved in the formation of atherosclerosis, and combine the application of CFD in hemodynamics, focusing on the mechanism of WSS and the complex interactions between WSS and plaque biological factors. It is expected to lay a foundation for revealing the pathophysiological mechanisms related to abnormal WSS in the progression and transformation of human atherosclerotic plaques.
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Affiliation(s)
- Manli Zhou
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Yunfeng Yu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Ruiyi Chen
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Xingci Liu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yilei Hu
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Zhiyan Ma
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Lingwei Gao
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Weixiong Jian
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- National Key Discipline of Traditional Chinese Medicine Diagnostics, Hunan Provincial Key Laboratory, Hunan University of Chinese Medicine, Changsha, China
- Correspondence: Weixiong Jian Liping Wang
| | - Liping Wang
- College of Rehabilitation Medicine and Health Care, Hunan University of Medicine, Huaihua, China
- Correspondence: Weixiong Jian Liping Wang
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Non-Newtonian Effects of Blood Flow on Hemodynamics in Pulmonary Stenosis: Numerical Simulation. Appl Bionics Biomech 2023. [DOI: 10.1155/2023/1434832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
This paper aims to explore the construction of an individualized pulmonary artery stenosis model based on computed tomography (CT) images. The stenosis model is simulated using a porous medium, and the numerical simulation is carried out by computational fluid dynamics (CFD) method to discuss non-Newtonian effects on hemodynamics. The hemodynamic parameters and quantitative pulmonary pressure ratio (QPPR) of the right pulmonary artery stenosis are obtained. The change curves of hemodynamic parameters show that the effects of non-Newtonian fluid are more significant than those of Newtonian fluid. Under the non-Newtonian condition, pressure and velocity drop more and faster when blood flow enters into the stenosis region. There is a high wall shear stress in the stenosis downstream. The margin of error between the QPPR value of the non-Newtonian fluid simulation and the clinical measurement value is not more than 10%. This work provides the evidence that the simulation of non-Newtonian fluid is closer to the reality when a porous medium model is used in a stenosis model. This contributes to assessing the severity of pulmonary stenosis behavior and is essential to guide disease treatment.
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Crespo-Quintanilla JA, Alfaro-Ayala JA, Ramírez-Minguela JJ, Vidal-Lesso A, Cano-Andrade S. A detailed analysis in thoracic aorta by means of the entropy generation rate: Prediction of the atherosclerotic lesion. Proc Inst Mech Eng H 2022; 236:1675-1684. [DOI: 10.1177/09544119221126270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A detailed numerical analysis is carried out in a real human thoracic aorta by means of the Computational Fluid Dynamics (CFD) for the prediction of the atherosclerosis lesion. Common hemodynamics parameters, such as, the oscillatory shear index (OSI) and the time average wall shear stress (TAWSS) are used for the prediction of the atherosclerosis lesion. Furthermore, the entropy generation rate is considered to obtain the main irreversibilities that occurs inside the thoracic aorta for the prediction of the atherosclerosis lesion. The model considers the blood flow inside the thoracic aorta in an unsteady state. The results show contours of velocity, streams lines, velocity profiles and the comparison of the hemodynamics parameters OSI versus TAWSS. Moreover, contours of the entropy generation rate are showed inside the aorta. The time averaged entropy generation rate (TAEGR) is obtained as a result of the entropy generation analysis. Finally, TAEGR index is compared and discussed with the common hemodynamics parameters, OSI and TAWSS. The accuracy to detect prone locations to atherosclerotic development in the real aorta using the TAEGR in comparison to the OSI and the TAWSS is in good agreement.
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Affiliation(s)
| | - Jorge A Alfaro-Ayala
- Department of Chemical Engineering, University of Guanajuato, DCNE, Guanajuato, Mexico
| | | | - Agustín Vidal-Lesso
- Department of Mechanical Engineering, University of Guanajuato, DICIS, Salamanca, Mexico
| | - Sergio Cano-Andrade
- Department of Mechanical Engineering, University of Guanajuato, DICIS, Salamanca, Mexico
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Shen L, Zhou K, Liu H, Yang J, Huang S, Yu F, Huang D. Prediction of Mechanosensitive Genes in Vascular Endothelial Cells Under High Wall Shear Stress. Front Genet 2022; 12:796812. [PMID: 35087573 PMCID: PMC8787366 DOI: 10.3389/fgene.2021.796812] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: The vulnerability of atherosclerotic plaques is among the leading cause of ischemic stroke. High wall shear stress (WSS) promotes the instability of atherosclerotic plaques by directly imparting mechanical stimuli, but the specific mechanisms remain unclear. We speculate that modulation of mechanosensitive genes may play a vital role in accelerating the development of plaques. The purpose of this study was to find mechanosensitive genes in vascular endothelial cells (ECs) through combining microarray data with bioinformatics technology and further explore the underlying dynamics–related mechanisms that cause the progression and destabilization of atherosclerotic plaques. Methods: Microarray data sets for human vascular ECs under high and normal WSS were retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified through the R language. The performance of enrichment analysis and protein–protein interaction (PPI) network presented the biological function and signaling pathways of the DEGs. Hub genes were identified based on the PPI network and validated by GEO data sets. Predicted transcription factor (TF) genes and miRNAs interaction with potential mechanosensitive genes were identified by NetworkAnalyst. Results: A total of 260 DEGs, 121 upregulated and 139 downregulated genes, were screened between high and normal WSS from GSE23289. A total of 10 hub genes and four cluster modules were filtered out based on the PPI network. The enrichment analysis showed that the biological functions of the hub genes were mainly involved in responses to unfolded protein and topologically incorrect protein, and t to endoplasmic reticulum stress. The significant pathways associated with the hub genes were those of protein processing in the endoplasmic reticulum, antigen processing, and presentation. Three out of the 10 hub genes, namely, activated transcription factor 3 (ATF3), heat shock protein family A (Hsp70) member 6 (HSPA6), and dual specificity phosphatase 1 (DUSP1, also known as CL100, HVH1, MKP-1, PTPN10), were verified in GSE13712. The expression of DUSP1 was higher in the senescent cell under high WSS than that of the young cell. The TF–miRNA–mechanosensitive gene coregulatory network was constructed. Conclusion: In this work, we identified three hub genes, ATF3, HSPA6, and DUSP1, as the potential mechanosensitive genes in the human blood vessels. DUSP1 was confirmed to be associated with the senescence of vascular ECs. Therefore, these three mechanosensitive genes may have emerged as potential novel targets for the prediction and prevention of ischemic stroke. Furthermore, the TF–miRNA–mechanosensitive genes coregulatory network reveals an underlying regulatory mechanism and the pathways to control disease progression.
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Affiliation(s)
- Lei Shen
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kaige Zhou
- School of Medicine, Tongji University, Shanghai, China
| | - Hong Liu
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jie Yang
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuqi Huang
- Department of Neurology, Shanghai Tianyou Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fei Yu
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dongya Huang
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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Anatomic and Flow Characteristics of Left Anterior Descending Coronary Artery Angiographic Stenoses Predisposing to Myocardial Infarction. Am J Cardiol 2021; 141:7-15. [PMID: 33220322 DOI: 10.1016/j.amjcard.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
The impact of the anatomic characteristics of coronary stenoses on the development of future coronary thrombosis has been controversial. This study aimed at identifying the anatomic and flow characteristics of left anterior descending (LAD) coronary artery stenoses that predispose to myocardial infarction, by examining angiograms obtained before the index event. We identified 90 patients with anterior ST-elevation myocardial infarction (STEMI) for whom coronary angiograms and their reconstruction in the three-dimensional space were available at 6 to 12 months before the STEMI, and at the revascularization procedure. The majority of culprit lesions responsible for STEMI occurred between 20 and 40 mm from the LAD ostium, whereas the majority of stable lesions not associated with STEMI were found in distances >60 mm (p < 0.001). Culprit lesions were significantly more stenosed (diameter stenosis 68.6 ± 14.2% vs 44.0 ± 10.4%, p < 0.001), and significantly longer than stable ones (15.3 ± 5.4 mm vs 9.2 ± 2.5 mm, p < 0.001). Bifurcations at culprit lesions were significantly more frequent (88.8%) compared with stable lesions (34.4%, p < 0.001). Computational fluid dynamics simulations demonstrated that hemodynamic conditions in the vicinity of culprit lesions promote coronary thrombosis due to flow recirculation. A multiple logistic regression model with diameter stenosis, lesion length, distance from the LAD ostium, distance from bifurcation, and lesion symmetry, showed excellent accuracy in predicting the development of a culprit lesion (AUC: 0.993 [95% CI: 0.969 to 1.000], p < 0.0001). In conclusion, specific anatomic and hemodynamic characteristics of LAD stenoses identified on coronary angiograms may assist risk stratification of patients by predicting sites of future myocardial infarction.
