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Rigatelli G, Zuin M, Marchese G, Rodino G, Hiso E, Mileva N, Vassilev D, Pasquetto G. Residence time in complex left main bifurcation disease after stenting. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:1-5. [PMID: 37996263 DOI: 10.1016/j.carrev.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Data regarding the mean resident time (RT) after left main (LM) bifurcation stenting are scant. In the present study we performed a patient-specific computational fluid dynamic (CFD) analysis to investigate the different post-stenting mean RT values in LM patients treated with single-or double stenting techniques. METHODS Patients were identified after reviewing the local Optical Coherence Tomography (OCT) scans database. Overall, 27 patients (mean age 65.5 ± 12.4, 21 males) [10 patients treated with provisional cross-over stenting, 7 with the double kissing crush (DK crush) and 10 with the nano-inverted T (NIT) technique, respectively] with isolated and significant LM bifurcation disease were analyzed. RESULTS After LM bifurcation stenting, the NIT showed a higher averages WSS values at all bifurcation sites compared to DK crush and provisional cross-over stenting. Moreover, the mean RT resulted lower after NIT compared to provisional or DK crush. During the diastolic phase, the average RT of the entire LM bifurcation was 0.46 s, 0.38 s and 0.33 s after using the provisional stenting, DK crush and NIT, respectively. Moreover, the average RT in the LM bifurcation decreased by 17.1 % using the DK crush and by 28.2 % using the NIT compared to the Provisional. CONCLUSION The present OCT-derived CFD analysis revealed that, in patients with complex bifurcation LM disease, the provisional approach resulted in lower WSS values, while double stenting techniques, especially the NIT technique, resulted in a marked reduction of average RT compared to the provisional approach. CONDENSED ABSTRACT In the present study we performed a patient-specific Optical coherence tomography (OCT)-based computational fluid dynamic (CFD) analysis to investigate the different post-stenting mean RT values in 27 patients treated with provisional cross-over stenting, DK crush and Nano-inverted-T (NIT) stenting. The NIT showed a higher averages WSS values at all bifurcation sites compared to DK crush and Provisional. The mean RT resulted lower in NIT compared to Provisional or DK crush. During the entire diastolic phase, the average RT of the entire LM bifurcation was 0.46 s, 0.38 s and 0.33 s after using the provisional stenting, DK crush and NIT, respectively. Moreover, the average RT in the entire LM bifurcation decreased by 17.1 % using the DK crush and by 28.2 % using the NIT compared to the Provisional.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy.
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giuseppe Marchese
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Giulio Rodino
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Ervis Hiso
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Niya Mileva
- Department of Cardiology, MedicaCor Hospital, Russe, Bulgaria
| | - Dobrin Vassilev
- Department of Cardiology, MedicaCor Hospital, Russe, Bulgaria
| | - Giampaolo Pasquetto
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
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Rafiei A, Saidi M. Aneurysm geometric features effect on the hemodynamic characteristics of blood flow in coronary artery: CFD simulation on CT angiography-based model. Med Biol Eng Comput 2022; 60:3357-3375. [DOI: 10.1007/s11517-022-02676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
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Chen S, Zhang H, Hou Q, Zhang Y, Qiao A. Multiscale Modeling of Vascular Remodeling Induced by Wall Shear Stress. Front Physiol 2022; 12:808999. [PMID: 35153816 PMCID: PMC8829510 DOI: 10.3389/fphys.2021.808999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/27/2021] [Indexed: 01/04/2023] Open
Abstract
Objective Hemodynamics-induced low wall shear stress (WSS) is one of the critical reasons leading to vascular remodeling. However, the coupling effects of WSS and cellular kinetics have not been clearly modeled. The aim of this study was to establish a multiscale modeling approach to reveal the vascular remodeling behavior under the interaction between the macroscale of WSS loading and the microscale of cell evolution. Methods Computational fluid dynamics (CFD) method and agent-based model (ABM), which have significantly different characteristics in temporal and spatial scales, were adopted to establish the multiscale model. The CFD method is for the second/organ scale, and the ABM is for the month/cell scale. The CFD method was used to simulate blood flow in a vessel and obtain the WSS in a vessel cross-section. The simulations of the smooth muscle cell (SMC) proliferation/apoptosis and extracellular matrix (ECM) generation/degradation in a vessel cross-section were performed by using ABM. During the simulation of the vascular remodeling procedure, the damage index of the SMC and ECM was defined as deviation from the obtained WSS. The damage index decreased gradually to mimic the recovery of WSS-induced vessel damage. Results (1) The significant wall thickening region was consistent with the low WSS region. (2) There was no evident change of wall thickness in the normal WSS region. (3) When the damage index approached to 0, the amount and distribution of SMCs and ECM achieved a stable state, and the vessel reached vascular homeostasis. Conclusion The established multiscale model can be used to simulate the vascular remodeling behavior over time under various WSS conditions.
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Sadeghian M, Mohammadi V, Shafiee A, Babakhani H. Non-Invasive Flow Ratio (NiFR) Measurement based on Angiography Images. J Biomed Phys Eng 2021; 11:685-692. [PMID: 34904065 PMCID: PMC8649163 DOI: 10.31661/jbpe.v0i0.1160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/08/2019] [Indexed: 11/16/2022]
Abstract
Background: Fractional flow reserve (FFR) is a gold standard to assess the impact of stenosis on the blood flow. The FFR method enhances diagnostic accuracy, lessens the need for stenting, and reduces costs.
However, FFR is used in less than 10% of percutaneous coronary intervention (PCI) procedures because it needs pressure wires to measure the distal and proximal pressures and adenosine to
create hyperemic conditions. Pressure-wire-based FFR measurement is, therefore, expensive and invasive. Objective: This study aims to introduce a new approach on the basis of 3D coronary angiography and the Thrombolysis in Myocardial Infarction (TIMI) frame count for fast computation of FFR in
patients with coronary artery disease. Material and Methods: In this simulation study, we herein introduce Non-Invasive Flow Ratio drawing upon CFD to measure FFR based on coronary angiography images with less run time.
In this study, 3D geometry was created based on coronary angiography images. The mean volumetric flow rate was calculated using the TIMI frame count.
FFR calculated based on CFD was compared with pressure-wire-based FFR and NiFR was calculated in 85 patients. Results: The NiFR (r = 0.738, P< 0.001) exhibited a strong correlation with pressure-wire-based FFR. The result indicated that FFR was higher than 0.8 in the arteries
with non-significant stenosis and lower than 0.8 in the arteries with significant stenosis. Conclusion: The computational simulation of FFR and hemodynamic parameters such as pressure drop is a safe, efficient, and cost-effective method to evaluate the severity of coronary stenosis.
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Affiliation(s)
- Mohammad Sadeghian
- MD, Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Mohammadi
- MD, Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- MD, Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Babakhani
- MSc, Department of Mechanical Engineering, Tarbiat Modarres University, Tehran, Iran
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Rigatelli G, Chiastra C, Pennati G, Dubini G, Migliavacca F, Zuin M. Applications of computational fluid dynamics to congenital heart diseases: a practical review for cardiovascular professionals. Expert Rev Cardiovasc Ther 2021; 19:907-916. [PMID: 34704881 DOI: 10.1080/14779072.2021.1999229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The increased survival rate of patients with congenital heart disease (CHD) has made it likely that 70%-95% of infants with CHDs surviving into adulthood often require careful follow-up and (repeat) interventions. Patients with CHDs often have abnormal blood flow patterns, due to both primary cardiac defect and the consequent surgical or endovascular repair. AREA COVERED Computational fluid dynamics (CFD) alone or coupled with advanced imaging tools can assess blood flow patterns of CHDs to both understand their pathophysiology and anticipate the results of surgical or interventional repair. EXPERT OPINION CFD is a mathematical technique that quantifies and describes the characteristics of fluid flow using the laws of physics. Through dedicated software based on virtual reconstruction and simulation and patients' real data coming from computed tomography, magnetic resonance imaging, and 3/4 D-ultrasound, reconstruction of models of circulation of most CHD can be accomplished. CFD can provide insights about the pathophysiology of coronary artery anomalies, interatrial shunts, coarctation of the aorta and aortic bicuspid valve, tetralogy of Fallot and univentricular heart, with the capability in some cases of simulating different types of surgical or interventional repair and tailoring the treatment on the basis of these findings.
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Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Claudio Chiastra
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics (Labs), Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan, Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (Labs), Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (Labs), Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy
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Hossain T, Anan N, Arafat MT. The effects of plaque morphological characteristics on the post-stenotic flow in left main coronary artery bifurcation. Biomed Phys Eng Express 2021; 7. [PMID: 34425569 DOI: 10.1088/2057-1976/ac202c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Abstract
Local post-stenotic hemodynamics has critical influence in the atherosclerotic plaque progression occurring in susceptible arterial sites, in particular the left main coronary artery (LMCA) bifurcation. Understanding the effects of plaque morphological characteristics: stenosis severity (SS), eccentricity index (EI) and lesion length (LL) on the post-stenotic flow behavior can significantly improve treatment planning. In order to investigate these effects, we have employed computational fluid dynamics (CFD) simulations in twenty computer-generated and five patient-specific LMCA models and the hemodynamic parameters: velocity, pressure (P), wall pressure gradient (WPG), wall shear stress (WSS), time averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT) and helicity intensity (h2) were analyzed. Our results revealed that the effect of stenosis eccentricity varied significantly for different values of stenosis severity and lesion length. Regions with low WSS, low TAWSS and high RRT were more prominent in models having higher stenosis severity. For smaller lesion length, at low and moderate stenosis severity, surface area with low TAWSS and high RRT decreased with increasing eccentricity index, whereas for high stenosis severity models, low TAWSS region and average RRT values increased with eccentricity. However, for models with longer lesion length, regions with high OSI and RRT overall increased gradually with eccentricity. The helicity intensity (h2) of all models remained very low except at the most eccentric model with longer lesion length. The presence of very high helical flow in this model suggests the possibility of atheroprotective flow. It can be concluded that all plaque morphological characteristics covered under this investigation play an important role in plaque progression.
