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D'Souza GA, Rinaldi JE, Meki M, Crusan A, Richardson E, Shinnar M, Herbertson LH. Using a Mock Circulatory Loop as a Regulatory Science Tool to Simulate Different Heart Failure Conditions. J Biomech Eng 2024; 146:011004. [PMID: 37831143 DOI: 10.1115/1.4063746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Mechanical circulatory support (MCS) device therapy is one of the primary treatment options for end-stage heart failure (HF), whereby a mechanical pump is integrated with the failing heart to maintain adequate tissue perfusion. The ISO 14708-5:2020 standard prescribes generic guidelines for nonclinical device evaluation and system performance testing of MCS devices using a mock circulatory loop (MCL). However, the utility of MCLs in premarket regulatory submissions of MCS devices is ambiguous, and the specific disease states that the device is intended to treat are not usually simulated. Hence, we aim to outline the potential of MCLs as a valuable regulatory science tool for characterizing MCS device systems by adequately representing target clinical-use HF conditions on the bench. Target pathophysiologic hemodynamics of HF conditions (i.e., cardiogenic shock (CS), left ventricular (LV) hypertrophy secondary to hypertension, and coronary artery disease), along with a healthy adult at rest and a healthy adult during exercise are provided as recommended test conditions. The conditions are characterized based on LV, aorta, and left atrium pressures using recommended cardiac hemodynamic indices such as systolic, diastolic, and mean arterial pressure, mean cardiac output (CO), cardiac cycle time, and systemic vascular resistance. This study is a first step toward standardizing MCLs to generate well-defined target HF conditions used to evaluate MCS devices.
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Affiliation(s)
- Gavin A D'Souza
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Jean E Rinaldi
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Moustafa Meki
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Annabelle Crusan
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Eric Richardson
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Meir Shinnar
- Circulatory Support Devices Team, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
| | - Luke H Herbertson
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD 20993
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Abuouf Y, AlBadawi M, Ookawara S, Ahmed M. Effect of guidewire insertion in fractional flow reserve procedure for real geometry using computational fluid dynamics. Biomed Eng Online 2021; 20:95. [PMID: 34583689 PMCID: PMC8479905 DOI: 10.1186/s12938-021-00935-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coronary artery disease is an abnormal contraction of the heart supply blood vessel. It limits the oxygenated blood flow to the heart. Thus, diagnosing its severity helps physicians to select the appropriate treatment plan. Fractional flow reserve (FFR) is the most accurate method to pinpoint the stenosis severity. However, inserting the guidewire across stenosis may cause a false overestimation of severity. METHODS To estimate the errors due to guidewire insertion, reconstructed three-dimensional coronary artery geometry from a patient-specific scan is used. A comprehensive three-dimensional blood flow model is developed. Blood is considered non-Newtonian and the flow is pulsatile. The model is numerically simulated using realistic boundary conditions. RESULTS The FFR value is calculated and compared with the actual flow ratio. Additionally, the ratio between pressure drop and distal dynamic pressure (CDP) is studied. The obtained results for each case are compared and analyzed with the case without a guidewire. It was found that placing the guidewire leads to overestimating the severity of moderate stenosis. It reduces the FFR value from 0.43 to 0.33 with a 23.26% error compared to 0.44 actual flow ratio and the CDP increases from 5.31 to 7.2 with a 35.6% error. FFR value in mild stenosis does not have a significant change due to placing the guidewire. The FFR value decreases from 0.83 to 0.82 compared to the 0.83 actual flow ratio. CONCLUSION Consequently, physicians should consider these errors while deciding the treatment plan.
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Affiliation(s)
- Yasser Abuouf
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), Postal Code 21934, New Borg El-Arab City, P.O. Box 179, Alexandria, Egypt. .,Mechanical Engineering Department, Faculty of Engineering, Alexandria University, Alexandria, Egypt.
| | - Muhamed AlBadawi
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), Postal Code 21934, New Borg El-Arab City, P.O. Box 179, Alexandria, Egypt.,Engineering Mathematics and Physics Department, Faculty of Engineering, Alexandria University, Alexandria, Egypt
| | - Shinichi Ookawara
- Department of Chemical Engineering, Graduate School of Science and Engineering, Tokyo Institute of Technology, O-okayama, Meguro-ku, Tokyo, 152-8552, Japan
| | - Mahmoud Ahmed
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), Postal Code 21934, New Borg El-Arab City, P.O. Box 179, Alexandria, Egypt.,Mechanical Engineering Department, Assiut University, Assiut, 71516, Egypt
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Abuouf Y, Ookawara S, Ahmed M. Analysis of the effect of guidewire position on stenosis diagnosis using computational fluid dynamics. Comput Biol Med 2020; 121:103777. [PMID: 32568672 DOI: 10.1016/j.compbiomed.2020.103777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fractional flow reserve is an accurate method for diagnosing stenosis. The difficulty in using this procedure lies in placing the guidewire precisely at the blood vessel centerline. Owing to the long distance between the insertion point and the stenosis, a guidewire inclination can occur. Therefore, the main objective of this study is to investigate how the measured pressure in a blood vessel varies with the guidewire position. METHODS A three-dimensional model of blood flow is developed and numerically simulated. Two positions and two inclination angles from the blood vessel centerline and three throat diameters are investigated. The predicted results are validated using the available experimental data. The predicted results and actual measurements are observed to agree well with each other. RESULTS The pressure drop coefficient (CDP) increases because of guidewire insertion. When the guidewire is placed at inclined positions in moderate stenosis, the values of CDP are 66 and 68, depending on the inclination angle; the errors in CDP are 69% and 76%, respectively. At a high flow rate, the errors are reduced to 67% and 70%, respectively. The error in the CDP ranges from 42% to 61% when the guidewire is placed parallel to the centerline. For severe stenosis, the CDP is nearly the same at all positions and varies between 240 and 250; without a guidewire, the CDP is 163. CONCLUSIONS The findings confirmed that practitioners should be aware of the guidewire position during the operation. The displacement of the guidewire should be estimated, and the corresponding error must be considered.