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Bourantas CV, Zanchin T, Torii R, Serruys PW, Karagiannis A, Ramasamy A, Safi H, Coskun AU, Koning G, Onuma Y, Zanchin C, Krams R, Mathur A, Baumbach A, Mintz G, Windecker S, Lansky A, Maehara A, Stone PH, Raber L, Stone GW. Shear Stress Estimated by Quantitative Coronary Angiography Predicts Plaques Prone to Progress and Cause Events. JACC Cardiovasc Imaging 2020; 13:2206-2219. [PMID: 32417338 DOI: 10.1016/j.jcmg.2020.02.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/05/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study examined the value of endothelial shear stress (ESS) estimated in 3-dimensional quantitative coronary angiography (3D-QCA) models in detecting plaques that are likely to progress and cause events. BACKGROUND Cumulative evidence has shown that plaque characteristics and ESS derived from intravascular ultrasound (IVUS)-based reconstructions enable prediction of lesions that will cause cardiovascular events. However, the prognostic value of ESS estimated by 3D-QCA in nonflow limiting lesions is yet unclear. METHODS This study analyzed baseline virtual histology (VH)-IVUS and angiographic data from 28 lipid-rich lesions (i.e., fibroatheromas) that caused major adverse cardiovascular events or required revascularization (MACE-R) at 5-year follow-up and 119 lipid-rich plaques from a control group that remained quiescent. The segments studied by VH-IVUS at baseline were reconstructed using 3D-QCA software. In the obtained geometries, blood flow simulation was performed, and the pressure gradient across the lipid-rich plaque and the mean ESS values in 3-mm segments were estimated. The additive value of these hemodynamic indexes in predicting MACE-R beyond plaque characteristics was examined. RESULTS MACE-R lesions were longer, had smaller minimum lumen area, increased plaque burden (PB), were exposed to higher ESS, and exhibited a higher pressure gradient. In multivariable analysis, PB (hazard ratio: 1.08; p = 0.004) and the maximum 3-mm ESS value (hazard ratio: 1.11; p = 0.001) were independent predictors of MACE-R. Lesions exposed to high ESS (>4.95 Pa) with a high-risk anatomy (minimal lumen area <4 mm2 and PB >70%) had a higher MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS who had high- (20.0%) or low-risk anatomy (7.1%; p < 0.001). CONCLUSIONS In the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information, and, in combination with lesion anatomy, enabled more accurate identification of MACE-R lesions.
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Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom.
| | - Thomas Zanchin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Alexios Karagiannis
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Hannah Safi
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Ahmet Umit Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts
| | - Gerhard Koning
- Medis medical imaging systems bv, Leiden, the Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Christian Zanchin
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Rob Krams
- Department of Molecular Bioengineering Engineering and Material Sciences, Queen Mary University London, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Gary Mintz
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Alexandra Lansky
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Akiko Maehara
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Peter H Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lorenz Raber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Gregg W Stone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Stone PH, Coskun AU. The effect of multidirectional wall shear stress on plaque characteristics: delving deeper into local shear stress metrics. EUROINTERVENTION 2019; 15:656-658. [DOI: 10.4244/eijv15i8a121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Coronary Shear Stress after Implantation of Bioresorbable Scaffolds – a Modern Interdisciplinary Concept at the Border between Interventional Cardiology and Cardiac Imaging. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Abstract
Bioresorbable scaffolds/stents offer new and exciting perspectives in the treatment of patients with acute coronary syndromes, especially after the recent development of invasive imaging techniques, such as optical coherence tomography, which allow complete assessment of vascu-lar segments. A particular advantage of bioresorbable scaffolds is that once the biosorption of the scaffold is complete, the vascular segment regains its normal physiological functions, thus eliminating the risk of late complications. New studies show the importance of shear stress in the progression of vascular atherosclerosis or in accelerating endothelial turnover. Based on the current knowledge in this field, a future standardized determination of shear stress may help in the long-term follow-up of patients that have suffered or are at risk of developing an acute coronary syndrome.
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Tenekecioglu E, Torii R, Bourantas CV, Cavalcante R, Sotomi Y, Zeng Y, Collet C, Crake T, Abizaid A, Onuma Y, Su S, Santoso T, Serruys PW. Hemodynamic analysis of a novel bioresorbable scaffold in porcine coronary artery model. Catheter Cardiovasc Interv 2018; 91:1084-1091. [PMID: 28843033 DOI: 10.1002/ccd.27253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 07/04/2017] [Accepted: 07/22/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The shear stress distribution assessment can provide useful insights for the hemodynamic performance of the implanted stent/scaffold. Our aim was to investigate the effect of a novel bioresorbable scaffold, Mirage on local hemodynamics in animal models. METHOD The main epicardial coronary arteries of 7 healthy mini-pigs were implanted with 11 Mirage Microfiber sirolimus-eluting Bioresorbable Scaffolds (MMSES). Optical coherence tomography (OCT) was performed post scaffold implantation and the obtained images were fused with angiographic data to reconstruct the coronary artery anatomy. Blood flow simulation was performed and Endothelial Shear Stress(ESS) distribution was estimated for each of the 11 scaffolds. ESS data were extracted in each circumferential 5-degree subunit of each cross-section in the scaffolded segment. The generalized linear mixed-effect analysis was implemented for the comparison of ESS in two scaffold groups; 150-µm strut thickness MMSES and 125-µm strut thickness MMSES. RESULTS ESS was significantly higher in MMSES (150 µm) [0.85(0.49-1.40) Pa], compared to MMSES (125 µm) [0.68(0.35-1.18) Pa]. Both MMSES (150 µm) and MMSES (125 µm) revealed low recirculation zone percentages per luminal surface area [3.17% ± 1.97% in MMSES (150 µm), 2.71% ± 1.32% in MMSES (125 µm)]. CONCLUSION Thinner strut Mirage scaffolds induced lower shear stress due to the small size vessels treated as compared to the thick strut version of the Mirage which was implanted in relatively bigger size vessels. Vessel size should be taken into account in planning BRS implantation. Small vessels may not get benefit from BRS implantation even with a streamlined strut profile. This pilot study warrants comparative assessment with commercially available bioresorbable scaffolds.
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Affiliation(s)
- Erhan Tenekecioglu
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Christos V Bourantas
- Department of Cardiology, University College of London Hospitals, London, United Kingdom
| | - Rafael Cavalcante
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yaping Zeng
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom Crake
- Department of Cardiology, University College of London Hospitals, London, United Kingdom
| | - Alexandre Abizaid
- Department of Invasive Cardiology, Institute Dante Pazzanese of Cardiology, São Paulo, Brazil
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | | | - Teguh Santoso
- Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo and Medistra Hospitals, University of Indonesia, Jakarta, Indonesia
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.,Department of Cardiology, International Centre for Circulatory Health, Imperial College, London, United Kingdom
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Wain RAJ, Smith DJ, Hammond DR, Whitty JPM. Influence of microvascular sutures on shear strain rate in realistic pulsatile flow. Microvasc Res 2018. [PMID: 29522755 DOI: 10.1016/j.mvr.2018.03.001] [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: 10/17/2022]
Abstract
Arterial thrombus formation is directly related to the mechanical shear experienced by platelets within flow. High shear strain rates (SSRs) and large shear gradients cause platelet activation, aggregation and production of thrombus. This study, for the first time, investigates the influence of pulsatile flow on local haemodynamics within sutured microarterial anastomoses. We measured physiological arterial waveform velocities experimentally using Doppler ultrasound velocimetry, and a representative example was applied to a realistic sutured microarterial geometry. Computational geometries were created using measurements taken from sutured chicken femoral arteries. Arterial SSRs were predicted using computational fluid dynamics (CFD) software, to indicate the potential for platelet activation, deposition and thrombus formation. Predictions of steady and sinusoidal inputs were compared to analyse whether the addition of physiological pulse characteristics affects local intravascular flow characteristics. Simulations were designed to evaluate flow in pristine and hand-sutured microarterial anastomoses, each with a steady-state and sinusoidal pulse component. The presence of sutures increased SSRmax in the anastomotic region by factors of 2.1 and 2.3 in steady-state and pulsatile flows respectively, when compared to a pristine vessel. SSR values seen in these simulations are analogous to the presence of moderate arterial stenosis. Steady-state simulations, driven by a constant inflow velocity equal to the peak systolic velocity (PSV) of the measured pulsatile flow, underestimated SSRs by ∼ 9% in pristine, and ∼ 19% in sutured vessels compared with a realistic pulse. Sinusoidal flows, with equivalent frequency and amplitude to a measured arterial waveform, represent a slight improvement on steady-state simulations, but still SSRs are underestimated by 1-2%. We recommend using a measured arterial waveform, of the form presented here, for simulating pulsatile flows in vessels of this nature. Under realistic pulsatile flow, shear gradients across microvascular sutures are high, of the order ∼ 7.9 × 106 m-1 s-1, which may also be associated with activation of platelets and formation of aggregates.
