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Zhang X, Chen J, Qiu C, He Y, Wang B, Zhang H, Wu Z, Chen D. Validation of classification system for isolated superior mesenteric artery dissections using image-based computational flow analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108364. [PMID: 39146760 DOI: 10.1016/j.cmpb.2024.108364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND AND OBJECTIVE The isolated superior mesenteric artery dissection (ISMAD) is a rare but potentially fatal vascular disorder. Classifications for ISMAD were previously proposed based on morphometric features. However, the classification systems were not standardized and verified yet. This study conducted computational flow analysis to validate the latest classification system of ISMAD and aid clinical decision-making based on hemodynamic parameters. METHODS 62 patients with ISMAD were included and classified into different types according to false lumen structures (five types, Type I-V) and true lumen patency (two types, Type P and Type S) according to Qiu classification system. Computational fluid dynamics and three-dimensional structural analyses were conducted on the basis of computed tomography angiography datasets. Quantitative and qualitative functional analyses were performed via parameters of interest including volume flow of each minute, pressure drop, pressure gradient, the derivative parameters of wall shear stress such as time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and the relative residence time (RRT). Statistical analyses were conducted among different ISMAD types. RESULTS TAWSS, OSI and RRT showed significant difference among different types when classified using false lumen structures. In detail, Type IV showed significantly higher TAWSS than other types (p = 0.007). OSI was obviously higher in Type II (p = 0.015). Type IV also presented the lowest RRT (p = 0.005). The pressure drop, pressure gradient, OSI and RRT showed higher value in Type S than that in Type P, demonstrating a statistical significance with p values of 0.017, 0.041, 0.001 and 0.012, respectively. While Type P had larger volume flow than Type S (p = 0.041). CONCLUSIONS The notable differences in hemodynamic features among different types demonstrated the feasibility of Qiu classification system. The evaluation based on hemodynamic simulation might also provide insights into risk identification and guide therapeutic decisions for ISMAD.
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Affiliation(s)
- Xuehuan Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jiale Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
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Otero-Cacho A, Villa MI, López-Otero D, Díaz-Fernández B, Bastos-Fernández M, Pérez-Muñuzuri V, Muñuzuri AP, González-Juanatey JR. Influence of the pressure wire on the fractional flow reserve calculation: CFD analysis of an ideal vessel and clinical patients with stenosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108325. [PMID: 39053351 DOI: 10.1016/j.cmpb.2024.108325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Fractional Flow Reserve (FFR) is generally considered the gold standard in hemodynamics to assess the impact of a stenosis on the blood flow. The standard procedure to measure involves the displacement of a pressure guide along the circulatory system until it is placed next to the lesion to be analyzed. The main objective of the present study is to analyze the influence of the pressure guide on the invasive FFR measurements and its implications in clinical practice. METHODS We studied the influence of pressure wires on the measurement of Fractional Flow Reserve (FFR) through a combination of Computational Fluid Dynamics (CFD) simulations using 45 clinical patient data with 58 lesions and ideal geometries. The analysis is conducted considering patients that were subjected to a computer tomography and also have direct measurements using a pressure guide. Influence of the stenosis severity, degree of occlusion and blood viscosity has also been studied. RESULTS The influence of pressure wires specifically affects severe stenosis with a lumen diameter reduction of 50 % or greater. This type of stenosis leads to reduced hyperemic flow and increased coronary pressure drop. Thus, we identified that the placement of wires during FFR measurements results in partial obstruction of the coronary artery lumen, leading to increased pressure drop and subsequent reduction in blood flow. The severity of low FFR values associated with severe stenosis may be prone to overestimation when compared to stenosis without severe narrowing. These results have practical implications, particularly in the interpretation of lesions falling within the "gray zone" (0,75-0,80). CONCLUSIONS The pressure wire's presence significantly alters the flow on severe lesions, which has an impact on the FFR calculation. In contrast, the impact of the pressure wire appears to be reduced when the FFR is larger than 0.8. The findings provide critical information for physicians, emphasizing the need for cautious interpretation of FFR values, particularly in severe stenosis. It also offers insights into improving the correlation between FFRct models and invasive measurements by incorporating the influence of pressure wires.