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Affiliation(s)
- Tahura Hossain
- Department of Biomedical Engineering, Military Institute of Science and Technology (MIST), Dhaka-1216, Bangladesh
| | - Noushin Anan
- Department of Biomedical Engineering, Military Institute of Science and Technology (MIST), Dhaka-1216, Bangladesh
| | - M Tarik Arafat
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka-1205, Bangladesh
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De Nisco G, Chiastra C, Hartman EMJ, Hoogendoorn A, Daemen J, Calò K, Gallo D, Morbiducci U, Wentzel JJ. Comparison of Swine and Human Computational Hemodynamics Models for the Study of Coronary Atherosclerosis. Front Bioeng Biotechnol 2021; 9:731924. [PMID: 34409022 PMCID: PMC8365882 DOI: 10.3389/fbioe.2021.731924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Coronary atherosclerosis is a leading cause of illness and death in Western World and its mechanisms are still non completely understood. Several animal models have been used to 1) study coronary atherosclerosis natural history and 2) propose predictive tools for this disease, that is asymptomatic for a long time, aiming for a direct translation of their findings to human coronary arteries. Among them, swine models are largely used due to the observed anatomical and pathophysiological similarities to humans. However, a direct comparison between swine and human models in terms of coronary hemodynamics, known to influence atherosclerotic onset/development, is still lacking. In this context, we performed a detailed comparative analysis between swine- and human-specific computational hemodynamic models of coronary arteries. The analysis involved several near-wall and intravascular flow descriptors, previously emerged as markers of coronary atherosclerosis initiation/progression, as well as anatomical features. To do that, non-culprit coronary arteries (18 right–RCA, 18 left anterior descending–LAD, 13 left circumflex–LCX coronary artery) from patients presenting with acute coronary syndrome were imaged by intravascular ultrasound and coronary computed tomography angiography. Similarly, the three main coronary arteries of ten adult mini-pigs were also imaged (10 RCA, 10 LAD, 10 LCX). The geometries of the imaged coronary arteries were reconstructed (49 human, 30 swine), and computational fluid dynamic simulations were performed by imposing individualized boundary conditions. Overall, no relevant differences in 1) wall shear stress-based quantities, 2) intravascular hemodynamics (in terms of helical flow features), and 3) anatomical features emerged between human- and swine-specific models. The findings of this study strongly support the use of swine-specific computational models to study and characterize the hemodynamic features linked to coronary atherosclerosis, sustaining the reliability of their translation to human vascular disease.
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Affiliation(s)
- Giuseppe De Nisco
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Eline M J Hartman
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Ayla Hoogendoorn
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Joost Daemen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Karol Calò
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
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van Zandwijk JK, Tuncay V, Vliegenthart R, Pelgrim GJ, Slump CH, Oudkerk M, van Ooijen PMA. Assessment of Dynamic Change of Coronary Artery Geometry and Its Relationship to Coronary Artery Disease, Based on Coronary CT Angiography. J Digit Imaging 2021; 33:480-489. [PMID: 31745678 PMCID: PMC7165136 DOI: 10.1007/s10278-019-00300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate the relationship between dynamic changes of coronary artery geometry and coronary artery disease (CAD) using computed tomography (CT). Seventy-one patients underwent coronary CT angiography with retrospective electrocardiographic gating. End-systolic (ES) and end-diastolic (ED) phases were automatically determined by dedicated software. Centerlines were extracted for the right and left coronary artery. Differences between ES and ED curvature and tortuosity were determined. Associations of change in geometrical parameters with plaque types and degree of stenosis were investigated using linear mixed models. The differences in number of inflection points were analyzed using Wilcoxon signed-rank tests. Tests were done on artery and segment level. One hundred thirty-seven arteries (64.3%) and 456 (71.4%) segments were included. Curvature was significantly higher in ES than in ED phase for arteries (p = 0.002) and segments (p < 0.001). The difference was significant only at segment level for tortuosity (p = 0.005). Number of inflection points was significantly higher in ES phase on both artery and segment level (p < 0.001). No significant relationships were found between degree of stenosis and plaque types and dynamic change in geometrical parameters. Non-invasive imaging by cardiac CT can quantify change in geometrical parameters of the coronary arteries during the cardiac cycle. Dynamic change of vessel geometry through the cardiac cycle was not found to be related to the presence of CAD.
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Affiliation(s)
- Jordy K van Zandwijk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Volkan Tuncay
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Gert Jan Pelgrim
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Matthijs Oudkerk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Sharzehee M, Seddighi Y, Sprague EA, Finol EA, Han HC. A Hemodynamic Comparison of Myocardial Bridging and Coronary Atherosclerotic Stenosis: A Computational Model With Experimental Evaluation. J Biomech Eng 2021; 143:031013. [PMID: 33269788 DOI: 10.1115/1.4049221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 11/08/2022]
Abstract
Myocardial bridging (MB) and coronary atherosclerotic stenosis can impair coronary blood flow and may cause myocardial ischemia or even heart attack. It remains unclear how MB and stenosis are similar or different regarding their impacts on coronary hemodynamics. The purpose of this study was to compare the hemodynamic effects of coronary stenosis and MB using experimental and computational fluid dynamics (CFD) approaches. For CFD modeling, three MB patients with different levels of lumen obstruction, mild, moderate, and severe were selected. Patient-specific left anterior descending (LAD) coronary artery models were reconstructed from biplane angiograms. For each MB patient, the virtually healthy and stenotic models were also simulated for comparison. In addition, an in vitro flow-loop was developed, and the pressure drop was measured for comparison. The CFD simulations results demonstrated that the difference between MB and stenosis increased with increasing MB/stenosis severity and flowrate. Experimental results showed that increasing the MB length (by 140%) only had significant impact on the pressure drop in the severe MB (39% increase at the exercise), but increasing the stenosis length dramatically increased the pressure drop in both moderate and severe stenoses at all flow rates (31% and 93% increase at the exercise, respectively). Both CFD and experimental results confirmed that the MB had a higher maximum and a lower mean pressure drop in comparison with the stenosis, regardless of the degree of lumen obstruction. A better understanding of MB and atherosclerotic stenosis may improve the therapeutic strategies in coronary disease patients and prevent acute coronary syndromes.
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Affiliation(s)
- Mohammadali Sharzehee
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249
| | - Yasamin Seddighi
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249
| | - Eugene A Sprague
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229
| | - Ender A Finol
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249
| | - Hai-Chao Han
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249
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Piemjaiswang R, Ding Y, Feng Y, Piumsomboon P, Chalermsinsuwan B. Effect of transport parameters on atherosclerotic lesion growth: A parameter sensitivity analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 199:105904. [PMID: 33360530 DOI: 10.1016/j.cmpb.2020.105904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Atherosclerosis is a degenerative disease of the arterial wall. It results in the formation of progressively growing plaque lesions that can harden and narrow their host arteries. Current computational models of the inflammatory process that govern atherosclerosis growth are reliant on a number of parameters that can freely vary and whose precise values are not well known. METHODS To identify the significance of variation in such parameters, a parametric sensitivity study had been conducted on the blood density, blood viscosity, plasma viscosity and bulk flow low density lipoprotein (LDL) concentration. Using computational modeling, the significance of variation in these parameters was assessed on the transport of LDL. The simulation was performed via the 2k factorial experimental design, which was conducted to identify the significance of the select parameters on the intima LDL concentration and endothelial LDL coverage area. RESULTS Results identified the blood viscosity and bulk flow LDL concentration are the dominant parameters for the atherosclerotic lesion growth. The coverage of LDL on the arterial wall surface was strongly dependent on the blood viscosity. The significance of these findings was discussed. CONCLUSION This statistical study identifies two dominating blood factors, LDL concentration and blood viscosity, and how they influence atherosclerosis which will serves as a guideline for further investigation on the atherosclerosis topic.
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Affiliation(s)
- Ratchanon Piemjaiswang
- Environmental Research Institute, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand; Department of Chemical Technology, Faculty of Science, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand
| | - Yan Ding
- Mathematical Sciences, School of Science, RMIT University, Victoria 3001, Australia
| | - Yuqing Feng
- CSIRO Minerals Resources, Clayton, Victoria 3169, Australia
| | - Pornpote Piumsomboon
- Department of Chemical Technology, Faculty of Science, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand; Advanced Computational Fluid Dynamics Research Unit, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand
| | - Benjapon Chalermsinsuwan
- Department of Chemical Technology, Faculty of Science, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand; Advanced Computational Fluid Dynamics Research Unit, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand.
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Rigatelli G, Zuin M. Computed Tomography-based Patient-specific Biomechanical and Fluid Dynamic Study of Anomalous Coronary Arteries with Origin from the Opposite Sinus and Intramural Course. Heart Int 2020; 14:105-111. [PMID: 36276502 PMCID: PMC9524708 DOI: 10.17925/hi.2020.14.2.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/04/2020] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) constitutes one of the most clinically relevant coronary artery anomalies in adults. Exact pathophysiology and the impact of intramural (IM) course segment stenting in ACAOS with IM course (ACAOS-IM) has not been clarified. We aimed to elucidate the pathophysiology and impact of stenting applying biomechanical and computational fluid dynamics to computed tomography (CT) in patient-specific coronary vessel reconstruction. METHODS We separated coronary artery (left or L-, right or R-) ACAOS-IM into segments (proximal, mid and distal), based on coronary angiography and coronary CT angiography features, in a series of patients at Rovigo General Hospital, Italy, between 1 January 2003 and 1 January 2018. Blood pressure gradient across the coronary circulation, calculated blood flow, vorticity magnitude, wall shear stress (WSS) and IM segment deformation were analysed by simulating exercise, before and after virtual stent implantation. RESULTS In 21 symptomatic patients (13 males, mean age 46.1 ± 8.1 years, L-ACAOS-IM in 9 and R-ACAOS-IM in 12 patients), computational fluid dynamic analysis in both L- and R-ACAOS demonstrated higher basal WSS values in the IM course (9.5 ± 0.2 and 8.6 ± 0.2 Pa for R- and L-ACAOS, respectively), than in the rest of the vessels. These values decreased after stenting. Vorticity magnitude significantly decreased after stenting as well, compared with baseline. Biomechanical deformation analysis revealed not only compression, but also a twisting of the IM segment with a mean distal pressure drop of 32% and 35% in R- and L-ACAOS, respectively, which was corrected by stent implantation. CONCLUSIONS In both L- and R-ACAOS subtypes, the IM segment appeared to be phasically compressed and deformed with a degree of twisting that causes resting and exercise cross-sectional deformation and a drop in distal pressure. Stenting of the IM segment results in normalisation of the flow profile, correction of the IM segment deformation and reverses the drop in pressure, for both variants of ACAOS.