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Affiliation(s)
- R A J Wain
- School of Mathematics, University of Birmingham, B15 2TT, UK; Institute of Translational Medicine, University of Birmingham, B15 2TT, UK; School of Medicine and Dentistry, University of Central Lancashire, Preston PR1 2HE, UK; Computational Mechanics Research Group, School of Engineering, University of Central Lancashire, Preston PR1 2HE, UK.
| | - D J Smith
- School of Mathematics, University of Birmingham, B15 2TT, UK; Institute for Metabolism and Systems Research, University of Birmingham, B15 2TT, UK
| | - D R Hammond
- School of Medicine and Dentistry, University of Central Lancashire, Preston PR1 2HE, UK
| | - J P M Whitty
- Computational Mechanics Research Group, School of Engineering, University of Central Lancashire, Preston PR1 2HE, UK
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Jewkes R, Burton HE, Espino DM. Towards Additive Manufacture of Functional, Spline-Based Morphometric Models of Healthy and Diseased Coronary Arteries: In Vitro Proof-of-Concept Using a Porcine Template. J Funct Biomater 2018; 9:E15. [PMID: 29393899 PMCID: PMC5872101 DOI: 10.3390/jfb9010015] [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: 12/31/2017] [Revised: 01/26/2018] [Accepted: 01/31/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of this study is to assess the additive manufacture of morphometric models of healthy and diseased coronary arteries. Using a dissected porcine coronary artery, a model was developed with the use of computer aided engineering, with splines used to design arteries in health and disease. The model was altered to demonstrate four cases of stenosis displaying varying severity, based on published morphometric data available. Both an Objet Eden 250 printer and a Solidscape 3Z Pro printer were used in this analysis. A wax printed model was set into a flexible thermoplastic and was valuable for experimental testing with helical flow patterns observed in healthy models, dominating the distal LAD (left anterior descending) and left circumflex arteries. Recirculation zones were detected in all models, but were visibly larger in the stenosed cases. Resin models provide useful analytical tools for understanding the spatial relationships of blood vessels, and could be applied to preoperative planning techniques, but were not suitable for physical testing. In conclusion, it is feasible to develop blood vessel models enabling experimental work; further, through additive manufacture of bio-compatible materials, there is the possibility of manufacturing customized replacement arteries.
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Affiliation(s)
- Rachel Jewkes
- Department of Mechanical Engineering, University of Birmingham, Birmingham B15 2TT, UK.
| | - Hanna E Burton
- Department of Mechanical Engineering, University of Birmingham, Birmingham B15 2TT, UK.
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham B15 2TT, UK.
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Chen Y, Deng X, Shan X, Xing Y. Study of helical flow inducers with different thread pitches and diameters in vena cava. PLoS One 2018; 13:e0190609. [PMID: 29298357 PMCID: PMC5752007 DOI: 10.1371/journal.pone.0190609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022] Open
Abstract
Pulmonary embolism is a severe, potentially life-threatening condition. Inferior vena cava filters have been used to prevent recurrent pulmonary embolisms. However, the build-up of thrombosis in vena cava filters after deployment presents a severe problem to patients. Previous studies proposed that filters with helical flow are beneficial and capable of alleviating this problem. In this study, the hemodynamic performances of four typical helical flow inducers in the vena cava are determined using computational fluid dynamics simulations (steady-state and pulsatile flow) and compared. Pilot in vitro experiments were also conducted. The simulation results demonstrate that large-diameter inducers produce helical flow. Among inducers with identical diameter, those with a smaller thread pitch are more likely to induce increased helical flow. We also observed that the small thread pitch inducers can yield higher shear rates. Furthermore, a large diameter, small thread pitch helical flow inducer increases the time-averaged wall shear stress and reduces the oscillating shear index and relative residence time on the vessel wall in the vicinity of the helical flow inducer. In vitro experiments also verify that large diameter inducers generate a helical flow. A notable observation of this study is that the diameter is the key parameter that affects the induction of a helical flow. This study will likely provide important guidance for the design of interventional treatments and the deployment of filters associated with helical flow in the vena cava.
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Affiliation(s)
- Ying Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
- * E-mail:
| | - Xinying Shan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Yubin Xing
- Department of Infection Management and Disease Control, The General Hospital of People’s Liberation Army, Beijing, China
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Tenekecioglu E, Torii R, Bourantas C, Sotomi Y, Cavalcante R, Zeng Y, Collet C, Crake T, Suwannasom P, Onuma Y, Serruys P. Difference in haemodynamic microenvironment in vessels scaffolded with Absorb BVS and Mirage BRMS: insights from a preclinical endothelial shear stress study. EUROINTERVENTION 2017; 13:1327-1335. [DOI: 10.4244/eij-d-17-00283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Choi A, McPherson DD, Kim H. Visualization of plaque distribution in a curved artery: three-dimensional intravascular ultrasound imaging. Comput Assist Surg (Abingdon) 2017; 22:120-126. [PMID: 29034729 DOI: 10.1080/24699322.2017.1389389] [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: 10/18/2022] Open
Abstract
Intravascular ultrasound (IVUS) imaging provides an excellent tool for evaluation of the type, morphology, extent, and severity of an atheromatous plaque. 3 D IVUS imaging offers additive information pertaining to morphology of the arterial structures and volumetric plaque distributions. A new 3 D IVUS visualization technique was developed to provide 3 D structural information of a curved artery. A virtual 3 D curved arterial phantom consisting of varying cross-sectional shapes, wall thicknesses, and acoustic intensity information was utilized to validate the nonlinear interpolation technique to create intermediary 2 D IVUS images. IVUS imaging was performed for the iliofemoral arterial segment of an atherosclerotic Yucatan miniswine model. These in-vivo IVUS data were utilized for intermediary IVUS image generation and volumetric 3 D IVUS visualization. Smooth transitional changes of cross-sectional shape, wall thickness and grayscale intensity were found between the intermediary images and the original arterial phantom slices. The 3 D IVUS imaging of the unfolded curved iliofemoral artery provided realistic 3 D luminal surface images of the arteries with physiologic grayscale intensity information. This unique 3 D IVUS imaging technique may help with assessment of 3 D plaque distribution across the curved arterial structure, and improve 3 D visualization of atheromatous components.
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Affiliation(s)
- Ahnryul Choi
- a Department of Biomedical Engineering , Catholic Kwandong University , Gangneung , Gangwon , Republic of Korea
| | - David D McPherson
- b Division of Cardiology, Department of Internal Medicine , The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Hyunggun Kim
- b Division of Cardiology, Department of Internal Medicine , The University of Texas Health Science Center at Houston , Houston , TX , USA.,c Department of Biomechatronic Engineering , Sungkyunkwan University , Suwon , Gyeonggi , Republic of Korea
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Liu X, Wu G, Xu C, He Y, Shu L, Liu Y, Zhang N, Lin C. Prediction of coronary plaque progression using biomechanical factors and vascular characteristics based on computed tomography angiography. Comput Assist Surg (Abingdon) 2017; 22:286-294. [PMID: 29032716 DOI: 10.1080/24699322.2017.1389407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Coronary atherosclerotic plaques progress in a highly individual manner. Accurately predicting plaque progression will promote clinical management of atherosclerosis. The purpose of this study was to investigate the role of local biomechanics factors and vascular characteristics in coronary plaque progression and arterial remodeling. METHODS Computed tomography angiography-based three-dimensional reconstruction of the native right coronary artery was performed in vivo in twelve patients with acute coronary syndrome at baseline and 12-month follow-up. The reconstructed arteries were divided into sequential 3-mm-long segments. Wall shear stress (WSS) and von Mises stress (VMS) were computed in all segments at baseline by applying fluid-structure interaction simulations. RESULTS In total, 365 segments 3-mm long were analyzed. The decrease in minimal lumen area was independently predicted by low baseline VMS (-0.73 ± 0.13 mm2), increase in plaque burden was independently predicted by small minimal lumen area and low baseline WSS (6.28 ± 0.96%), and decrease in plaque volume was independently predicted by low baseline VMS (-0.99 ± 0.49 mm3). Negative remodeling was more likely to occur in low- (55%) and moderate-VMS (40%) segments, but expansive remodeling was more likely to occur in high-VMS (44%) segments. CONCLUSIONS Local von Mises stress, wall shear stress, minimal lumen area, and plaque burden provide independent and additive prediction in identifying coronary plaque progression and arterial remodeling.
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Affiliation(s)
- Xiujian Liu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Guanghui Wu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Chuangye Xu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Yuna He
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Lixia Shu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Yuyang Liu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Nan Zhang
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Changyan Lin
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
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Chistiakov DA, Orekhov AN, Bobryshev YV. Effects of shear stress on endothelial cells: go with the flow. Acta Physiol (Oxf) 2017; 219:382-408. [PMID: 27246807 DOI: 10.1111/apha.12725] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/17/2016] [Accepted: 05/30/2016] [Indexed: 12/11/2022]
Abstract
Haemodynamic forces influence the functional properties of vascular endothelium. Endothelial cells (ECs) have a variety of receptors, which sense flow and transmit mechanical signals through mechanosensitive signalling pathways to recipient molecules that lead to phenotypic and functional changes. Arterial architecture varies greatly exhibiting bifurcations, branch points and curved regions, which are exposed to various flow patterns. Clinical studies showed that atherosclerotic plaques develop preferentially at arterial branches and curvatures, that is in the regions exposed to disturbed flow and shear stress. In the atheroprone regions, the endothelium has a proinflammatory phenotype associated with low nitric oxide production, reduced barrier function and increased proadhesive, procoagulant and proproliferative properties. Atheroresistant regions are exposed to laminar flow and high shear stress that induce prosurvival antioxidant signals and maintain the quiescent phenotype in ECs. Indeed, various flow patterns contribute to phenotypic and functional heterogeneity of arterial endothelium whose response to proatherogenic stimuli is differentiated. This may explain the preferential development of endothelial dysfunction in arterial sites with disturbed flow.