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Affiliation(s)
- Alberto Otero-Cacho
- FlowReserve Labs S.L., Santiago de Compostela, Spain; Galician Center for Mathematical Research and Technology (CITMAga), Santiago de Compostela, E15782, Spain; Group of Nonlinear Physics, Department of Physics, University of Santiago de Compostela, Santiago de Compostela, E15782, Spain.
| | | | - Diego López-Otero
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Brais Díaz-Fernández
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - María Bastos-Fernández
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Vicente Pérez-Muñuzuri
- CRETUS Research Center, University of Santiago de Compostela, Spain; Group of Nonlinear Physics, Department of Physics, University of Santiago de Compostela, Santiago de Compostela, E15782, Spain
| | - Alberto P Muñuzuri
- Galician Center for Mathematical Research and Technology (CITMAga), Santiago de Compostela, E15782, Spain; Group of Nonlinear Physics, Department of Physics, University of Santiago de Compostela, Santiago de Compostela, E15782, Spain
| | - José Ramón González-Juanatey
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Manta A, Tzirakis K. A comprehensive review on computational analysis, research advances, and major findings on Abdominal Aortic Aneurysms for the years 2021 to 2023. Ann Vasc Surg 2024:S0890-5096(24)00566-1. [PMID: 39343357 DOI: 10.1016/j.avsg.2024.07.111] [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: 04/25/2024] [Revised: 06/27/2024] [Accepted: 07/15/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Abdominal Aortic Aneurysm (AAA) is a pathological condition characterized by the dilation of the lower part of the aorta, where significant hemodynamic forces are present. The prevalence and high mortality risk associated with AAA remain major concerns within the scientific community. There is a critical need for extensive research to understand the underlying mechanisms, pathophysiological characteristics, and effective detection methods for abdominal aortic abnormalities. Additionally, it is imperative to develop and refine both medical and surgical management strategies. This review aims to indicate the role of computational analysis in the comprehension and management of AAAs and covers recent research studies regarding the computational analysis approach conducted between 2021 and 2023. Computational analysis methods have emerged as sophisticated and non-invasive approaches, providing detailed insights into the complex dynamics of AAA and enhancing our ability to study and manage this condition effectively. METHODS Computational analysis relies on fluid mechanics principles applied to arterial flow, using the Navier-Stokes equations to model blood flow dynamics. Key hemodynamic indicators relevant to AAAs include Time-Average Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), Endothelial Cell Activation Potential (ECAP), and Relative Residence Time (RRT). The primary methods employed for simulating the abdominal aorta and studying its biomechanical environment are Computational Fluid Dynamics (CFD) and Finite Element Methods (FEM). This review paper encompasses a thorough examination of recent literature, focusing on studies conducted between 2021 and 2023. RESULTS The latest studies have elucidated crucial insights into the blood flow characteristics and geometric attributes of AAAs. Notably, blood flow patterns within AAAs are associated with increased rupture risk, along with elevated intraluminal thrombus volume and specific calcification thresholds. Asymmetric AAAs exhibit heightened risks of rupture and thrombus formation due to low and oscillating wall shear stresses. Moreover, larger aneurysms demonstrate increased wall stress, pressure, and energy loss. Advanced modeling techniques have augmented predictive capabilities concerning growth rates and surgical thresholds. Additionally, the influence of material properties and thrombus volume on wall stress levels is noteworthy, while inlet velocity profiles significantly modulate blood flow dynamics within AAAs. CONCLUSIONS This review highlights the potential utility of computational modeling. However, the clinical applicability of computational modeling has been limited by methodological variability, despite the ongoing accumulation of evidence supporting the prognostic significance of biomechanical and hemodynamic indices in this field. The establishment of standardized reporting is critical for clinical implementation.
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Affiliation(s)
- Anastasia Manta
- Department of Mechanical Engineering, School of Engineering, Hellenic Mediterranean University, Heraklion, Greece; School of Medicine, University of Crete, Heraklion, Greece.