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Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
- Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy
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Su B, Zhang JM, Zou H, Ghista D, Le TT, Chin C. Generating wall shear stress for coronary artery in real-time using neural networks: Feasibility and initial results based on idealized models. Comput Biol Med 2020; 126:104038. [PMID: 33039809 DOI: 10.1016/j.compbiomed.2020.104038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/14/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022]
Abstract
Computational fluid dynamics (CFD) and medical imaging can be integrated to derive some important hemodynamic parameters such as wall shear stress (WSS). However, CFD suffers from a relatively long computational time that usually varies from dozens of minutes to hours. Machine learning is a popular tool that has been applied to many fields, and it can predict outcomes fast and even instantaneously in most applications. This study aims to use machine learning as an alternative to CFD for generating hemodynamic parameters in real-time diagnosis during medical examinations. To perform the feasibility study, we used CFD to model the blood flow in 2000 idealized coronary arteries, and the calculated WSS values in these models were used as the dataset for training and testing. The preparation of the dataset was automated by scripts programmed in Python, and OpenFOAM was used as the CFD solver. We have explored multivariate linear regression, multi-layer perceptron, and convolutional neural network architectures to generate WSS values from coronary artery geometry directly without CFD. These architectures were implemented in TensorFlow 2.0. Our results showed that these algorithms were able to generate results in less than 1 s, proving its capability in real-time applications, in terms of computational time. Based on the accuracy, convolutional neural network outperformed the other architectures with a normalized mean absolute error of 2.5%. Although this study is based on idealized models, to the best of our knowledge, it is the first attempt to predict WSS in a stenosed coronary artery using machine learning approaches.
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Affiliation(s)
- Boyang Su
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.
| | - Jun-Mei Zhang
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore
| | - Hua Zou
- Department of Statistics, Texas A&M University, TX, USA
| | | | - Thu Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore
| | - Calvin Chin
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore
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13
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Lodi Rizzini M, Gallo D, De Nisco G, D'Ascenzo F, Chiastra C, Bocchino PP, Piroli F, De Ferrari GM, Morbiducci U. Does the inflow velocity profile influence physiologically relevant flow patterns in computational hemodynamic models of left anterior descending coronary artery? Med Eng Phys 2020; 82:58-69. [PMID: 32709266 DOI: 10.1016/j.medengphy.2020.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/03/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Patient-specific computational fluid dynamics is a powerful tool for investigating the hemodynamic risk in coronary arteries. Proper setting of flow boundary conditions in computational hemodynamic models of coronary arteries is one of the sources of uncertainty weakening the findings of in silico experiments, in consequence of the challenging task of obtaining in vivo 3D flow measurements within the clinical framework. Accordingly, in this study we evaluated the influence of assumptions on inflow velocity profile shape on coronary artery hemodynamics. To do that, (1) ten left anterior descending coronary artery (LAD) geometries were reconstructed from clinical angiography, and (2) eleven velocity profiles with realistic 3D features such as eccentricity and differently shaped (single- and double-vortex) secondary flows were generated analytically and imposed as inflow boundary conditions. Wall shear stress and helicity-based descriptors obtained prescribing the commonly used parabolic velocity profile were compared with those obtained with the other velocity profiles. Our findings indicated that the imposition of idealized velocity profiles as inflow boundary condition is acceptable as long the results of the proximal vessel segment are not considered, in LAD coronary arteries. As a pragmatic rule of thumb, a conservative estimation of the length of influence of the shape of the inflow velocity profile on LAD local hemodynamics can be given by the theoretical entrance length for cylindrical conduits in laminar flow conditions.
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Affiliation(s)
- Maurizio Lodi Rizzini
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Giuseppe De Nisco
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Pier Paolo Bocchino
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Piroli
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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14
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Abbasian M, Shams M, Valizadeh Z, Moshfegh A, Javadzadegan A, Cheng S. Effects of different non-Newtonian models on unsteady blood flow hemodynamics in patient-specific arterial models with in-vivo validation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 186:105185. [PMID: 31739277 DOI: 10.1016/j.cmpb.2019.105185] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/16/2019] [Accepted: 11/03/2019] [Indexed: 05/17/2023]
Abstract
The aim of this study is to demonstrate the implications of using different blood rheological models in the simulation of blood flow dynamics in atherosclerotic coronary arteries. Computational fluid dynamics simulation was performed using three-dimensional (3D) patient-specific models of diseased left anterior descending (LAD) coronary arteries with varying degrees of stenosis severity. The three-dimensional arterial models were reconstructed from 3D quantitative coronary angiography, and input flow conditions were prescribed with blood flow conditions measured in-vivo. Different blood viscosity models were used for the simulations, and they include Newtonian and also non-Newtonian models such as Bingham, Carreau, Carreau-Yasuda, Casson, modified Casson, Cross, modified Cross, simplified Cross, Herschel Bulkley, Kuang-Luo (K-L), PowellErying, modified PowellErying, Power-law, Quemada and Walburn-Schneck models. Results from this study show that the time-averaged velocity at the centre of the arteries produced in the CFD simulations that uses the Carreau, modified Casson or Quemada blood viscosity models corresponded exceptionally well with the clinical measurements regardless of stenosis severities and hence, highlights the usefulness of these models to determine the potential determinants of blood vessel wall integrity such as dynamic blood viscosity, blood velocity and wall shear stress.
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Affiliation(s)
- Majid Abbasian
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Mehrzad Shams
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran.
| | - Ziba Valizadeh
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Abouzar Moshfegh
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia
| | - Ashkan Javadzadegan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia
| | - Shaokoon Cheng
- Department of Engineering, Macquarie University, Sydney, NSW 2109, Australia
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15
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Zuin M, Rigatelli G, Vassilev D, Ronco F, Rigatelli A, Roncon L. Computational fluid dynamic-derived wall shear stress of non-significant left main bifurcation disease may predict acute vessel thrombosis at 3-year follow-up. Heart Vessels 2020; 35:297-306. [PMID: 31482218 DOI: 10.1007/s00380-019-01494-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023]
Abstract
Wall shear stress (WSS) plays a pivotal role on plaque progression in coronary artery disease. We assess the prognostic role of baseline mean WSS in developing a bifurcation-located myocardial infarction (B-MI) over the following 3 years in angiographically non-significant LM bifurcation disease. For this purpose, we retrospectively reviewed the procedural and medical records of consecutive patients evaluated in our center from 1st January 2014 to 1st January 2019 who had a non-significant LM bifurcation disease as evaluated at coronary computed tomography angiography (CCTA) and confirmed by coronary angiography. Each bifurcation model was reconstructed on the patient-specific geometries derived from the CCTA. The population was divided into two groups: patients with (n = 12) and without B-MI (n = 20) over the following 3 years. Both the mean WSSprox of each branch and the WSSentire_lesion of each vessel, adjusted for the respective mean lesions lengths and 3-dimensional percentage of stenosis (DS%), resulted in independent predictors of 3-year B-MI. Multivariate Cox-regression analysis confirmed that a baseline mean WSSentire_model ≥ 5.05 Pa (HR 1.98, 95% CI 1.83-2.10, p = 0.001) was a predictor of 3-year B-MI independently from the entire mean lesions lengths (HR 1.56. 95% CI 1.43.1.68, p = 0.002) and DS% (HR 1.26, 95% CI 1.18-1.37, p = 0.03). In conclusion, in patients with angiographically non-significant LM bifurcation disease, both the mean WSSprox of each branch and WSSentire_lesion of each stenotic vessel predicted the occurrence of B-MI over the following 3 years. Moreover, the WSSentire_bifurcation ≥ 5.05 Pa seems to be a predictor of 3-year B-MI independently from the DS% and lesions lengths.
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Affiliation(s)
- Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria Della Misericordia Hospital, Viale Tre Martiri, 45100, Rovigo, Italy.
| | - Dobrin Vassilev
- "Alexandrovska" University Hospital, Medical University, Sofia, Bulgaria
| | - Federico Ronco
- Interventional Cardiology, Cardiology Department, Mestre General Hospital, Mestre, Italy
| | - Alberto Rigatelli
- Department of Emergency, Borgo Trento University Hospital, Verona, Italy
| | - Loris Roncon
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
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16
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Migliori S, Chiastra C, Bologna M, Montin E, Dubini G, Genuardi L, Aurigemma C, Mainardi L, Burzotta F, Migliavacca F. Application of an OCT-based 3D reconstruction framework to the hemodynamic assessment of an ulcerated coronary artery plaque. Med Eng Phys 2020; 78:74-81. [PMID: 32037282 DOI: 10.1016/j.medengphy.2019.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/23/2019] [Accepted: 12/01/2019] [Indexed: 01/09/2023]
Abstract
The rupture of a vulnerable plaque, known as ulceration, is the most common cause of myocardial infarction. It can be recognized by angiographic features, such as prolonged intraluminal filling and delayed clearance of the contrast liquid. The diagnosis of such an event is an open challenge due to the limited angiographic resolution and acquisition frequency. The treatment of ulcerated plaques is an open discussion, due to the high heterogeneity and the lack of evidences that support particular strategies. Therefore, the therapeutic decision should follow a detailed investigation with angiography and intravascular imaging, such as optical coherence tomography (OCT), to locate the lesion, besides its geometric features and the lumen occlusion severity. The aim of this study is the application of a framework for the in-silico analysis of the disrupted hemodynamics due to an ulcerated lesion. The study employed a validated OCT-based reconstruction methodology and computational fluid dynamics (CFD) simulations for the computation of local hemodynamic quantities, such as wall shear stress. The reported findings, such as disrupted pre-operative flow conditions, proved the applicability of the developed framework for CFD analyses on complicated patient-specific anatomies that feature ulcerated plaques. The prediction of lesion expansion and the clinical decision making can benefit from a reliable computation of wall shear stress distributions that result from the peculiar anatomy of the lesion. The application of intravascular OCT imaging, high fidelity 3D reconstructions and CFD simulations might guide the treatment of such pathology.