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Affiliation(s)
- D. A. Chistiakov
- Department of Medical Nanobiotechnology; Pirogov Russian State Medical University; Moscow Russia
| | - A. N. Orekhov
- Institute of General Pathology and Pathophysiology; Russian Academy of Medical Sciences; Moscow Russia
- Institute for Atherosclerosis Research; Skolkovo Innovative Center; Moscow Russia
- Department of Biophysics; Biological Faculty; Moscow State University; Moscow Russia
| | - Y. V. Bobryshev
- Institute of General Pathology and Pathophysiology; Russian Academy of Medical Sciences; Moscow Russia
- Faculty of Medicine and St Vincent's Centre for Applied Medical Research; University of New South Wales; Sydney NSW Australia
- School of Medicine; University of Western Sydney; Campbelltown NSW Australia
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Tenekecioglu E, Torii R, Bourantas C, Abdelghani M, Cavalcante R, Sotomi Y, Crake T, Su S, Santoso T, Onuma Y, Serruys PW. Assessment of the hemodynamic characteristics of Absorb BVS in a porcine coronary artery model. Int J Cardiol 2017; 227:467-473. [DOI: 10.1016/j.ijcard.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
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Tenekecioglu E, Poon EKW, Collet C, Thondapu V, Torii R, Bourantas CV, Zeng Y, Onuma Y, Ooi ASH, Serruys PW, Barlis P. The Nidus for Possible Thrombus Formation: Insight From the Microenvironment of Bioresorbable Vascular Scaffold. JACC Cardiovasc Interv 2016; 9:2167-2168. [PMID: 27692818 DOI: 10.1016/j.jcin.2016.08.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/11/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Erhan Tenekecioglu
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric K W Poon
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
| | - Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Vikas Thondapu
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Melbourne, Australia; Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Christos V Bourantas
- Department of Cardiovascular Sciences, University College London, London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
| | - Yaping Zeng
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andrew S H Ooi
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Imperial College, London, United Kingdom.
| | - Peter Barlis
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Melbourne, Australia; Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
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Shishido K, Antoniadis AP, Takahashi S, Tsuda M, Mizuno S, Andreou I, Papafaklis MI, Coskun AU, O'Brien C, Feldman CL, Saito S, Edelman ER, Stone PH. Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans. J Am Heart Assoc 2016; 5:JAHA.115.002949. [PMID: 27628570 PMCID: PMC5079004 DOI: 10.1161/jaha.115.002949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background In‐stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. Methods and Results We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three‐dimensional coronary reconstruction was performed in 374 post‐PCI patients at baseline and 6 to 10 months follow‐up as part of the PREDICTION Study. Each vessel was divided into 1.5‐mm‐long segments, and we calculated the local ESS within each stented segment at baseline. At follow‐up, we assessed ISH and the occurrence of a clinically indicated repeat PCI for in‐stent restenosis. In 246 total stents (54 overlapping), 100 (40.7%) were bare‐metal stents (BMS), 104 (42.3%) sirolimus‐eluting stents, and 42 (17.1%) paclitaxel‐eluting stents. In BMS, low ESS post‐PCI at baseline was independently associated with ISH (β=1.47 mm2 per 1‐Pa decrease; 95% CI, 0.38–2.56; P<0.01). ISH was minimal in drug‐eluting stents. During follow‐up, repeat PCI in BMS was performed in 21 stents (8.5%). There was no significant association between post‐PCI ESS and in‐stent restenosis requiring PCI. Conclusions Low ESS after BMS implantation is associated with subsequent ISH. ISH is strongly inhibited by drug‐eluting stents. Post‐PCI ESS is not associated with in‐stent restenosis requiring repeat PCI. ESS is an important determinant of ISH in BMS, but ISH of large magnitude to require PCI for in‐stent restenosis is likely attributed to factors other than ESS within the stent.
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Affiliation(s)
- Koki Shishido
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA
| | - Caroline O'Brien
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Elazer R Edelman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Papadopoulos KP, Gavaises M, Pantos I, Katritsis DG, Mitroglou N. Derivation of flow related risk indices for stenosed left anterior descending coronary arteries with the use of computer simulations. Med Eng Phys 2016; 38:929-39. [DOI: 10.1016/j.medengphy.2016.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/15/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
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Brown RA, Shantsila E, Varma C, Lip GYH. Epidemiology and pathogenesis of diffuse obstructive coronary artery disease: the role of arterial stiffness, shear stress, monocyte subsets and circulating microparticles. Ann Med 2016; 48:444-455. [PMID: 27282244 DOI: 10.1080/07853890.2016.1190861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Despite falling age-adjusted mortality rates coronary artery disease (CAD) remains the leading cause of death worldwide. Advanced diffuse CAD is becoming an important entity of modern cardiology as more patients with historical revascularisation no longer have suitable anatomy for additional procedures. Advances in the treatment of diffuse obstructive CAD are hampered by a poor understanding of its development. Although the likelihood of developing clinically significant (obstructive) CAD is linked to traditional risk factors, the morphology of obstructive CAD among individuals is highly variable - some patients have diffuse stenotic disease, while others have a focal stenosis. This is challenging to explain in mechanistic terms as vascular endothelium is equally exposed to injury stimulants. Patients with diffuse disease are at high risk of adverse outcomes, particularly if unsuitable for revascularisation. We searched multiple electronic databases (MEDLINE, EMBASE and the Cochrane Database) and reviewed the epidemiology, pathogenesis and prognosis relating to advanced diffuse CAD with particular focus on the role of endothelial shear stress, large artery stiffness, monocyte subsets and circulating microparticles. Key messages Although traditional CAD risk factors correlate strongly with disease severity, significant individual variation in disease morphology exists. Advanced, diffuse CAD is difficult to treat effectively and can significantly impair quality of life and increases mortality. The pathophysiology associated with the progression of CAD is the result of complex maladaptive interaction between the endothelium, cells of the immune system and patterns of blood flow.
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Affiliation(s)
- Richard A Brown
- a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , UK
| | - Eduard Shantsila
- a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , UK.,b Cardiology Department, City Hospital , Birmingham , UK
| | - Chetan Varma
- b Cardiology Department, City Hospital , Birmingham , UK
| | - Gregory Y H Lip
- a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , UK.,b Cardiology Department, City Hospital , Birmingham , UK
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Associations between elevated resting heart rate and subclinical atherosclerosis in asymptomatic Korean adults undergoing coronary artery calcium scoring. Int J Cardiovasc Imaging 2016; 32:1587-93. [PMID: 27443318 DOI: 10.1007/s10554-016-0944-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
Elevated resting heart rate (RHR) and the presence of coronary artery calcium (CAC) are closely related with inflammatory activity and cardiovascular disease outcomes. To date, however, the relationship between a high RHR and CAC has not been well studied, especially in non-western populations. We therefore aimed to examine the cross-sectional relationship between high RHR and the burden of subclinical atherosclerosis as measured by CAC score in a large sample of Korean adults. A total 26,018 subjects were enrolled and underwent CAC screening as part of a broader general health examination. RHR was categorized into four groups as: <60, 60-69, 70-79, and ≥80 beats per minute. Multivariable logistic regression models were employed to estimate the odds of having a CAC score of either >0, >100, or >400 based on RHR. Mean age of the study population was 53.9 ± 8.2 years, and 79.7 % were male. After adjustment, each 10 beat per minute increment in RHR was associated with greater odds of having a CAC score above 100 (OR 1.13, 95 % CI 1.08-1.18) or 400 (OR 1.22, 95 % CI 1.13-1.31). Likewise, following adjustment, the odds of having a CAC >100 or >400 for those with a RHR ≥80 beats per minute were 1.42 (95 % CI 1.19-1.69) and 1.86 (95 % CI 1.42-2.47), respectively, compared with those who had a RHR <60 beats per minute. In a large cohort of Korean adults, elevations in the RHR, particularly above 80 beats per minute, were found to be independently associated with the presence of subclinical atherosclerosis as measured by CAC scoring.