| | - Konstantinos Tzirakis
- Department of Mechanical Engineering, School of Engineering, Hellenic Mediterranean University, Heraklion, Greece
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Chakraborty S, Mantripragada VT, Chakravarty A, Goswami D, Poddar A. Unraveling the complex interplay between abnormal hemorheology and shape asymmetry in flow through stenotic arteries. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 257:108437. [PMID: 39357092 DOI: 10.1016/j.cmpb.2024.108437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Stenosis or narrowing of arteries due to the buildup of plaque is a common occurrence in atherosclerosis and coronary artery disease (CAD), limiting blood flow to the heart and posing substantial cardiovascular risk. While the role of geometric irregularities in arterial stenosis is well-documented, the complex interplay between the abnormal hemorheology and asymmetric shape in flow characteristics remains unexplored. METHODS This study investigates the influence of varying hematocrit (Hct) levels, often caused by conditions such as diabetes and anemia, on flow patterns in an idealized eccentric stenotic artery using computational fluid dynamics simulations. We consider three physiological levels of Hct, 25%, 45%, and 65%, representing anemia, healthy, and diabetic conditions, respectively. The numerical simulations are performed for different combinations of shape eccentricity and blood rheological parameters, and hemodynamic indicators such as wall shear stress (WSS), oscillatory shear index (OSI), are relative residence time (RRT) are calculated to assess the arterial health. RESULTS Our results reveal the significant influence of Hct level on stenosis progression. CAD patients with anemia are exposed to lower WSS and higher OSI, which may increase the propensity for plaque progression and rupture. However, for CAD patients with high Hct level - as is often the case in diabetes - the WSS at the minimal lumen area increases rapidly, which may also lead to plaque rupture and cause adverse events such as heart attacks. These disturbances promote endothelial dysfunction, inflammation, and thrombus formation, thereby intensifying cardiovascular risk. CONCLUSIONS Our findings underscore the significance of incorporating hemorheological parameters, such as Hct, into computational models for accurate assessment of flow dynamics. We envision that insights gained from this study will inform the development of tailored treatment strategies and interventions in CAD patients with common comorbidities such as diabetes and anemia, thus mitigating the adverse effects of abnormal hemorheology and reducing the ever-growing burden of cardiovascular diseases.
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Affiliation(s)
- Soumen Chakraborty
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, Jharkhand 826004, India
| | - Vishnu Teja Mantripragada
- Department of Fuel, Minerals and Metallurgical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, Jharkhand 826004, India
| | - Aranyak Chakravarty
- School of Nuclear Studies and Application, Jadavpur University, Kolkata, West Bengal 700106, India
| | - Debkalpa Goswami
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Antarip Poddar
- Department of Mechanical Engineering, Indian Institute of Technology (Indian School of Mines), Dhanbad, Jharkhand 826004, India.
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5
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Kandangwa P, Cheng K, Patel M, Sherwin SJ, de Silva R, Weinberg PD. Relative Residence Time Can Account for Half of the Anatomical Variation in Fatty Streak Prevalence Within the Right Coronary Artery. Ann Biomed Eng 2024:10.1007/s10439-024-03607-9. [PMID: 39287909 DOI: 10.1007/s10439-024-03607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/17/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE The patchy anatomical distribution of atherosclerosis has been attributed to variation in haemodynamic wall shear stress (WSS). The consensus is that low WSS and a high Oscillatory Shear Index (OSI) trigger the disease. We found that atherosclerosis at aortic branch sites correlates threefold better with transverse WSS (transWSS), a metric which quantifies multidirectional near-wall flow. Coronary artery disease has greater clinical significance than aortic disease but computation of WSS metrics is complicated by the substantial vessel motion occurring during each cardiac cycle. Here we present the first comparison of the distribution of atherosclerosis with WSS metrics computed for moving coronary arteries. METHODS Maps of WSS metrics were computed using dynamic geometries reconstructed from angiograms of ten non-stenosed human right coronary arteries (RCAs). They were compared with maps of fatty streak prevalence derived from a previous study of 1852 RCAs. RESULTS Time average WSS (TAWSS), OSI, transWSS and the cross-flow index (CFI), a non-dimensional form of the transWSS, gave non-significant or significant but low spatial correlations with lesion prevalence. The highest correlation coefficient (0.71) was for the relative residence time (RRT), a metric that decreases with TAWSS and increases with OSI. The coefficient was not changed if RRT was calculated using CFI, which captures multidirectional WSS only, rather than OSI, which encompasses both multidirectional and oscillatory WSS. CONCLUSION Contrary to our earlier findings in the aorta, low WSS in combination with highly multidirectional flow correlates best with lesion location in the RCA, explaining approximately half of its anatomical variation.
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Affiliation(s)
- Pratik Kandangwa
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
- Department of Aeronautics, Imperial College London, London, SW7 2AZ, UK
| | - Kevin Cheng
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Miten Patel
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Spencer J Sherwin
- Department of Aeronautics, Imperial College London, London, SW7 2AZ, UK
| | - Ranil de Silva
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Peter D Weinberg
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK.