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Affiliation(s)
- Susanna Migliori
- Research and Development Department, Caristo Diagnostics, Oxford, United Kingdom; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marco Bologna
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Eros Montin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy; Center for Advanced Imaging Innovation and Research (CAI2R), and the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, United States
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Lorenzo Genuardi
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
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17
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Computational analysis of the coronary artery hemodynamics with different anatomical variations. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Zuin M, Rigatelli G, Chiastra C. Optimal Site for Proximal Optimization Technique in Complex Coronary Bifurcation Stenting: A Computational Fluid Dynamics Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:826-832. [PMID: 31866275 DOI: 10.1016/j.carrev.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE The optimal position of the balloon distal radio-opaque marker during the post optimization technique (POT) remains debated. We analyzed three potential different balloon positions for the final POT in two different two-stenting techniques, to compare the hemodynamic effects in terms of wall shear stress (WSS) in patients with complex left main (LM) coronary bifurcation. METHODS/MATERIALS We reconstructed the patient-specific coronary bifurcation anatomy using the coronary computed tomography angiography (CCTA) data of 8 consecutive patients (6 males, mean age 68.2± 18.6 years) affected by complex LM bifurcation disease. Subsequently a virtual bench test was performed in each patient using two different double stenting techniques represented by the DK and Nano crush using the reconstruction of Orsiro stents (Biotronik IC, Bulack, Switzerland). RESULTS A significant reduction in the mean WSS values in all the lesion's sites was observed when the final POT was performed 1 mm distally the carina cut plane in both techniques. Moreover, a significant improvement in the mean WSS values of the entire SB (e.g. LCX) was obtained performing the POT 1 mm distally to the carina cut plane. The proximal POT resulted in larger area of lower WSS values at the carina using both the Nano crush and the DK crush techniques. CONCLUSIONS In patients with complex LM bifurcation disease the use of a final POT performed 1 mm distally to the carina cut plane might results in more favorable WSS patterns (i.e. higher WSS values) along all stented segments and, especially, along the entire LCX lesions.
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Affiliation(s)
- Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Faculty of Medicine Ferrara, Italy; Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Rovigo, Italy.
| | - Claudio Chiastra
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Martens J, Panzer S, den Wijngaard J, Siebes M, Schreiber LM. Influence of contrast agent dispersion on bolus‐based MRI myocardial perfusion measurements: A computational fluid dynamics study. Magn Reson Med 2019; 84:467-483. [DOI: 10.1002/mrm.28125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Johannes Martens
- Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure CenterUniversity Hospitals Würzburg Germany
- Department of Cardiovascular Imaging Comprehensive Heart Failure Center University Hospitals Würzburg Germany
| | - Sabine Panzer
- Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure CenterUniversity Hospitals Würzburg Germany
- Department of Cardiovascular Imaging Comprehensive Heart Failure Center University Hospitals Würzburg Germany
| | - Jeroen den Wijngaard
- Department of Biomedical Engineering & Physics Amsterdam University Medical Center University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam Netherlands
- Department of Clinical Chemistry and Hematology Diakonessenhuis Utrecht Netherlands
| | - Maria Siebes
- Department of Biomedical Engineering & Physics Amsterdam University Medical Center University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam Netherlands
| | - Laura M. Schreiber
- Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure CenterUniversity Hospitals Würzburg Germany
- Department of Cardiovascular Imaging Comprehensive Heart Failure Center University Hospitals Würzburg Germany
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20
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Sharzehee M, Chang Y, Song JP, Han HC. Hemodynamic effects of myocardial bridging in patients with hypertrophic cardiomyopathy. Am J Physiol Heart Circ Physiol 2019; 317:H1282-H1291. [PMID: 31674812 DOI: 10.1152/ajpheart.00466.2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Myocardial bridging (MB) is linked to angina and myocardial ischemia and may lead to sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, it remains unclear how MB affect the coronary blood flow in HCM patients. The aim of this study was to assess the effects of MB on coronary hemodynamics in HCM patients. Fifteen patients with MB (7 HCM and 8 non-HCM controls) in their left anterior descending (LAD) coronary artery were chosen. Transient computational fluid dynamics (CFD) simulations were conducted in anatomically realistic models of diseased (with MB) and virtually healthy (without MB) LAD from these patients, reconstructed from biplane angiograms. Our CFD simulation results demonstrated that dynamic compression of MB led to diastolic flow disturbances and could significantly reduce the coronary flow in HCM patients as compared with non-HCM group (P < 0.01). The pressure drop coefficient was remarkably higher (P < 0.05) in HCM patients. The flow rate change is strongly correlated with both upstream Reynolds number and MB compression ratio, while the MB length has less impact on coronary flow. The hemodynamic results and clinical outcomes revealed that HCM patients with an MB compression ratio higher than 65% required a surgical intervention. In conclusion, the transient MB compression can significantly alter the diastolic flow pattern and wall shear stress distribution in HCM patients. HCM patients with severe MB may need a surgical intervention.NEW & NOTEWORTHY In this study, the hemodynamic significance of myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) was investigated to provide valuable information for surgical decision-making. Our results illustrated that the transient MB compression led to complex flow patterns, which can significantly alter the diastolic flow and wall shear stress distribution. The hemodynamic results and clinical outcomes demonstrated that patients with HCM and an MB compression ratio higher than 65% required a surgical intervention.
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Affiliation(s)
- Mohammadali Sharzehee
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, Texas
| | - Yuan Chang
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiang-Ping Song
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Hai-Chao Han
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, Texas
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Abstract
Background and Objective Ostial LM stenting potentially induces turbulence in the aortic wall near the LM ostium, which might be correlated with aorta dilation and dissection. We investigated through a computational fluid dynamic analysis (CFD), the presence and potential consequences of flow turbulences both in the ascending aorta and arch after a stenting left main (LM) mid shaft or distal disease. Methods The model of the ascending aorta and left coronary artery was reconstructed reviewing both angiographic and echocardiographic measurements of 80 consecutive patients (43 males, mean age 75.1 ± 6.2 years) with significant LM mid shaft or distal disease treated in our institution. For stent simulation, a third-generation everolimus-eluting stent was reconstructed. Two stenting procedures (lesion 1:1 or ostial coverage) were investigated. Results The net area averaged WSS of the model resulted higher when the stent covered the lesion 1:1 compared to the ostial coverage (3.68 vs. 2.06 Pa, P=0.01 and 3.97 vs. 1.98 Pa, P < 0.001, respectively). LM ostial coverage generates more turbulences in the LM itself, in the aortic wall at ostium level, and at the sino-tubular junction compared with the stenting of the lesion 1:1. Conversely, in the ascending aorta, the WSS appears lower when stenting the lesion 1:1. Conclusion Extending the stent coverage up to the ostium, when the ostial region is not diseased, might induce unfavorable alterations of flow; not only both at the level of the LM lesion and ostium sites, but also in the ascending aorta and aortic arch, potentially predisposing the aortic wall to long-term damage.
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22
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Javadzadegan A, Moshfegh A, Hassanzadeh Afrouzi H. Relationship between myocardial bridge compression severity and haemodynamic perturbations. Comput Methods Biomech Biomed Engin 2019; 22:752-763. [DOI: 10.1080/10255842.2019.1589458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ashkan Javadzadegan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Abouzar Moshfegh
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Hamid Hassanzadeh Afrouzi
- Faculty of Mechanical Engineering, Babol Noshirvani University of Technology, Babol, Iran
- Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
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23
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Javadzadegan A, Moshfegh A, Qian Y, Kritharides L, Yong AS. Myocardial bridging and endothelial dysfunction – Computational fluid dynamics study. J Biomech 2019; 85:92-100. [DOI: 10.1016/j.jbiomech.2019.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 12/26/2022]
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24
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Rigatelli G, Zuin M, Galasso P, Carraro M, D'Elia K, Daniela L, Roncon L, Truyen TTTT, Nguyen T. Mechanisms of Myocardial Ischemia Inducing Sudden Cardiac Death in Athletes with Anomalous Coronary Origin from the Opposite Sinus: Insights from a computational fluid dynamic study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1112-1116. [PMID: 30808598 DOI: 10.1016/j.carrev.2019.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 12/26/2022]
Abstract
AIMS The left coronary anomalous origin from the opposite sinus (L- ACAOS) constitutes the most clinically relevant arterial abnormality among the wide spectrum of coronary artery anomalies. We investigated the physiology of L-ACAOS with and without intramural course (IM) in athletes, using the computational fluid dynamic (CFD) analysis. METHODS AND RESULTS The coronary artery circulation with L-ACAOS with and without IM has been segmented and then reconstructed, after reviewing both the angiographic and computed tomography findings of 13 consecutive athletes (10 males, mean age 45.1 ± 8.2 years) with L-ACAOS collected in our institution between 1st January 2003 and 1st January 2018. Vorticity magnitude, static pressure and wall shear stress (WSS) have been analysed in a model of L-ACAOS with no IM course and in L-ACAOS-IM at rest and during exercise. The mean vorticity magnitude and WSS significantly increased from rest to exercise in both models, in right coronary artery, left anterior descending and left circumflex coronary arteries. The mean static pressure significantly increased with exercise in IM (1.118e + 004 vs 1.164e + 004 Pa, p < 0.001) as well as the mean vorticity magnitude and the mean WSS (7012.78 1/s vs 9019.56 1/s, p < 0.001, Δ = 2006.78 1/s and 3.02 Pa vs 2.11 Pa, p < 0.001, Δ = 0.91 Pa). This net increment was transmitted to the entire left coronary system in L-ACAOS-IM but not in L-ACAOS with no IM. CONCLUSIONS In L-ACAOS, different hemodynamic parameters observed in the intramural segment seem to confirm that IM is compressed during exercise. These rheological properties might propagated along the left coronary system, potentially predisposing, if confirmed in vivo, distal coronary segments to a higher risk of spasm and thrombosis in athletes.