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Zahnd G, Schrauwen J, Karanasos A, Regar E, Niessen W, van Walsum T, Gijsen F. Fusion of fibrous cap thickness and wall shear stress to assess plaque vulnerability in coronary arteries: a pilot study. Int J Comput Assist Radiol Surg 2016; 11:1779-90. [PMID: 27236652 PMCID: PMC5034011 DOI: 10.1007/s11548-016-1422-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/11/2016] [Indexed: 12/16/2022]
Abstract
Purpose Identification of rupture-prone plaques in coronary arteries is a major clinical challenge. Fibrous cap thickness and wall shear stress are two relevant image-based risk factors, but these two parameters are generally computed and analyzed separately. Accordingly, combining these two parameters can potentially improve the identification of at-risk regions. Therefore, the purpose of this study is to investigate the feasibility of the fusion of wall shear stress and fibrous cap thickness of coronary arteries in patient data. Methods Fourteen patients were included in this pilot study. Imaging of the coronary arteries was performed with optical coherence tomography and with angiography. Fibrous cap thickness was automatically quantified from optical coherence tomography pullbacks using a contour segmentation approach based on fast marching. Wall shear stress was computed by applying computational fluid dynamics on the 3D volume reconstructed from two angiograms. The two parameters then were co-registered using anatomical landmarks such as side branches. Results The two image modalities were successfully co-registered, with a mean (±SD) error corresponding to \documentclass[12pt]{minimal}
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\begin{document}$$8.6\,\pm \,6.7\,\%$$\end{document}8.6±6.7% of the length of the analyzed region. For all the analyzed participants, the average thinnest portion of each fibrous cap was \documentclass[12pt]{minimal}
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\begin{document}$$129\,\pm \,69\,\upmu \text {m}$$\end{document}129±69μm, and the average WSS value at the location of the fibrous cap was \documentclass[12pt]{minimal}
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\begin{document}$$1.46\,\pm \,1.16\,\text {Pa}$$\end{document}1.46±1.16Pa. A unique index was finally generated for each patient via the fusion of fibrous cap thickness and wall shear stress measurements, to translate all the measured parameters into a single risk map. Conclusion The introduced risk map integrates two complementary parameters and has potential to provide valuable information about plaque vulnerability.
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Affiliation(s)
- Guillaume Zahnd
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
| | - Jelle Schrauwen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Antonios Karanasos
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Wiro Niessen
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Frank Gijsen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
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Schrauwen JTC, Schwarz JCV, Wentzel JJ, van der Steen AFW, Siebes M, Gijsen FJH. The impact of scaled boundary conditions on wall shear stress computations in atherosclerotic human coronary bifurcations. Am J Physiol Heart Circ Physiol 2016; 310:H1304-12. [PMID: 26945083 DOI: 10.1152/ajpheart.00896.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/26/2016] [Indexed: 01/06/2023]
Abstract
The aim of this study was to determine if reliable patient-specific wall shear stress (WSS) can be computed when diameter-based scaling laws are used to impose the boundary conditions for computational fluid dynamics. This study focused on mildly diseased human coronary bifurcations since they are predilection sites for atherosclerosis. Eight patients scheduled for percutaneous coronary intervention were imaged with angiography. The velocity proximal and distal of a bifurcation was acquired with intravascular Doppler measurements. These measurements were used for inflow and outflow boundary conditions for the first set of WSS computations. For the second set of computations, absolute inflow and outflow ratios were derived from geometry-based scaling laws based on angiography data. Normalized WSS maps per segment were obtained by dividing the absolute WSS by the mean WSS value. Absolute and normalized WSS maps from the measured-approach and the scaled-approach were compared. A reasonable agreement was found between the measured and scaled inflows, with a median difference of 0.08 ml/s [-0.01; 0.20]. The measured and the scaled outflow ratios showed a good agreement: 1.5 percentage points [-19.0; 4.5]. Absolute WSS maps were sensitive to the inflow and outflow variations, and relatively large differences between the two approaches were observed. For normalized WSS maps, the results for the two approaches were equivalent. This study showed that normalized WSS can be obtained from angiography data alone by applying diameter-based scaling laws to define the boundary conditions. Caution should be taken when absolute WSS is assessed from computations using scaled boundary conditions.
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Affiliation(s)
- Jelle T C Schrauwen
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Janina C V Schwarz
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands; and
| | - Jolanda J Wentzel
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Antonius F W van der Steen
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Maria Siebes
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands; and
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands;
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O’Brien CC, Kolandaivelu K, Brown J, Lopes AC, Kunio M, Kolachalama VB, Edelman ER. Constraining OCT with Knowledge of Device Design Enables High Accuracy Hemodynamic Assessment of Endovascular Implants. PLoS One 2016; 11:e0149178. [PMID: 26906566 PMCID: PMC4764338 DOI: 10.1371/journal.pone.0149178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/27/2015] [Indexed: 11/21/2022] Open
Abstract
Background Stacking cross-sectional intravascular images permits three-dimensional rendering of endovascular implants, yet introduces between-frame uncertainties that limit characterization of device placement and the hemodynamic microenvironment. In a porcine coronary stent model, we demonstrate enhanced OCT reconstruction with preservation of between-frame features through fusion with angiography and a priori knowledge of stent design. Methods and Results Strut positions were extracted from sequential OCT frames. Reconstruction with standard interpolation generated discontinuous stent structures. By computationally constraining interpolation to known stent skeletons fitted to 3D ‘clouds’ of OCT-Angio-derived struts, implant anatomy was resolved, accurately rendering features from implant diameter and curvature (n = 1 vessels, r2 = 0.91, 0.90, respectively) to individual strut-wall configurations (average displacement error ~15 μm). This framework facilitated hemodynamic simulation (n = 1 vessel), showing the critical importance of accurate anatomic rendering in characterizing both quantitative and basic qualitative flow patterns. Discontinuities with standard approaches systematically introduced noise and bias, poorly capturing regional flow effects. In contrast, the enhanced method preserved multi-scale (local strut to regional stent) flow interactions, demonstrating the impact of regional contexts in defining the hemodynamic consequence of local deployment errors. Conclusion Fusion of planar angiography and knowledge of device design permits enhanced OCT image analysis of in situ tissue-device interactions. Given emerging interests in simulation-derived hemodynamic assessment as surrogate measures of biological risk, such fused modalities offer a new window into patient-specific implant environments.
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Affiliation(s)
- Caroline C. O’Brien
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- * E-mail:
| | - Kumaran Kolandaivelu
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Jonathan Brown
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Augusto C. Lopes
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Mie Kunio
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Vijaya B. Kolachalama
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Charles Stark Draper Laboratory, 555 Technology Square, Cambridge, MA, United States of America
| | - Elazer R. Edelman
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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Schrauwen JTC, Karanasos A, van Ditzhuijzen NS, Aben JP, van der Steen AFW, Wentzel JJ, Gijsen FJH. Influence of the Accuracy of Angiography-Based Reconstructions on Velocity and Wall Shear Stress Computations in Coronary Bifurcations: A Phantom Study. PLoS One 2015; 10:e0145114. [PMID: 26690897 PMCID: PMC4686962 DOI: 10.1371/journal.pone.0145114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 11/28/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Wall shear stress (WSS) plays a key role in the onset and progression of atherosclerosis in human coronary arteries. Especially sites with low and oscillating WSS near bifurcations have a higher propensity to develop atherosclerosis. WSS computations in coronary bifurcations can be performed in angiography-based 3D reconstructions. It is essential to evaluate how reconstruction errors influence WSS computations in mildly-diseased coronary bifurcations. In mildly-diseased lesions WSS could potentially provide more insight in plaque progression. MATERIALS METHODS Four Plexiglas phantom models of coronary bifurcations were imaged with bi-plane angiography. The lumens were segmented by two clinically experienced readers. Based on the segmentations 3D models were generated. This resulted in three models per phantom: one gold-standard from the phantom model itself, and one from each reader. Steady-state and transient simulations were performed with computational fluid dynamics to compute the WSS. A similarity index and a noninferiority test were used to compare the WSS in the phantoms and their reconstructions. The margin for this test was based on the resolution constraints of angiography. RESULTS The reconstruction errors were similar to previously reported data; in seven out of eight reconstructions less than 0.10 mm. WSS in the regions proximal and far distal of the stenosis showed a good agreement. However, the low WSS areas directly distal of the stenosis showed some disagreement between the phantoms and the readers. This was due to small deviations in the reconstruction of the stenosis that caused differences in the resulting jet, and consequently the size and location of the low WSS area. DISCUSSION This study showed that WSS can accurately be computed within angiography-based 3D reconstructions of coronary arteries with early stage atherosclerosis. Qualitatively, there was a good agreement between the phantoms and the readers. Quantitatively, the low WSS regions directly distal to the stenosis were sensitive to small reconstruction errors.