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Wiśniewski K, Reorowicz P, Tyfa Z, Price B, Jian A, Fahlström A, Obidowski D, Jaskólski DJ, Jóźwik K, Drummond K, Wessels L, Vajkoczy P, Adamides AA. Intracranial bypass for giant aneurysms treatment assessed by computational fluid dynamics (CFD) analysis. Sci Rep 2024; 14:21548. [PMID: 39278964 PMCID: PMC11402993 DOI: 10.1038/s41598-024-72591-w] [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: 04/18/2024] [Accepted: 09/09/2024] [Indexed: 09/18/2024] Open
Abstract
Unruptured giant intracranial aneurysms (GIA) are those with diameters of 25 mm or greater. As aneurysm size is correlated with rupture risk, GIA natural history is poor. Parent artery occlusion or trapping plus bypass revascularization should be considered to encourage intra-aneurysmal thrombosis when other treatment options are contraindicated. The mechanistic background of these methods is poorly studied. Thus, we assessed the potential of computational fluid dynamics (CFD) and fluid-structure interaction (FSI) analyses for clinical use in the preoperative stage. A CFD investigation in three patient-specific flexible models of whole arterial brain circulation was performed. A C6 ICA segment GIA model was created based on CT angiography. Two models were then constructed that simulated a virtual bypass in combination with proximal GIA occlusion, but with differing middle cerebral artery (MCA) recipient vessels for the anastomosis. FSI and CFD investigations were performed in three models to assess changes in flow pattern and haemodynamic parameters alternations (wall shear stress (WSS), oscillatory shear index (OSI), maximal time averaged WSS (TAWSS), and pressure). General flow splitting across the entire domain was affected by virtual bypass procedures, and any deficiency was partially compensated by a specific configuration of the circle of Willis. Following the implementation of bypass procedures, a reduction in haemodynamic parameters was observed within the aneurysm in both cases under analysis. In the case of the temporal MCA branch bypass, the decreases in the studied parameters were slightly greater than in the frontal MCA branch bypass. The reduction in the magnitude of the chosen area-averaged parameters (averaged over the aneurysm wall surface) was as follows: WSS 35.7%, OSI 19.0%, TAWSS 94.7%, and pressure 24.2%. FSI CFD investigation based on patient-specific anatomy models with subsequent stimulation of virtual proximal aneurysm occlusion in conjunction with bypass showed that this method creates a pro-thrombotic favourable environment whilst reducing intra-aneurysmal pressure leading to shrinking. MCA branch recipient selection for optimum haemodynamic conditions should be evaluated individually in the preoperative stage.
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Affiliation(s)
- Karol Wiśniewski
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Lodz, Poland.
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str, 90-924, Lodz, Poland.
| | - Piotr Reorowicz
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str, 90-924, Lodz, Poland
| | - Zbigniew Tyfa
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str, 90-924, Lodz, Poland
| | - Benjamin Price
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia
| | - Anne Jian
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia
| | - Andreas Fahlström
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 75185, Uppsala, Sweden
| | - Damian Obidowski
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str, 90-924, Lodz, Poland.
| | - Dariusz J Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Lodz, Poland
| | - Krzysztof Jóźwik
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str, 90-924, Lodz, Poland
| | - Katharine Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, 3050, Australia
| | - Lars Wessels
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexios A Adamides
- Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, 3050, Australia
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Al-Jumaily AM, Al-Rawi M, Belkacemi D, Sascău RA, Stătescu C, Țurcanu FE, Anghel L. Computational Modeling Approach to Profile Hemodynamical Behavior in a Healthy Aorta. Bioengineering (Basel) 2024; 11:914. [PMID: 39329656 PMCID: PMC11428636 DOI: 10.3390/bioengineering11090914] [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: 08/16/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024] Open
Abstract
Cardiovascular diseases (CVD) remain the leading cause of mortality among older adults. Early detection is critical as the prognosis for advanced-stage CVD is often poor. Consequently, non-invasive diagnostic tools that can assess hemodynamic function, particularly of the aorta, are essential. Computational fluid dynamics (CFD) has emerged as a promising method for simulating cardiovascular dynamics efficiently and cost-effectively, using increasingly accessible computational resources. This study developed a CFD model to assess the aorta geometry using tetrahedral and polyhedral meshes. A healthy aorta was modeled with mesh sizes ranging from 0.2 to 1 mm. Key hemodynamic parameters, including blood pressure waveform, pressure difference, wall shear stress (WSS), and associated wall parameters like relative residence time (RRT), oscillatory shear index (OSI), and endothelial cell activation potential (ECAP) were evaluated. The performance of the CFD simulations, focusing on accuracy and processing time, was assessed to determine clinical viability. The CFD model demonstrated clinically acceptable results, achieving over 95% accuracy while reducing simulation time by up to 54%. The entire simulation process, from image construction to the post-processing of results, was completed in under 120 min. Both mesh types (tetrahedral and polyhedral) provided reliable outputs for hemodynamic analysis. This study provides a novel demonstration of the impact of mesh type in obtaining accurate hemodynamic data, quickly and efficiently, using CFD simulations for non-invasive aortic assessments. The method is particularly beneficial for routine check-ups, offering improved diagnostics for populations with limited healthcare access or higher cardiovascular disease risk.