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Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy.
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy; Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Paola Galasso
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Mauro Carraro
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Katia D'Elia
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Lanza Daniela
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Loris Roncon
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | | | - Thach Nguyen
- Tan Tao University, School of Medicine, Long An, Viet Nam; Cardiovascular Research, Methodist Hospital, Merrillville, IN, USA
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The relationship between coronary lesion characteristics and pathologic shear in human coronary arteries. Clin Biomech (Bristol, Avon) 2018; 60:177-184. [PMID: 30384262 DOI: 10.1016/j.clinbiomech.2018.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/06/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pathological shear stress is associated with distinct pathogenic biological pathways relevant to coronary thrombosis and atherogenesis. Although the individual effects of lesion characteristics including stenosis severity, eccentricity and lesion length on coronary haemodynamics is known, their relative importance remains poorly understood. METHODS Computational fluid dynamics (CFD) was implemented for haemodynamic analysis of 104 coronary arteries. For each coronary artery, maximum shear stress at the site of maximal stenosis, average shear stress over the sites of maximal stenosis segment, average shear stress in the proximal segments and average shear stress in the distal segments were determined. In addition, the area of low wall shear stress (ALWSS) sites in post-stenotic regions were quantified as a proportion of the vessel segment. RESULTS With increasing stenosis severity, eccentricity and lesion length, maximal and average shear stress over the sites of maximal stenosis and ALWSS increased whereas average shear stress in the proximal segments decreased. Two-way ANCOVA analysis revealed that stenosis severity and lesion length were both independent predictors of maximum shear at the site of maximal stenosis [F (1, 104) = 10.94, P = 0.001 for diameter stenosis and F (1, 104) = 6.21, P = 0.014 for lesion length] and ALWSS [F (1, 104) = 66.10, P = 0.001 for diameter stenosis and F (1, 104) = 4.23, P = 0.047 for lesion length]. CONCLUSION Our findings demonstrate that although all lesion characteristics correlate with abnormal shear stress, only stenosis severity and lesion length are independent predictors of pathogenic physiological processes.
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The Atheroprotective Nature of Helical Flow in Coronary Arteries. Ann Biomed Eng 2018; 47:425-438. [DOI: 10.1007/s10439-018-02169-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022]
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Javadzadegan A, Moshfegh A, Afrouzi HH, Omidi M. Magnetohydrodynamic blood flow in patients with coronary artery disease. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 163:111-122. [PMID: 30119846 DOI: 10.1016/j.cmpb.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/26/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We aim to investigate the effect of a magnetic field with varying intensities on haemodynamic perturbations in a cohort of patients with coronary artery disease. METHODS Transient computational fluid dynamics (CFD) simulations were performed in three-dimensional (3D) models of coronary arteries reconstructed from 3D quantitative coronary angiography. The effect of magnetic field on wall shear stress (WSS) derived parameters including maximum wall shear stress (MWSS) and size of regions with low wall shear stress (ALWSS) as well as length of flow recirculation zones were determined. RESULTS The results showed a substantial reduction in MWSS, ALWSS and length of flow recirculation zones in the presence of magnetic field, in particular for coronaries with moderate to severe stenoses. When the whole cohort examined, time-averaged wall shear stress (TAWSS), ALWSS and the length of flow recirculation zones in the absence of magnetic field were approximately 1.71, 4.69 and 8.46 times greater than those in the presence of magnetic field, respectively. CONCLUSION Our findings imply that an externally applied magnetic field can improve haemodynamic perturbations in human coronary arteries.
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Affiliation(s)
- Ashkan Javadzadegan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia; Concord Repatriation General Hospital, Sydney Local Health District, NSW 2139, Australia.
| | - Abouzar Moshfegh
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia; Concord Repatriation General Hospital, Sydney Local Health District, NSW 2139, Australia
| | | | - Mohammad Omidi
- Faculty of Mechanical Engineering, Babol Noshirvani University of Technology, Babol, Iran
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Javadzadegan A, Moshfegh A, Fulker D, Barber T, Qian Y, Kritharides L, Yong ASC. Development of a Computational Fluid Dynamics Model for Myocardial Bridging. J Biomech Eng 2018; 140:2681003. [DOI: 10.1115/1.4040127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 01/08/2023]
Abstract
Computational fluid dynamics (CFD) modeling of myocardial bridging (MB) remains challenging due to its dynamic and phasic nature. This study aims to develop a patient-specific CFD model of MB. There were two parts to this study. The first part consisted of developing an in silico model of the left anterior descending (LAD) coronary artery of a patient with MB. In this regard, a moving-boundary CFD algorithm was developed to simulate the patient-specific muscle compression caused by MB. A second simulation was also performed with the bridge artificially removed to determine the hemodynamics in the same vessel in the absence of MB. The second part of the study consisted of hemodynamic analysis of three patients with mild and moderate and severe MB in their LAD by means of the developed in silico model in the first part. The average shear stress in the proximal and bridge segments for model with MB were significantly different from those for model without MB (proximal segment: 0.32 ± 0.14 Pa (with MB) versus 0.97 ± 0.39 Pa (without MB), P < 0.0001 — bridge segment: 2.60 ± 0.94 Pa (with MB) versus 1.50 ± 0.64 Pa (without MB), P < 0.0001). When all three patients were evaluated, increasing the degree of vessel compression shear stress in the proximal segment decreased, whereas the shear stress in the bridge segment increased. The presence of MB resulted in hemodynamic abnormalities in the proximal segment, whereas segments within the bridge exhibited hemodynamic patterns which tend to discourage atheroma development.
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Affiliation(s)
- Ashkan Javadzadegan
- Faculty of Medicine and Health Sciences, Macquarie University, Level 1, 75 Talavera Road, Sydney 2109, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia e-mail:
| | - Abouzar Moshfegh
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia
| | - David Fulker
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia
| | - Tracie Barber
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia
| | - Yi Qian
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, NSW, Australia
| | - Leonard Kritharides
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney 2139, NSW, Australia
| | - Andy S. C. Yong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, NSW, Australia
- ANZAC Research Institute, The University of Sydney, Sydney 2139, NSW, Australia
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney 2139, NSW, Australia
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Rigatelli G, Zuin M, Dell'Avvocata F, Nguyen T. Rheolytic effects of left main mid-shaft/distal stenting: a computational flow dynamic analysis. Ther Adv Cardiovasc Dis 2018; 12:161-168. [PMID: 29589515 DOI: 10.1177/1753944718765734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to evaluate the rheolytic effects of stenting a mid-shaft/distal left main coronary artery (LMCA) lesion with and without ostial coverage. Stenting of the LMCA has emerged as a valid alternative in place of traditional coronary bypass graft surgery. However, in case of mid-shaft/distal lesion, there is no consensus regarding the extension of the strut coverage up to the ostium or to stent only the culprit lesion. Methods We reconstructed a left main-left descending coronary artery (LM-LCA)-left circumflex (LCX) bifurcation after analysing 100 consecutive patients (mean age 71.4 ± 9.3, 49 males) with LM mid-shaft/distal disease. The mean diameter of proximal LM, left anterior descending (LAD) and LCX, evaluated with quantitative coronary angiography (QCA) was 4.62 ± 0.86 mm, 3.31 ± 0.92 mm, and 2.74 ± 0.93 mm, respectively. For the stent simulation, a third-generation, everolimus-eluting stent was virtually reconstructed. Results After virtual stenting, the net area averaged wall shear stress (WSS) of the model and the WSS at the LCA-LCX bifurcation resulted higher when the stent covered the culprit mid-shaft lesion only compared with the extension of the stent covering the ostium (3.68 versus 2.06 Pa, p = 0.01 and 3.97 versus 1.98 Pa, p < 0.001, respectively. Similarly, the static pressure and the Reynolds number were significantly higher after stent implantation covering up the ostium. At the ostium, the flow resulted more laminar when stenting only the mid-shaft lesion than including the ostium. Conclusions Although these findings cannot be translated directly into real practice our brief study suggests that stenting lesion 1:1 or extending the stent to cover the LM ostium impacts differently the rheolytic properties of LMCA bifurcation with potential insights for restenosis or thrombosis.