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Affiliation(s)
- Jelle T C Schrauwen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonios Karanasos
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Antonius F W van der Steen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands
| | - Jolanda J Wentzel
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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Physical and computational fluid dynamics models for the hemodynamics of the artiodactyl carotid rete. J Theor Biol 2015; 386:122-31. [DOI: 10.1016/j.jtbi.2015.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 11/23/2022]
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Morris PD, van de Vosse FN, Lawford PV, Hose DR, Gunn JP. "Virtual" (Computed) Fractional Flow Reserve: Current Challenges and Limitations. JACC Cardiovasc Interv 2015; 8:1009-1017. [PMID: 26117471 PMCID: PMC4726733 DOI: 10.1016/j.jcin.2015.04.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/27/2015] [Accepted: 04/23/2015] [Indexed: 01/05/2023]
Abstract
Fractional flow reserve (FFR) is the “gold standard” for assessing the physiological significance of coronary artery disease during invasive coronary angiography. FFR-guided percutaneous coronary intervention improves patient outcomes and reduces stent insertion and cost; yet, due to several practical and operator related factors, it is used in <10% of percutaneous coronary intervention procedures. Virtual fractional flow reserve (vFFR) is computed using coronary imaging and computational fluid dynamics modeling. vFFR has emerged as an attractive alternative to invasive FFR by delivering physiological assessment without the factors that limit the invasive technique. vFFR may offer further diagnostic and planning benefits, including virtual pullback and virtual stenting facilities. However, there are key challenges that need to be overcome before vFFR can be translated into routine clinical practice. These span a spectrum of scientific, logistic, commercial, and political areas. The method used to generate 3-dimensional geometric arterial models (segmentation) and selection of appropriate, patient-specific boundary conditions represent the primary scientific limitations. Many conflicting priorities and design features must be carefully considered for vFFR models to be sufficiently accurate, fast, and intuitive for physicians to use. Consistency is needed in how accuracy is defined and reported. Furthermore, appropriate regulatory and industry standards need to be in place, and cohesive approaches to intellectual property management, reimbursement, and clinician training are required. Assuming successful development continues in these key areas, vFFR is likely to become a desirable tool in the functional assessment of coronary artery disease.
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Affiliation(s)
- Paul D Morris
- Department of Cardiovascular Science, University of Sheffield, and Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Patricia V Lawford
- Department of Cardiovascular Science, University of Sheffield, and Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
| | - D Rodney Hose
- Department of Cardiovascular Science, University of Sheffield, and Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
| | - Julian P Gunn
- Department of Cardiovascular Science, University of Sheffield, and Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Papafaklis MI, Takahashi S, Antoniadis AP, Coskun AU, Tsuda M, Mizuno S, Andreou I, Nakamura S, Makita Y, Hirohata A, Saito S, Feldman CL, Stone PH. Effect of the local hemodynamic environment on the de novo development and progression of eccentric coronary atherosclerosis in humans: insights from PREDICTION. Atherosclerosis 2015; 240:205-11. [PMID: 25801012 DOI: 10.1016/j.atherosclerosis.2015.03.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/17/2015] [Accepted: 03/10/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Eccentric distribution of atheroma has been associated with plaques likely to rupture and cause an acute coronary syndrome, but the factors responsible for the development of eccentricity remain unknown. Endothelial shear stress (ESS) drives plaque formation. We aimed to investigate the role of the local ESS characteristics in the de novo development and progressive worsening of plaque eccentricity in humans. METHODS Vascular profiling (3-vessel 3D coronary reconstruction by angiography/intravascular ultrasound, and blood flow simulation for ESS computation) was performed in 374 patients at baseline & 6-10 months follow-up. At baseline, we identified (i) disease-free segments (n=2157), and (ii) diseased regions of luminal obstructions (n=408). RESULTS In disease-free regions, baseline low ESS magnitude (p<0.001), marked ESS circumferential heterogeneity (p=0.001), and their interaction (p=0.026) were associated with an increased probability of de novo eccentric plaque formation at follow-up. In diseased regions, baseline low ESS (odds ratio [OR]: 2.33, p=0.003) and large plaque burden (OR: 2.46, p=0.002) were independent predictors of substantially increasing plaque eccentricity index with worsening lumen encroachment. This combined outcome was more frequent in obstructions with both features vs. all others (33 vs. 12%; p<0.001). The incidence of percutaneous coronary intervention in worsening obstructions with increasing plaque eccentricity was higher (13.3 vs. 4.3%, p=0.011). CONCLUSIONS The local hemodynamic environment has a critical effect on the development of eccentric coronary plaques at both an early and advanced stage of atherosclerosis. Local ESS assessment could help in predicting sites prone to plaque disruption and acute coronary syndromes in humans.
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Affiliation(s)
- Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Masaya Tsuda
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shingo Mizuno
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Frattolin J, Zarandi MM, Pagiatakis C, Bertrand OF, Mongrain R. Numerical study of stenotic side branch hemodynamics in true bifurcation lesions. Comput Biol Med 2015; 57:130-8. [DOI: 10.1016/j.compbiomed.2014.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/19/2014] [Accepted: 11/28/2014] [Indexed: 11/15/2022]
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Abdoli A, Dulikravich GS, Bajaj C, Stowe DF, Jahania MS. Human heart conjugate cooling simulation: unsteady thermo-fluid-stress analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1372-1386. [PMID: 25045006 PMCID: PMC4351112 DOI: 10.1002/cnm.2662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/25/2014] [Accepted: 07/06/2014] [Indexed: 06/03/2023]
Abstract
The main objective of this work was to demonstrate computationally that realistic human hearts can be cooled much faster by performing conjugate heat transfer consisting of pumping a cold liquid through the cardiac chambers and major veins while keeping the heart submerged in cold gelatin filling a cooling container. The human heart geometry used for simulations was obtained from three-dimensional, high resolution CT-angio scans. Two fluid flow domains for the right (pulmonic) and left (systemic) heart circulations, and two solid domains for the heart tissue and gelatin solution were defined for multi-domain numerical simulation. Detailed unsteady temperature fields within the heart tissue were calculated during the conjugate cooling process. A linear thermoelasticity analysis was performed to assess the stresses applied on the heart due to the coolant fluid shear and normal forces and to examine the thermal stress caused by temperature variation inside the heart. It was demonstrated that a conjugate cooling effort with coolant temperature at +4°C is capable of reducing the average heart temperature from +37°C to +8°C in 25 minutes for cases in which the coolant was steadily pumped only through major heart inlet veins and cavities.
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Affiliation(s)
- Abas Abdoli
- Department of Mechanical and Materials Engineering, MAIDROC Laboratory, Florida International University, Miami, FL, 33174
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ZHOU TIAN, ZHENG YIMING, QIU JUHUI, HU JIANJUN, SUN DAMING, TANG CHAOJUN, WANG GUIXUE. ENDOTHELIAL MECHANOTRANSDUCTION MECHANISMS FOR VASCULAR PHYSIOLOGY AND ATHEROSCLEROSIS. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414300063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vascular physiology and disease progression, such as atherosclerosis, are mediated by hemodynamic force generated from blood flow. The hemodynamic force exerts on vascular endothelial cells (ECs), which could perceive the mechanical signals and transmit them into cell interior by multiple potential shear sensors, collectively known as mechanotransduction. However, we do not understand completely how these shear-sensitive components orchestrate physiological and atherosclerotic responses to shear stress. In this review, we provide an overview of biomechanical mechanisms underlying vascular physiology and atherosclerotic progression. Additionally, we summarize current evidences to illustrate that atherosclerotic lesions preferentially develop in arterial regions experiencing disturbance in blood flow, during which endothelial dysfunction is the initial event of atherosclerosis, inflammation plays dominant roles in atherosclerotic progression, and angiogenesis emerges as compensatory explanation for atherosclerotic plaque rupture. Especially in the presence of systemic risk factors (e.g., hyperlipidaemia, hypertension and hyperglycemia), the synergy between these systemic risk factors with hemodynamic factors aggravates atherosclerosis by co-stimulating some of these biomechanical events. Given the hemodynamic environment of vasculature, understanding how the rapid shear-mediated signaling, particularly in combination with systemic risk factors, contribute to atherosclerotic progression through endothelial dysfunction, inflammation and angiogenesis helps to elucidate the role for atherogenic shear stress in specifically localizing atherosclerotic lesions in arterial regions with disturbed flow.