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Affiliation(s)
- Ahmed M Al-Jumaily
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland 1010, New Zealand
| | - Mohammad Al-Rawi
- Center for Engineering and Industrial Design, Waikato Institute of Technology, Hamilton 3240, New Zealand
- Faculty of Engineering, Chemical and Materials Engineering, The University of Auckland, Auckland 1010, New Zealand
| | - Djelloul Belkacemi
- Unité de Développement des Equipements Solaires, UDES, Centre de Développement des Energies Renouvelables, CDER, Tipaza 42004, Algeria
| | - Radu Andy Sascău
- Internal Medicine Department, Grigore T. Popa University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute, Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, Grigore T. Popa University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute, Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
| | - Florin-Emilian Țurcanu
- Building Services Department, Faculty of Civil Engineering and Building Services, Gheorghe Asachi Technical University, 700050 Iaşi, Romania
| | - Larisa Anghel
- Internal Medicine Department, Grigore T. Popa University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute, Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
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8
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Chen L, Qu H, Liu B, Chen BC, Yang Z, Shi DZ, Zhang Y. Low or oscillatory shear stress and endothelial permeability in atherosclerosis. Front Physiol 2024; 15:1432719. [PMID: 39314624 PMCID: PMC11417040 DOI: 10.3389/fphys.2024.1432719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
Endothelial shear stress is a tangential stress derived from the friction of the flowing blood on the endothelial surface of the arterial wall and is expressed in units of force/unit area (dyne/cm2). Branches and bends of arteries are exposed to complex blood flow patterns that generate low or oscillatory endothelial shear stress, which impairs glycocalyx integrity, cytoskeleton arrangement and endothelial junctions (adherens junctions, tight junctions, gap junctions), thus increasing endothelial permeability. The lipoproteins and inflammatory cells penetrating intima due to the increased endothelial permeability characterizes the pathological changes in early stage of atherosclerosis. Endothelial cells are critical sensors of shear stress, however, the mechanisms by which the complex shear stress regulate endothelial permeability in atherosclerosis remain unclear. In this review, we focus on the molecular mechanisms of the endothelial permeability induced by low or oscillatory shear stress, which will shed a novel sight in early stage of atherosclerosis.
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Affiliation(s)
- Li Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Beijing, China
| | - Bin Liu
- The First Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Bing-Chang Chen
- Graduate school, Shanxi University of Chinese Medicine, Taiyuan, China
| | - Zhen Yang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Da-Zhuo Shi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Ying Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
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Zhang M, Gharleghi R, Shen C, Beier S. A new understanding of coronary curvature and haemodynamic impact on the course of plaque onset and progression. ROYAL SOCIETY OPEN SCIENCE 2024; 11:241267. [PMID: 39309260 PMCID: PMC11416812 DOI: 10.1098/rsos.241267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/01/2024] [Indexed: 09/25/2024]
Abstract
The strong link between atherosclerosis and luminal biomechanical stresses is well established. Yet, this understanding has not translated into preventative coronary diagnostic imaging, particularly due to the under-explored role of coronary anatomy and haemodynamics in plaque onset, which we aim to address with this work. The left coronary trees of 20 non-stenosed (%diameter stenosis [%DS] = 0), 12 moderately (0 < %DS < 70) and 7 severely (%DS ≥ 70) stenosed cases were dissected into bifurcating and non-bifurcating segments for whole-tree and segment-specific comparisons, correlating nine three-dimensional coronary anatomical features, topological shear variation index (TSVI) and luminal areas subject to low time-average endothelial shear stress (%LowTAESS), high oscillatory shear index (%HighOSI) and high relative residence time (%HighRRT). We found that TSVI is the only metric consistently differing between non-stenosed and stenosed cases across the whole tree, bifurcating and non-bifurcating segments (p < 0.002, AUC = 0.876), whereas average curvature and %HighOSI differed only for the whole trees (p < 0.024) and non-bifurcating segments (p < 0.027), with AUC > 0.711. Coronary trees with moderate or severe stenoses differed only in %LowTAESS (p = 0.009) and %HighRRT (p = 0.012). This suggests TSVI, curvature and %HighOSI are potential factors driving plaque onset, with greater predictive performance than the previously recognized %LowTAESS and %HighRRT, which appears to play a role in plaque progression.