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Affiliation(s)
- Gianluca Rigatelli
- Ospedale Santa Maria della Misericordia, Via Tre Martiri 140, Rovigo, 45100, Italy
| | - Marco Zuin
- Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | - Thach Nguyen
- Department of Cardiology, St Mary Medical Center, Hobart, Indiana, USA
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Javadzadegan A, Moshfegh A, Behnia M. Effect of magnetic field on haemodynamic perturbations in atherosclerotic coronary arteries. J Med Eng Technol 2018; 42:148-156. [DOI: 10.1080/03091902.2018.1447034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ashkan Javadzadegan
- Macquarie University, Sydney, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | - Abouzar Moshfegh
- Macquarie University, Sydney, Australia
- ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | - Masud Behnia
- School of Management, Macquarie University, Sydney, Australia
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Rigatelli G, Zuin M, Dell'Avvocata F, Vassilev D, Daggubati R, Nguyen T, Nguyễn MTN, Foin N. Complex coronary bifurcation treatment by a novel stenting technique: Bench test, fluid dynamic study and clinical outcomes. Catheter Cardiovasc Interv 2018; 92:907-914. [PMID: 29368394 DOI: 10.1002/ccd.27494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We assess the mid-term outcomes of ultrathin biodegradable polymer double stenting using a very minimal crushing (Nano-Crush) technique in large complex coronary bifurcation. BACKGROUND Complex bifurcations have been suggested to be better approached by a planned double stent technique. METHODS Two hundred and five consecutive patients (107 males and 98 females) referred for large complex coronary bifurcation percutaneous coronary interventions were enrolled. The technique was also evaluated by both a bench test with a silicon tubes phantom resembling a coronary bifurcation and a computed fluid dynamic (CFD) analysis. RESULTS Left main bifurcation accounted for 40.9% of cases (84 patients). Mean angles between main branch (MB) and side branch (SB) were 63.6 ± 21.3°. SB intravascular ultrasound-calculated MSA was 5.6 ± 1.5 mm2 . Clinical follow-up was available for 100% of patients and at a mean follow-up of 16.2 ± 6.7 months 8 deaths, all due to cardiovascular reason, (3.9%, 4 patients for stroke, two for heart failure, one after surgical aortic valve substitution, and one after acute massive pulmonary embolism) and no presumptive stent thrombosis or target vessel induced ischemia were observed. Angiographic follow-up was available in 108 patients (52.7%) and showed a very low significant restenosis (5 patients, 4.6%). Bench study and CFD evaluation suggested a complete coverage of the SB ostium with a very high strut-free area at the SB. CONCLUSIONS The revascularization of complex large coronary bifurcation disease using the Nano-crush technique appeared promising thanks to the favorable fluid dynamic profile, complete coverage of the SD ostium, and very small metal amount at the carina.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy and Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Fabio Dell'Avvocata
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Dobrin Vassilev
- Head, Department of Cardiology; Hospital, University School of Medicine, Sofia, Bulgaria
| | - Ramesh Daggubati
- Head, Cardiac Catheterization Laboratories, Winthrop University Hospital, Mineola, New York 11501
| | - Thach Nguyen
- Director of Cardiovascular Research, Methodist Hospital, Merrillville, Indiana 46410.,Tan Tao University School of Medicine, Tan Duc eCity, Long An Vietnam
| | | | - Nicolas Foin
- Lead, Medtech Research Theme, National Heart Centre Singapore and Duke-NUS Medical School, Singapore
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Rigatelli G, Dell'Avvocata F, Zuin M, Giatti S, Duong K, Pham T, Tuan NS, Vassiliev D, Daggubati R, Nguyen T. Comparative Computed Flow Dynamic Analysis of Different Optimization Techniques in Left Main Either Provisional or Culotte Stenting. J Transl Int Med 2017; 5:205-212. [PMID: 29340277 DOI: 10.1515/jtim-2017-0035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives Provisional and culotte are the most commonly used techniques in left main (LM) stenting. The impact of different post-dilation techniques on fluid dynamic of LM bifurcation has not been yet investigated. The aim of this study is to evaluate, by means of computational fluid dynamic analysis (CFD), the impact of different post-dilation techniques including proximal optimization technique (POT), kissing balloon (KB), POT-Side-POT and POT-KB-POT, 2-steps Kissing (2SK) and Snuggle Kissing balloon (SKB) on flow dynamic profile after LM provisional or culotte stenting. Methods We considered an LM-LCA-LCX bifurcation reconstructed after reviewing 100 consecutive patients (mean age 71.4 ± 9.3 years, 49 males) with LM distal disease. The diameters of LAD and LCX were modelled according to the Finnet's law as following: LM 4.5 mm, LAD 3.5 mm, LCX 2.75 mm, with bifurcation angle set up at 55°. Xience third-generation stent (Abbot Inc., USA) was reconstructed and virtually implanted in provisional/cross-over and culotte fashion. POT, KB, POT-side-POT, POT-KB-POT, 2SK and SKB were virtually applied and analyzed in terms of the wall shear stress (WSS). Results Analyzing the provisional stenting, the 2SK and KB techniques had a statistically significant lower impact on the WSS at the carina, while POT seemed to obtain a neutral effect. In the wall opposite to the carina, the more physiological profile has been obtained by KB and POT with higher WSS value and smaller surface area of the lower WSS. In culotte stenting, at the carina, POT-KB-POT and 2SK had a very physiological profile; while at the wall opposite to the carina, 2SK and POT-KB-POT decreased significantly the surface area of the lower WSS compared to the other techniques. Conclusion From the fluid dynamic point of view in LM provisional stenting, POT, 2SK and KB showed a similar beneficial impact on the bifurcation rheology, while in LM culotte stenting, POT-KB-POT and 2SK performed slightly better than the other techniques, probably reflecting a better strut apposition.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Fabio Dell'Avvocata
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Sara Giatti
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Khanh Duong
- Tan Tao University, School of Medicine, Long An, Vietnam
| | - Trung Pham
- Tan Tao University, School of Medicine, Long An, Vietnam
| | - Nguyen Si Tuan
- Tan Tao University, School of Medicine, Long An, Vietnam
| | - Dobrin Vassiliev
- Department of Cardiology, Alexandrovska University School of Medicine, Sofia, Bulgaria
| | - Ramesh Daggubati
- Cardiac Catheterization Laboratories, Winthrop University Hospital Mineola, Mineola, NY, USA
| | - Thach Nguyen
- Cardiovascular Research, Methodist Hospital, Merrillville IN, USA
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Evaluation of potential substrates for restenosis and thrombosis in overlapped versus edge-to-edge juxtaposed bioabsorbable scaffolds: Insights from a computed fluid dynamic study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:273-278. [PMID: 28918876 DOI: 10.1016/j.carrev.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/08/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Multiple BRSs and specifically the Absorb scaffold (BVS) (Abbott Vascular, Santa Clara, CA USA) have been often used to treat long diffuse coronary artery lesions. We evaluate by a computational fluid dynamic(CFD) study the impact on the intravascular fluid rheology on multiple bioabsorbable scaffolds (BRS) by standard overlapping versus edge-to-edge technique. METHODS/MATERIALS We simulated the treatment of a real long significant coronary lesion (>70% luminal narrowing) involving the left anterior descending artery (LAD) treated with a standard or edge-to-edge technique, respectively. Simulations were performed after BVS implantations in two different conditions: 1) Edge-to-edge technique, where the scaffolds are kissed but not overlapped resulting in a luminal encroachment of 0.015cm (150μm); 2) Standard overlapping, where the scaffolds are overlapped resulting in a luminal encroachment of 0.030cm (300μm). After positioning the BVS across the long lesion, the implantation procedure was performed in-silico following all the usual procedural steps. RESULTS Analysis of the wall shear stress (WSS) suggested that at the vessel wall level the WSS were lower in the overlapping zones overlapping compared to the edge-to-edge zone (∆=0.061Pa, p=0.01). At the struts level the difference between the two WSS was more striking (∆=1.065e-004 p=0.01) favouring the edge-to-edge zone. CONCLUSIONS Our study suggested that at both vessel wall and scaffold struts levels, there was lowering WSS when multiple BVS were implanted with the standard overlapping technique compared to the "edge-to-edge" technique. This lower WSS might represent a substrate for restenosis, early and late BVS thrombosis, potentially explaining at least in part the recent evidences of devices poor performance.
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Chiastra C, Gallo D, Tasso P, Iannaccone F, Migliavacca F, Wentzel JJ, Morbiducci U. Healthy and diseased coronary bifurcation geometries influence near-wall and intravascular flow: A computational exploration of the hemodynamic risk. J Biomech 2017; 58:79-88. [PMID: 28457603 DOI: 10.1016/j.jbiomech.2017.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 01/09/2023]
Abstract
Local hemodynamics has been identified as one main determinant in the onset and progression of atherosclerotic lesions at coronary bifurcations. Starting from the observation that atherosensitive hemodynamic conditions in arterial bifurcation are majorly determined by the underlying anatomy, the aim of the present study is to investigate how peculiar coronary bifurcation anatomical features influence near-wall and intravascular flow patterns. Different bifurcation angles and cardiac curvatures were varied in population-based, idealized models of both stenosed and unstenosed bifurcations, representing the left anterior descending (LAD) coronary artery with its diagonal branch. Local hemodynamics was analyzed in terms of helical flow and exposure to low/oscillatory shear stress by performing computational fluid dynamics simulations. Results show that bifurcation angle impacts lowly hemodynamics in both stenosed and unstenosed cases. Instead, curvature radius influences the generation and transport of helical flow structures, with smaller cardiac curvature radius associated to higher helicity intensity. Stenosed bifurcation models exhibit helicity intensity values one order of magnitude higher than the corresponding unstenosed cases. Cardiac curvature radius moderately affects near-wall hemodynamics of the stenosed cases, with smaller curvature radius leading to higher exposure to low shear stress and lower exposure to oscillatory shear stress. In conclusion, the proposed controlled benchmark allows investigating the effect of various geometrical features on local hemodynamics at the LAD/diagonal bifurcation, highlighting that cardiac curvature influences near wall and intravascular hemodynamics, while bifurcation angle has a minor effect.
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Affiliation(s)
- Claudio Chiastra
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Paola Tasso
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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Rigatelli G, Zuin M, Dell'Avvocata F, Vassilev D, Daggubati R, Nguyen T, Van Viet Thang N, Foin N. Evaluation of coronary flow conditions in complex coronary artery bifurcations stenting using computational fluid dynamics: Impact of final proximal optimization technique on different double-stent techniques. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:233-240. [PMID: 28108202 DOI: 10.1016/j.carrev.2017.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND/PURPOSE Computational fluid dynamics (CFD) have been recently adopted in many fields of cardiovascular medicine and in interventional cardiology. Using CFD analysis we compared the use of different PCI procedures, with and without the utilization of a proximal optimization technique (POT), on a complex coronary artery bifurcation. METHODS/MATERIALS For the analysis, we considered a hypothetic model of a left anterior descending artery-diagonal Medina 1,1,1 bifurcation type with a diameter of the proximal main branch (MB) and the side branch (SB) set at 3.5mm and 2.5mm, respectively. The bifurcation angle has been set to 50°. For the stent simulation, we reconstructed a third-generation, ultra-thin strut everolimus-eluting stent (ORSIRO stent, Biotronik IC, Bulack, Switzerland). RESULTS The Nano-crush and the modified T techniques seem able to restore the most physiologic fluid dynamic profile. Conversely, the DK-crush and the culotte demonstrated an intermediate and worst effect, respectively. The addition of a final POT resulted favorably for both Nano-crush and reverse modified T techniques, whereas a neutral and lack of significant effects have been observed for the DK-crush and culotte technique, respectively. CONCLUSION Different double-stenting techniques (DST) have a different impact on coronary flow physiology. Both Nano-crush and modified T techniques achieved the most physiologic profile. The addition of a final POT appears to be a favourable step for both Nano-crush and modified T.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
| | - Marco Zuin
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Fabio Dell'Avvocata
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Dobrin Vassilev
- Department of Cardiology; Hospital, University School of Medicine, Sofia, Bulgaria
| | - Ramesh Daggubati
- Cardiac Catheterization Laboratories, Winthrop University Hospital, Mineola, NY 11501
| | | | | | - Nicolas Foin
- Medtech Research Theme, National Heart Centre Singapore and Duke-NUS Medical School, Singapore
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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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Javadzadegan A, Yong ASC, Chang M, Ng MKC, Behnia M, Kritharides L. Haemodynamic assessment of human coronary arteries is affected by degree of freedom of artery movement. Comput Methods Biomech Biomed Engin 2016; 20:260-272. [DOI: 10.1080/10255842.2016.1215439] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patient-Specific Computational Models of Coronary Arteries Using Monoplane X-Ray Angiograms. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:2695962. [PMID: 27403203 PMCID: PMC4925948 DOI: 10.1155/2016/2695962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Abstract
Coronary artery disease (CAD) is the most common type of heart disease in western countries. Early detection and diagnosis of CAD is quintessential to preventing mortality and subsequent complications. We believe hemodynamic data derived from patient-specific computational models could facilitate more accurate prediction of the risk of atherosclerosis. We introduce a semiautomated method to build 3D patient-specific coronary vessel models from 2D monoplane angiogram images. The main contribution of the method is a robust segmentation approach using dynamic programming combined with iterative 3D reconstruction to build 3D mesh models of the coronary vessels. Results indicate the accuracy and robustness of the proposed pipeline. In conclusion, patient-specific modelling of coronary vessels is of vital importance for developing accurate computational flow models and studying the hemodynamic effects of the presence of plaques on the arterial walls, resulting in lumen stenoses, as well as variations in the angulations of the coronary arteries.