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Affiliation(s)
- TIAN ZHOU
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, P. R. China
| | - YIMING ZHENG
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, P. R. China
| | - JUHUI QIU
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, P. R. China
| | - JIANJUN HU
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, P. R. China
| | - DAMING SUN
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, P. R. China
| | - CHAOJUN TANG
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, P. R. China
| | - GUIXUE WANG
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400044, P. R. China
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Schrauwen J, Wentzel J, van der Steen A, Gijsen F. Geometry-based pressure drop prediction in mildly diseased human coronary arteries. J Biomech 2014; 47:1810-5. [DOI: 10.1016/j.jbiomech.2014.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/14/2014] [Accepted: 03/19/2014] [Indexed: 12/18/2022]
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Computer methods for follow-up study of hemodynamic and disease progression in the stented coronary artery by fusing IVUS and X-ray angiography. Med Biol Eng Comput 2014; 52:539-56. [DOI: 10.1007/s11517-014-1155-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
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Caballero A, Laín S. Numerical simulation of non-Newtonian blood flow dynamics in human thoracic aorta. Comput Methods Biomech Biomed Engin 2014; 18:1200-1216. [DOI: 10.1080/10255842.2014.887698] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Melchionna S, Amati G, Bernaschi M, Bisson M, Succi S, Mitsouras D, Rybicki FJ. Risk assessment of atherosclerotic plaques based on global biomechanics. Med Eng Phys 2013; 35:1290-7; discussion 1290. [DOI: 10.1016/j.medengphy.2013.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 01/14/2023]
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Javadzadegan A, Yong ASC, Chang M, Ng ACC, Yiannikas J, Ng MKC, Behnia M, Kritharides L. Flow recirculation zone length and shear rate are differentially affected by stenosis severity in human coronary arteries. Am J Physiol Heart Circ Physiol 2013; 304:H559-66. [DOI: 10.1152/ajpheart.00428.2012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Flow recirculation zones and shear rate are associated with distinct pathogenic biological pathways relevant to thrombosis and atherogenesis. The interaction between stenosis severity and lesion eccentricity in determining the length of flow recirculation zones and peak shear rate in human coronary arteries in vivo is unclear. Computational fluid dynamic simulations were performed under resting and hyperemic conditions on computer-generated models and three-dimensional (3-D) reconstructions of coronary arteriograms of 25 patients. Boundary conditions for 3-D reconstructions simulations were obtained by direct measurements using a pressure-temperature sensor guidewire. In the computer-generated models, stenosis severity and lesion eccentricity were strongly associated with recirculation zone length and maximum shear rate. In the 3-D reconstructions, eccentricity increased recirculation zone length and shear rate when lesions of the same stenosis severity were compared. However, across the whole population of coronary lesions, eccentricity did not correlate with recirculation zone length or shear rate ( P = not signficant for both), whereas stenosis severity correlated strongly with both parameters ( r = 0.97, P < 0.001, and r = 0.96, P < 0.001, respectively). Nonlinear regression analyses demonstrated that the relationship between stenosis severity and peak shear was exponential, whereas the relationship between stenosis severity and recirculation zone length was sigmoidal, with an apparent threshold effect, demonstrating a steep increase in recirculation zone length between 40% and 60% diameter stenosis. Increasing stenosis severity and lesion eccentricity can both increase flow recirculation and shear rate in human coronary arteries. Flow recirculation is much more sensitive to mild changes in the severity of intermediate stenoses than is peak shear.
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Affiliation(s)
- Ashkan Javadzadegan
- Department of Mechanical Engineering, University of Sydney, Sydney, New South Wales, Australia
| | - Andy S. C. Yong
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; and
| | - Michael Chang
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; and
| | - Austin C. C. Ng
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; and
| | - John Yiannikas
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; and
| | - Martin K. C. Ng
- Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Masud Behnia
- Department of Mechanical Engineering, University of Sydney, Sydney, New South Wales, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; and
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40
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Yakushiji T, Maehara A, Mintz GS, Saito S, Araki H, Oviedo C, Choi SY, Tahk SJ, Leon MB, Stone GW, Moses JW, Ochiai M. An intravascular ultrasound comparison of left anterior descending artery/first diagonal branch versus distal left main coronary artery bifurcation lesions. EUROINTERVENTION 2013; 8:1040-6. [PMID: 23339810 DOI: 10.4244/eijv8i9a160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We report the intravascular ultrasound (IVUS) analysis of plaque distribution in left anterior descending (LAD) artery/first diagonal (D1) and distal left main coronary artery (LMCA) bifurcation lesion location. METHODS AND RESULTS We reviewed 58 angiograms of LAD/D1 bifurcation lesions with pre-intervention IVUS of both the LAD and D1 and compared these data to a corresponding cohort (n=81) of LMCA bifurcations, dividing each bifurcation into three segments: MV (main vessel), MB (main branch distal to the carina), and SB (side branch). In the LAD/D1 cohort, D1 (SB) had less calcium and a smaller plaque burden compared to the other two segments. Continuous plaque from the LAD proximal to the carina (MV) into the LAD distal to the carina (MB) was seen in 90%, from the MV into the SB in 72%, and from the MV into both the MB and SB in 62%. In the LMCA cohort, ostial left circumflex (LCX) (SB) had less calcium and a smaller plaque burden compared to the distal LMCA (MV) and ostial LAD (MB). Continuous plaque from MV to MB was seen in 96%, from MV to the SB in 78%, and from MV to both branches in 74%. CONCLUSIONS The IVUS analysis of the LAD/D1 and LMCA bifurcations revealed that most lesions had diffuse plaques extending from the MV into the MB with the SB having the least amount of calcium and the smallest plaque burden, regardless of location.
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Affiliation(s)
- Tadayuki Yakushiji
- The Cardiovascular Research Foundation and Columbia University Medical Center, 111 East 59th Street, New York, NY 10022, USA
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41
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Hossain SS, Zhang Y, Liang X, Hussain F, Ferrari M, Hughes TJR, Decuzzi P. In silico vascular modeling for personalized nanoparticle delivery. Nanomedicine (Lond) 2012. [PMID: 23199308 DOI: 10.2217/nnm.12.124] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS To predict the deposition of nanoparticles in a patient-specific arterial tree as a function of the vascular architecture, flow conditions, receptor surface density and nanoparticle properties. MATERIALS & METHODS The patient-specific vascular geometry is reconstructed from computed tomography angiography images. The isogeometric analysis framework integrated with a special boundary condition for the firm wall adhesion of nanoparticles is implemented. A parallel plate flow chamber system is used to validate the computational model in vitro. RESULTS Particle adhesion is dramatically affected by changes in patient-specific attributes, such as branching angle and receptor density. The adhesion pattern correlates well with the spatial and temporal distribution of the wall shear rates. For the case considered, the larger (2.0 µm) particles adhere two-times more in the lower branches of the arterial tree, whereas the smaller (0.5 µm) particles deposit more in the upper branches. CONCLUSION Our computational framework in conjunction with patient-specific attributes can be used to rationally select nanoparticle properties to personalize, and thus optimize, therapeutic interventions.
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Affiliation(s)
- Shaolie S Hossain
- Department of Translational Imaging, The Methodist Hospital Research Institute, 6670 Bertner Avenue, Room R8-218, Houston, TX 77030, USA.
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42
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Clinical implications of coronary pressure measurement after stent implantation. Cardiovasc Interv Ther 2012; 28:170-7. [DOI: 10.1007/s12928-012-0147-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 11/06/2012] [Indexed: 11/25/2022]
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43
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Jamison RA, Siu KKW, Dubsky S, Armitage JA, Fouras A. X-ray velocimetry within the ex vivo carotid artery. JOURNAL OF SYNCHROTRON RADIATION 2012; 19:1050-1055. [PMID: 23093769 DOI: 10.1107/s0909049512033912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/29/2012] [Indexed: 06/01/2023]
Abstract
X-ray velocimetry offers a non-invasive method by which blood flow, blood velocity and wall shear stress can be measured in arteries prone to atherosclerosis. Analytical tools for measuring haemodynamics in artificial arteries have previously been developed and here the first quantification of haemodynamics using X-ray velocimetry in a living mammalian artery under physiologically relevant conditions is demonstrated. Whole blood seeded with a clinically used ultrasound contrast agent was pumped with a steady flow through live carotid arterial tissue from a rat, which was kept alive in a physiological salt solution. Pharmacological agents were then used to produce vascular relaxation. Velocity measurements were acquired with a spatial resolution of 14 µm × 14 µm and at a rate of 5000 acquisitions per second. Subtle velocity changes that occur are readily measurable, demonstrating the ability of X-ray velocimetry to sensitively and accurately measure haemodynamics ex vivo. Future applications and possible limitations of the technique are discussed, which allows for detailed living tissue investigations to be carried out for various disease models, including atherosclerosis and diabetic vasculopathy.
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Affiliation(s)
- R A Jamison
- Division of Biological Engineering, Monash University, Victoria 3800, Australia
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44
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Wentzel JJ, Chatzizisis YS, Gijsen FJH, Giannoglou GD, Feldman CL, Stone PH. Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling: current understanding and remaining questions. Cardiovasc Res 2012; 96:234-43. [PMID: 22752349 DOI: 10.1093/cvr/cvs217] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The heterogeneity of plaque formation, the vascular remodelling response to plaque formation, and the consequent phenotype of plaque instability attest to the extraordinarily complex pathobiology of plaque development and progression, culminating in different clinical coronary syndromes. Atherosclerotic plaques predominantly form in regions of low endothelial shear stress (ESS), whereas regions of moderate/physiological and high ESS are generally protected. Low ESS-induced compensatory expansive remodelling plays an important role in preserving lumen dimensions during plaque progression, but when the expansive remodelling becomes excessive promotes continued influx of lipids into the vessel wall, vulnerable plaque formation and potential precipitation of an acute coronary syndrome. Advanced plaques which start to encroach into the lumen experience high ESS at their most stenotic region, which appears to promote plaque destabilization. This review describes the role of ESS from early atherogenesis to early plaque formation, plaque progression to advanced high-risk stenotic or non-stenotic plaque, and plaque destabilization. The critical implication of the vascular remodelling response to plaque growth is also discussed. Current developments in technology to characterize local ESS and vascular remodelling in vivo may provide a rationale for innovative diagnostic and therapeutic strategies for coronary patients that aim to prevent clinical coronary syndromes.
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Affiliation(s)
- Jolanda J Wentzel
- Biomedical Engineering, Department Cardiology, ErasmusMC, Rotterdam, The Netherlands.