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Affiliation(s)
- Yasser Abuouf
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City, Postal Code 21934, Alexandria, Egypt.
| | - Shinichi Ookawara
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City, Postal Code 21934, Alexandria, Egypt; Department of Chemical Engineering, Graduate School of Science and Engineering, Tokyo Institute of Technology, O-okayama, Meguro-ku, Tokyo, 152-8552, Japan.
| | - Mahmoud Ahmed
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City, Postal Code 21934, Alexandria, Egypt; Mechanical Engineering Department, Assiut University, Assiut, 71516, Egypt.
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D'Souza GA, Taylor MD, Banerjee RK. Methodology for Hemodynamic Assessment of a Three-Dimensional Printed Patient-Specific Vascular Test Device. J Med Device 2019. [DOI: 10.1115/1.4043992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Assessing hemodynamics in vasculature is important for the development of cardiovascular diagnostic parameters and evaluation of medical devices. Benchtop experiments are a safe and comprehensive preclinical method for testing new diagnostic endpoints and devices within a controlled environment. Recent advances in three-dimensional (3D) printing have enhanced benchtop tests by allowing generation of patient-specific and pathophysiologic conditions. We used 3D printing, coupled with image processing and computer-aided design (CAD), to develop a patient-specific vascular test device from clinical data. The proximal pulmonary artery (PA) tree including the main, left, and right pulmonary arteries, with a stenosis within the left PA was selected as a representative anatomy for developing the vascular test device. Three test devices representing clinically relevant stenosis severities, 90%, 80%, and 70% area stenosis, were evaluated at different cardiac outputs (COs). A mock circulatory loop (MCL) generating pathophysiologic pulmonary pressure and flow was used to evaluate the hemodynamics within the devices. The dimensionless pressure drop–velocity ratio characteristic curves for the three stenosis severities were obtained. At a fixed CO, the dimensionless pressure drop increased nonlinearly with an increase in (a) the velocity ratio for a fixed stenosis severity and (b) the stenosis severity at a specific velocity ratio. The dimensionless pressure drop observed in vivo was similar (within 1%) to that measured in moderate area stenosis of 70% because both flows were viscous dominated. The hemodynamics of the 3D printed test device can be used for evaluating diagnostic endpoints and medical devices in a preclinical setting under realistic conditions.
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Affiliation(s)
- Gavin A. D'Souza
- Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH 45221
| | - Michael D. Taylor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229
| | - Rupak K. Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, 593 Rhodes Hall, Cincinnati, OH 45221 e-mail:
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Coppel R, Gomez AL, Finet G, Mauro M, Pettigrew RI, Ohayon J, Lagache M. Experimental Bench for Hemodynamic Study of Coronary Artery with Serial Stenoses: Fractional Flow Reserve Assessment. Comput Methods Biomech Biomed Engin 2017; 20:45-46. [PMID: 29088640 DOI: 10.1080/10255842.2017.1382853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Coppel
- a Laboratory TIMC-IMAG/DyCTiM2 , UJF, CNRS UMR 5525 , Grenoble , France
| | - A L Gomez
- a Laboratory TIMC-IMAG/DyCTiM2 , UJF, CNRS UMR 5525 , Grenoble , France
| | - G Finet
- b Department of Hemodynamics and Interventional Cardiology , Hospices Civils de Lyon and Claude Bernard University Lyon1, INSERM Unit 886 , Lyon , France
| | - M Mauro
- c Department of Mechanical Engineering, Energetics and Materials , Public University of Navarra , Pamplona , Spain
| | - R I Pettigrew
- d Laboratory of Integrative Cardiovascular Imaging Science , National Institute of Diabetes Digestive and Kidney Diseases, National Institutes of Health , Bethesda , MD , USA
| | - J Ohayon
- a Laboratory TIMC-IMAG/DyCTiM2 , UJF, CNRS UMR 5525 , Grenoble , France.,e University of Savoie Mont-Blanc, Polytech Annecy-Chambéry , Le Bourget du Lac , France
| | - M Lagache
- e University of Savoie Mont-Blanc, Polytech Annecy-Chambéry , Le Bourget du Lac , France.,f Laboratory SYMME , Chambéry , France
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Peelukhana SV, Kerr H, Kolli KK, Fernandez-Ulloa M, Gerson M, Effat M, Arif I, Helmy T, Banerjee R. Benefit of cardiac N-13 PET CFR for combined anatomical and functional diagnosis of ischemic coronary artery disease: a pilot study. Ann Nucl Med 2014; 28:746-60. [DOI: 10.1007/s12149-014-0869-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/05/2014] [Indexed: 01/26/2023]
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