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Selvarasu NKC, Tafti DK. Effects of elastic modulus change in helical tubes under the influence of dynamic changes in curvature and torsion. J Biomech Eng 2015; 136:1873134. [PMID: 24886746 DOI: 10.1115/1.4027661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/14/2014] [Indexed: 11/08/2022]
Abstract
The incidence of stent late restenosis is high (Zwart et al., 2010, "Coronary Stent Thrombosis in the Current Era: Challenges and Opportunities for Treatment," Curr. Treat. Options Cardiovasc. Med., 12(1), pp. 46-57) despite the extensive use of stents, and is most prevalent at the proximal and distal ends of the stent. Elastic modulus change in stented coronary arteries subject to the motion of the myocardium is not studied extensively. It is our objective to understand and reveal the mechanism by which changes in elastic modulus and geometry contribute to the generation of nonphysiological wall shear stress (WSS). Such adverse hemodynamic conditions could have an effect on the onset of restenosis. Three-dimensional (3D), spatiotemporally resolved computational fluid dynamics (CFD) simulations of pulsatile flow with moving wall boundaries and fluid structure interaction (FSI) were carried out for a helical artery with physiologically relevant flow parameters. To study the effect of coronary artery (CA) geometry change on stent elastic modulus mismatch, models where the curvature, torsion and both curvature and torsion change were examined. The elastic modulus is increased by a factor of two, five, and ten in the stented section for all three modes of motion. The changes in elastic modulus and arterial geometry cause critical variations in the local pressure and velocity gradients and secondary flow patterns. The pressure gradient change is 47%, with respect to the unstented baseline when the elastic modulus is increased to 10. The corresponding WSS change is 15.4%. We demonstrate that these changes are attributed to the production of vorticity (vorticity flux) caused by the wall movement and elastic modulus discontinuity. The changes in curvature dominate torsion changes in terms of the effects to local hemodynamics. The elastic modulus discontinuities along with the dynamic change in geometry affected the secondary flow patterns and vorticity flux, which in turn affects the WSS.
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Chiastra C, Migliavacca F, Martínez MÁ, Malvè M. On the necessity of modelling fluid–structure interaction for stented coronary arteries. J Mech Behav Biomed Mater 2014; 34:217-30. [DOI: 10.1016/j.jmbbm.2014.02.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/23/2014] [Accepted: 02/05/2014] [Indexed: 01/17/2023]
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Su B, Huo Y, Kassab GS, Kabinejadian F, Kim S, Leo HL, Zhong L. Numerical investigation of blood flow in three-dimensional porcine left anterior descending artery with various stenoses. Comput Biol Med 2014; 47:130-8. [PMID: 24607680 DOI: 10.1016/j.compbiomed.2014.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 01/02/2014] [Accepted: 01/04/2014] [Indexed: 12/15/2022]
Abstract
Coronary heart disease causes obstruction of coronary blood flow and is the leading cause of death worldwide. The effect of focal stenosis on downstream flow pattern in the coronary arterial tree is not well understood. Here, the blood flows in normal and diseased porcine left anterior descending (LAD) arterial tree were modeled and compared to determine the effects of stenosis on the blood flow distribution and hemodynamic parameters. The anatomical model of LAD was extracted from a porcine heart by computed tomography (CT), which was comprised of a main trunk and nine side branches. Stenoses with various severities were imposed into the main trunk between the first and second side branches, and the boundary condition at each outlet accounted for the effect of stenosis on the flow rate in the downstream vasculature. It was found that only significant stenosis (≥75% area reduction) considerably altered pressure drop and total flow rate distribution in branches and at each bifurcation. The effect of significant stenosis on bifurcations, however, diminished at downstream locations. As demonstrated by distributions of oscillatory shear index and relative residence time, non-significant stenosis (<75% area reduction) has the potential to induce atherosclerosis near the ostium of downstream side branch, while significant stenosis can promote atherosclerosis in its wake.
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Affiliation(s)
- Boyang Su
- Research and Development Unit, National Heart Centre Singapore, 17 third hospital avenue, Mistri Wing, Singapore 168752, Singapore
| | - Yunlong Huo
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Mechanics Building 507, Beijing 10087, China
| | - Ghassan S Kassab
- School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Foad Kabinejadian
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Singapore
| | - Sangho Kim
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Singapore.
| | - Liang Zhong
- Research and Development Unit, National Heart Centre Singapore, 17 third hospital avenue, Mistri Wing, Singapore 168752, Singapore
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Contrast Agent Bolus Dispersion in a Realistic Coronary Artery Geometry: Influence of Outlet Boundary Conditions. Ann Biomed Eng 2013; 42:787-96. [DOI: 10.1007/s10439-013-0950-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/19/2013] [Indexed: 01/02/2023]
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Xie X, Wang Y, Zhou H. Impact of coronary tortuosity on the coronary blood flow: a 3D computational study. J Biomech 2013; 46:1833-41. [PMID: 23777815 DOI: 10.1016/j.jbiomech.2013.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/22/2013] [Accepted: 05/07/2013] [Indexed: 01/11/2023]
Abstract
Tortuous coronary arteries are commonly observed but the etiology and clinical importance are still unclear. Hemodynamic factors are vital modulators of the vascular structure and a full understanding of hemodynamic changes caused by the coronary tortuosity (CT) is meaningful for clinical researches. A three-dimensional computational fluid dynamic study was conducted to evaluate hemodynamic changes caused by the CT. Six idealized small sections of the left anterior descending coronary artery (LAD) with different levels of tortuosity were employed. The dynamic vessel motion was added to the three-dimensional tortuous coronary models to make the computational results more realistic. The rest and exercise conditions were modeled by specifying proper boundary conditions. Results showed that a low and oscillated wall shear stress (WSS) region was formed at the inner wall downstream of the bend section when the bend angle was larger than 120°. The resistance of the coronary arteries increased up to 92% due to the CT during exercise. A maximum increase of 96% was observed in the mean diastole driving pressure for the CT model as compared to the non-tortuous model during exercise. This study indicated that the severe CT may be a risk factor for atherosclerosis and may make the regulation of the blood flow ineffective during exercise.
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Affiliation(s)
- Xinzhou Xie
- Department of Electronic Engineering, Fudan University, No. 220 Handan Road, Shanghai, China
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Chiastra C, Morlacchi S, Gallo D, Morbiducci U, Cárdenes R, Larrabide I, Migliavacca F. Computational fluid dynamic simulations of image-based stented coronary bifurcation models. J R Soc Interface 2013; 10:20130193. [PMID: 23676893 DOI: 10.1098/rsif.2013.0193] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
One of the relevant phenomenon associated with in-stent restenosis in coronary arteries is an altered haemodynamics in the stented region. Computational fluid dynamics (CFD) offers the possibility to investigate the haemodynamics at a level of detail not always accessible within experimental techniques. CFD can quantify and correlate the local haemodynamics structures which might lead to in-stent restenosis. The aim of this work is to study the fluid dynamics of realistic stented coronary artery models which replicate the complete clinical procedure of stent implantation. Two cases of pathologic left anterior descending coronary arteries with their bifurcations are reconstructed from computed tomography angiography and conventional coronary angiography images. Results of wall shear stress and relative residence time show that the wall regions more prone to the risk of restenosis are located next to stent struts, to the bifurcations and to the stent overlapping zone for both investigated cases. Considering a bulk flow analysis, helical flow structures are generated by the curvature of the zone upstream from the stent and by the bifurcation regions. Helical recirculating microstructures are also visible downstream from the stent struts. This study demonstrates the feasibility to virtually investigate the haemodynamics of patient-specific coronary bifurcation geometries.
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Affiliation(s)
- Claudio Chiastra
- Chemistry, Materials and Chemical Engineering Department, Politecnico di Milano, Milan, Italy.