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45
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Stone PH, Saito S, Takahashi S, Makita Y, Nakamura S, Kawasaki T, Takahashi A, Katsuki T, Nakamura S, Namiki A, Hirohata A, Matsumura T, Yamazaki S, Yokoi H, Tanaka S, Otsuji S, Yoshimachi F, Honye J, Harwood D, Reitman M, Coskun AU, Papafaklis MI, Feldman CL. Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study. Circulation 2012; 126:172-81. [PMID: 22723305 DOI: 10.1161/circulationaha.112.096438] [Citation(s) in RCA: 464] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159.
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Affiliation(s)
- Peter H Stone
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
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46
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Coffindaffer-Wilson M, Craig MP, Hove JR. Normal interstitial flow is critical for developmental lymphangiogenesis in the zebrafish. Lymphat Res Biol 2012; 9:151-8. [PMID: 22066745 DOI: 10.1089/lrb.2011.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The lymphatic system plays a critical role in the body's fluid and protein homeostasis, immune regulation, and dietary fat absorption. One of the major pathologies of the lymphatic system is primary lymphedema, which occurs in approximately 0.6% of live births and is caused by missing or impaired lymphatic vessels. Although there is a great need for medical intervention into diseases of the lymphatic system, very little is known about its development or how it maintains integrity over time. Recent studies have suggested that biophysical components, such as local extracellular fluid flow, may be important factors during initiation of lymphangiogenesis. We hypothesize that interstitial fluid flow functions as an important morphoregulator during developmental lymphangiogenesis. METHODS AND RESULTS In the present study we use pharmacological agents and a mutant fish line to modulate interstitial flow. Our data confirm that a sufficient increase or decrease in interstitial flow can profoundly affect lymphatic patterning and may result in a lymphedema-like phenotype. Proper interstitial flow appears to be necessary during LEC migration for proper lymphatic development. CONCLUSIONS These results support the contention that interstitial flow is an important morphoregulator of developmental lymphangiogenesis.
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Affiliation(s)
- Mikah Coffindaffer-Wilson
- Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0576, USA.
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47
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Samady H, Eshtehardi P, McDaniel MC, Suo J, Dhawan SS, Maynard C, Timmins LH, Quyyumi AA, Giddens DP. Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease. Circulation 2011; 124:779-88. [PMID: 21788584 DOI: 10.1161/circulationaha.111.021824] [Citation(s) in RCA: 505] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Experimental studies suggest that low wall shear stress (WSS) promotes plaque development and high WSS is associated with plaque destabilization. We hypothesized that low-WSS segments in patients with coronary artery disease develop plaque progression and high-WSS segments develop necrotic core progression with fibrous tissue regression. METHODS AND RESULTS Twenty patients with coronary artery disease underwent baseline and 6-month radiofrequency intravascular ultrasound (virtual histology intravascular ultrasound) and computational fluid dynamics modeling for WSS calculation. For each virtual histology intravascular ultrasound segment (n=2249), changes in plaque area, virtual histology intravascular ultrasound-derived plaque composition, and remodeling were compared in low-, intermediate-, and high-WSS categories. Compared with intermediate-WSS segments, low-WSS segments developed progression of plaque area (P=0.027) and necrotic core (P<0.001), whereas high-WSS segments had progression of necrotic core (P<0.001) and dense calcium (P<0.001) and regression of fibrous (P<0.001) and fibrofatty (P<0.001) tissue. Compared with intermediate-WSS segments, low-WSS segments demonstrated greater reduction in vessel (P<0.001) and lumen area (P<0.001), and high-WSS segments demonstrated an increase in vessel (P<0.001) and lumen (P<0.001) area. These changes resulted in a trend toward more constrictive remodeling in low- compared with high-WSS segments (73% versus 30%; P=0.06) and more excessive expansive remodeling in high- compared with low-WSS segments (42% versus 15%; P=0.16). CONCLUSIONS Compared with intermediate-WSS coronary segments, low-WSS segments develop greater plaque and necrotic core progression and constrictive remodeling, and high-WSS segments develop greater necrotic core and calcium progression, regression of fibrous and fibrofatty tissue, and excessive expansive remodeling, suggestive of transformation to a more vulnerable phenotype. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00576576.
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Affiliation(s)
- Habib Samady
- Department of Medicine, Emory University School of Medicine, 1365 Clifton Rd, Ste F606, Atlanta, GA 30322, USA.
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48
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Melchionna S, Kaxiras E, Bernaschi M, Succi S. Endothelial shear stress from large-scale blood flow simulations. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:2354-2361. [PMID: 21536583 DOI: 10.1098/rsta.2011.0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We discuss the optimal evaluation of endothelial shear stress for real-life case studies based on anatomic data acquisition. The fluid dynamic simulations require smoothing of the geometric dataset to avoid major artefacts in the flow patterns, especially in the proximity of bifurcations. A systematic series of simulations at different corrugation levels shows that, below a smoothing length of about 0.5 mm, the numerical data are insensitive to further smoothing.
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Affiliation(s)
- Simone Melchionna
- Istituto per i Processi Chimico-Fisici, Consiglio Nazionale delle Ricerche, Rome, Italy.
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49
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Behan MW, Holm NR, Curzen NP, Erglis A, Stables RH, de Belder AJ, Niemelä M, Cooter N, Chew DP, Steigen TK, Oldroyd KG, Jensen JS, Lassen JF, Thuesen L, Hildick-Smith D. Simple or Complex Stenting for Bifurcation Coronary Lesions. Circ Cardiovasc Interv 2011; 4:57-64. [DOI: 10.1161/circinterventions.110.958512] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Controversy persists regarding the correct strategy for bifurcation lesions. Therefore, we combined the patient-level data from 2 large trials with similar methodology: the NORDIC Bifurcation Study (NORDIC I) and the British Bifurcation Coronary Study (BBC ONE).
Methods and Results—
Both randomized trials compared simple (provisional T-stenting) versus complex techniques, using drug-eluting stents. In the simple group (n=457), 129 patients had final kissing balloon dilatation in addition to main vessel stenting, and 16 had T-stenting. In the complex group (n=456), 272 underwent crush, 118 culotte, and 59 T-stenting techniques. A composite end point at 9 months of all-cause death, myocardial infarction, and target vessel revascularization occurred in 10.1% of the simple versus 17.3% of the complex group (hazard ratio 1.84 [95% confidence interval 1.28 to 2.66],
P
=0.001). Procedure duration, contrast, and x-ray dose favored the simple approach. Subgroup analysis revealed similar composite end point results for true bifurcations (n=657, simple 9.2% versus complex 17.3%; hazard ratio 1.90 [95% confidence interval 1.22 to 2.94],
P
=0.004), wide-angled bifurcations >60 to 70° (n=217, simple 9.6% versus complex 15.7%; hazard ratio 1.67 [ 95% confidence interval 0.78 to 3.62],
P
=0.186), large (≥2.75 mm) diameter side branches (n=281, simple 10.4% versus complex 20.7%; hazard ratio 2.42 [ 95% confidence interval 1.22 to 4.80],
P
=0.011), longer length (>5 mm) ostial side branch lesions (n=464, simple 12.1% versus complex 19.1%; hazard ratio 1.71 [95% confidence interval 1.05 to 2.77],
P
=0.029), or equivalent sized vessels (side branch <0.25 mm smaller than main vessel) (n=108, simple 12.0% versus complex 15.5%; hazard ratio 1.35 [95% confidence interval 0.48 to 3.70],
P
=0.57).
Conclusions—
For bifurcation lesions, a provisional single-stent approach is superior to systematic dual stenting techniques in terms of safety and efficacy. A complex approach does not appear to be beneficial in more anatomically complicated lesions.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT 00376571 and NCT 00351260.
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Affiliation(s)
- Miles W. Behan
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Niels R. Holm
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Nicholas P. Curzen
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Andrejs Erglis
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Rodney H. Stables
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Adam J. de Belder
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Matti Niemelä
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Nina Cooter
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Derek P. Chew
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Terje K. Steigen
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Keith G. Oldroyd
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Jan S. Jensen
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Jens Flensted Lassen
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - Leif Thuesen
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
| | - David Hildick-Smith
- From the Golden Jubilee National Hospital (M.W.B., K.G.O.), Glasgow, United Kingdom; Department of Cardiology (N.R.H., J.F.L., L.T.), Aarhus University Hospital, Skejby, Aarhus, Denmark; Southampton University Hospitals (N.P.C.), Southampton, United Kingdom; Latvian Centre of Cardiology (A.E.), Paul Stradins Clinical Hospital, Riga, Latvia; Liverpool Heart and Chest Hospital (R.H.S.), Liverpool, United Kingdom; Sussex Cardiac Centre (A.J.d.B., N.C., D.H.-S.), Brighton and Sussex University Hospitals
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Custodis F, Schirmer SH, Baumhäkel M, Heusch G, Böhm M, Laufs U. Vascular Pathophysiology in Response to Increased Heart Rate. J Am Coll Cardiol 2010; 56:1973-83. [DOI: 10.1016/j.jacc.2010.09.014] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/29/2010] [Accepted: 09/15/2010] [Indexed: 11/25/2022]
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