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Selvarasu NKC, Tafti DK. Investigation of the Effects of Dynamic Change in Curvature and Torsion on Pulsatile Flow in a Helical Tube. J Biomech Eng 2012; 134:1475438. [DOI: 10.1115/1.4006984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Cardiovascular diseases are the number one cause of death in the world, making the understanding of hemodynamics and the development of treatment options imperative. The effect of motion of the coronary artery due to the motion of the myocardium is not extensively studied. In this work, we focus our investigation on the localized hemodynamic effects of dynamic changes in curvature and torsion. It is our objective to understand and reveal the mechanism by which changes in curvature and torsion contribute towards the observed wall shear stress distribution. Such adverse hemodynamic conditions could have an effect on circumferential intimal thickening. Three-dimensional spatiotemporally resolved computational fluid dynamics (CFD) simulations of pulsatile flow with moving wall boundaries were carried out for a simplified coronary artery with physiologically relevant flow parameters. A model with stationary walls is used as the baseline control case. In order to study the effect of curvature and torsion variation on local hemodynamics, this baseline model is compared to models where the curvature, torsion, and both curvature and torsion change. The simulations provided detailed information regarding the secondary flow dynamics. The results suggest that changes in curvature and torsion cause critical changes in local hemodynamics, namely, altering the local pressure and velocity gradients and secondary flow patterns. The wall shear stress (WSS) varies by a maximum of 22% when the curvature changes, by 3% when the torsion changes, and by 26% when both the curvature and torsion change. The oscillatory shear stress (OSI) varies by a maximum of 24% when the curvature changes, by 4% when the torsion changes, and by 28% when both the curvature and torsion change. We demonstrate that these changes are attributed to the physical mechanism associating the secondary flow patterns to the production of vorticity (vorticity flux) due to the wall movement. The secondary flow patterns and augmented vorticity flux affect the wall shear stresses. As a result, this work reveals how changes in curvature and torsion act to modify the near wall hemodynamics of arteries.
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Affiliation(s)
- N. K. C. Selvarasu
- Mechanical Engineering Department, Virginia Polytechnic Institute and State University, 114-I Randolph Hall, Mail Code 0238,Blacksburg, VA 24061
| | - Danesh K. Tafti
- Mechanical Engineering Department, Virginia Polytechnic Institute and State University, 114-I Randolph Hall, Mail Code 0238,Blacksburg, VA 24061
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Katritsis DG, Theodorakakos A, Pantos I, Gavaises M, Karcanias N, Efstathopoulos EP. Flow patterns at stented coronary bifurcations: computational fluid dynamics analysis. Circ Cardiovasc Interv 2012; 5:530-9. [PMID: 22763345 DOI: 10.1161/circinterventions.112.968347] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The ideal bifurcation stenting technique is not established, and data on the hemodynamic characteristics at stented bifurcations are limited. METHODS AND RESULTS We used computational fluid dynamics analysis to assess hemodynamic parameters known affect the risk of restenosis and thrombosis at coronary bifurcations after the use of various single- and double-stenting techniques. We assessed the distributions and surface integrals of the time averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (t(r)). Single main branch stenting without side branch balloon angioplasty or stenting provided the most favorable hemodynamic results (integrated values of TAWSS=4.13·10(-4) N, OSI=7.52·10(-6) m(2), t(r)=5.57·10(-4) m(2)/Pa) with bifurcational area subjected to OSI values >0.25, >0.35, and >0.45 calculated as 0.36 mm(2), 0.04 mm(2), and 0 mm(2), respectively. Extended bifurcation areas subjected to these OSI values were seen after T-stenting: 0.61 mm(2), 0.18 mm(2), and 0.02 mm(2), respectively. Among the considered double-stenting techniques, crush stenting (integrated values of TAWSS=1.18·10(-4) N, OSI=7.75·10(-6) m(2), t(r)=6.16·10(-4) m(2)/Pa) gave the most favorable results compared with T-stenting (TAWSS=0.78·10(-4) N, OSI=10.40·10(-6) m(2), t(r)=6.87·10(-4) m(2)/Pa) or the culotte technique (TAWSS=1.30· 10(-4) N, OSI=9.87·10(-6) m(2), t(r)=8.78·10(-4) m(2)/Pa). CONCLUSIONS In the studied models of computer simulations, stenting of the main branch with our without balloon angioplasty of the side branch offers hemodynamic advantages over double stenting. When double stenting is considered, the crush technique with the use of a thin-strut stent may result in improved immediate hemodynamics compared with culotte or T-stenting.
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Saito M, Ikenaga Y, Matsukawa M, Watanabe Y, Asada T, Lagrée PY. One-dimensional model for propagation of a pressure wave in a model of the human arterial network: comparison of theoretical and experimental results. J Biomech Eng 2012; 133:121005. [PMID: 22206422 DOI: 10.1115/1.4005472] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pulse wave evaluation is an effective method for arteriosclerosis screening. In a previous study, we verified that pulse waveforms change markedly due to arterial stiffness. However, a pulse wave consists of two components, the incident wave and multireflected waves. Clarification of the complicated propagation of these waves is necessary to gain an understanding of the nature of pulse waves in vivo. In this study, we built a one-dimensional theoretical model of a pressure wave propagating in a flexible tube. To evaluate the applicability of the model, we compared theoretical estimations with measured data obtained from basic tube models and a simple arterial model. We constructed different viscoelastic tube set-ups: two straight tubes; one tube connected to two tubes of different elasticity; a single bifurcation tube; and a simple arterial network with four bifurcations. Soft polyurethane tubes were used and the configuration was based on a realistic human arterial network. The tensile modulus of the material was similar to the elasticity of arteries. A pulsatile flow with ejection time 0.3 s was applied using a controlled pump. Inner pressure waves and flow velocity were then measured using a pressure sensor and an ultrasonic diagnostic system. We formulated a 1D model derived from the Navier-Stokes equations and a continuity equation to characterize pressure propagation in flexible tubes. The theoretical model includes nonlinearity and attenuation terms due to the tube wall, and flow viscosity derived from a steady Hagen-Poiseuille profile. Under the same configuration as for experiments, the governing equations were computed using the MacCormack scheme. The theoretical pressure waves for each case showed a good fit to the experimental waves. The square sum of residuals (difference between theoretical and experimental wave-forms) for each case was <10.0%. A possible explanation for the increase in the square sum of residuals is the approximation error for flow viscosity. However, the comparatively small values prove the validity of the approach and indicate the usefulness of the model for understanding pressure propagation in the human arterial network.
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Affiliation(s)
- Masashi Saito
- Laboratory of Ultrasonic Electronics, Doshisha University, 1-3 Tatara-Miyakodani, Kyotanabeshi, Kyoto, 610-0321, Japan
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Katritsis DG, Theodorakakos A, Pantos I, Andriotis A, Efstathopoulos EP, Siontis G, Karcanias N, Redwood S, Gavaises M. Vortex formation and recirculation zones in left anterior descending artery stenoses: computational fluid dynamics analysis. Phys Med Biol 2010; 55:1395-411. [PMID: 20150685 DOI: 10.1088/0031-9155/55/5/009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Flow patterns may affect the potential of thrombus formation following plaque rupture. Computational fluid dynamics (CFD) were employed to assess hemodynamic conditions, and particularly flow recirculation and vortex formation in reconstructed arterial models associated with ST-elevation myocardial infraction (STEMI) or stable coronary stenosis (SCS) in the left anterior descending coronary artery (LAD). Results indicate that in the arterial models associated with STEMI, a 50% diameter stenosis immediately before or after a bifurcation creates a recirculation zone and vortex formation at the orifice of the bifurcation branch, for most of the cardiac cycle, thus allowing the creation of stagnating flow. These flow patterns are not seen in the SCS model with an identical stenosis. Post-stenotic recirculation in the presence of a 90% stenosis was evident at both the STEMI and SCS models. The presence of 90% diameter stenosis resulted in flow reduction in the LAD of 51.5% and 35.9% in the STEMI models and 37.6% in the SCS model, for a 10 mmHg pressure drop. CFD simulations in a reconstructed model of stenotic LAD segments indicate that specific anatomic characteristics create zones of vortices and flow recirculation that promote thrombus formation and potentially myocardial infarction.
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Affiliation(s)
- D G Katritsis
- Department of Cardiology, Athens Euroclinic, Athens, Greece.
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Spiegel M, Redel T, Zhang Y, Struffert T, Hornegger J, Grossman RG, Doerfler A, Karmonik C. Tetrahedral and polyhedral mesh evaluation for cerebral hemodynamic simulation--a comparison. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:2787-90. [PMID: 19964600 DOI: 10.1109/iembs.2009.5333829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Computational fluid dynamic (CFD) based on patient-specific medical imaging data has found widespread use for visualizing and quantifying hemodynamics in cerebrovascular disease such as cerebral aneurysms or stenotic vessels. This paper focuses on optimizing mesh parameters for CFD simulation of cerebral aneurysms. Valid blood flow simulations strongly depend on the mesh quality. Meshes with a coarse spatial resolution may lead to an inaccurate flow pattern. Meshes with a large number of elements will result in unnecessarily high computation time which is undesirable should CFD be used for planning in the interventional setting. Most CFD simulations reported for these vascular pathologies have used tetrahedral meshes. We illustrate the use of polyhedral volume elements in comparison to tetrahedral meshing on two different geometries, a sidewall aneurysm of the internal carotid artery and a basilar bifurcation aneurysm. The spatial mesh resolution ranges between 5,119 and 228,118 volume elements. The evaluation of the different meshes was based on the wall shear stress previously identified as a one possible parameter for assessing aneurysm growth. Polyhedral meshes showed better accuracy, lower memory demand, shorter computational speed and faster convergence behavior (on average 369 iterations less).
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Affiliation(s)
- Martin Spiegel
- Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Computer Science, Germany.
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50
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Abstract
Visualization of, and measurements related to, haemodynamic phenomena in arteries may be made using ultrasound systems. Most ultrasound technology relies on simple measurements of blood velocity taken from a single site, such as the peak systolic velocity for assessment of the degree of lumen reduction caused by an arterial stenosis. Real-time two-dimensional (2D) flow field visualization is possible using several methods, such as colour flow, blood flow imaging, and echo particle image velocimetry; these have applications in the examination of the flow field in diseased arteries and in heart chambers. Three-dimensional (3D) and four-dimensional ultrasound systems have been described. These have been used to provide 2D velocity profile data for the estimation of volumetric flow. However, they are limited for haemodynamic evaluation in that they provide only one component of the velocity. The provision of all seven components (three space, three velocity, and one time) is possible using image-guided modelling, in which 3D ultrasound is combined with computational fluid dynamics. This method also allows estimation of turbulence data and of relevant quantities such as the wall shear stress.
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Affiliation(s)
- P R Hoskins
- Department of Medical Physics, Edinburgh University, Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK,
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