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Affiliation(s)
- Mingzi Zhang
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, New South Wales2052, Australia
| | - Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, New South Wales2052, Australia
| | - Chi Shen
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, New South Wales2052, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, New South Wales2052, Australia
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10
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Hernández-López P, Cilla M, Martínez MA, Peña E, Malvè M. Impact of geometric and hemodynamic changes on a mechanobiological model of atherosclerosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 254:108296. [PMID: 38941860 DOI: 10.1016/j.cmpb.2024.108296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVE In this work, the analysis of the importance of hemodynamic updates on a mechanobiological model of atheroma plaque formation is proposed. METHODS For that, we use an idealized and axisymmetric model of carotid artery. In addition, the behavior of endothelial cells depending on hemodynamical changes is analyzed too. A total of three computational simulations are carried out and their results are compared: an uncoupled model and two models that consider the opposite behavior of endothelial cells caused by hemodynamic changes. The model considers transient blood flow using the Navier-Stokes equation. Plasma flow across the endothelium is determined with Darcy's law and the Kedem-Katchalsky equations, considering the three-pore model, which is also employed for the flow of substances across the endothelium. The behavior of the considered substances in the arterial wall is modeled with convection-diffusion-reaction equations, and the arterial wall is modeled as a hyperelastic Yeoh's material. RESULTS Significant variations are noted in both the morphology and stenosis ratio of the plaques when comparing the uncoupled model to the two models incorporating updates for geometry and hemodynamic stimuli. Besides, the phenomenon of double-stenosis is naturally reproduced in the models that consider both geometric and hemodynamical changes due to plaque growth, whereas it cannot be predicted in the uncoupled model. CONCLUSIONS The findings indicate that integrating the plaque growth model with geometric and hemodynamic settings is essential in determining the ultimate shape and dimensions of the carotid plaque.
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Affiliation(s)
| | - Myriam Cilla
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, 50015, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain.
| | - Miguel A Martínez
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, 50015, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain.
| | - Estefanía Peña
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, 50015, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain.
| | - Mauro Malvè
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain; Public University of Navarra (UPNA), Pamplona, Spain.
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11
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Xiao Z, Postma RJ, van Zonneveld AJ, van den Berg BM, Sol WM, White NA, van de Stadt HJ, Mirza A, Wen J, Bijkerk R, Rotmans JI. A bypass flow model to study endothelial cell mechanotransduction across diverse flow environments. Mater Today Bio 2024; 27:101121. [PMID: 38988818 PMCID: PMC11234155 DOI: 10.1016/j.mtbio.2024.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/07/2024] [Accepted: 06/08/2024] [Indexed: 07/12/2024] Open
Abstract
Disturbed flow is one of the pathological initiators of endothelial dysfunction in intimal hyperplasia (IH) which is commonly seen in vascular bypass grafts, and arteriovenous fistulas. Various in vitro disease models have been designed to simulate the hemodynamic conditions found in the vasculature. Nonetheless, prior investigations have encountered challenges in establishing a robust disturbed flow model, primarily attributed to the complex bifurcated geometries and distinctive flow dynamics. In the present study, we aim to address this gap by introducing an in vitro bypass flow model capable of inducing disturbed flow and other hemodynamics patterns through a pulsatile flow in the same model. To assess the model's validity, we employed computational fluid dynamics (CFD) to simulate hemodynamics and compared the morphology and functions of human umbilical venous endothelial cells (HUVECs) under disturbed flow conditions to those in physiological flow or stagnant conditions. CFD analysis revealed the generation of disturbed flow within the model, pinpointing the specific location in the channel where the effects of disturbed flow were observed. High-content screening, a single-cell morphological profile assessment, demonstrated that HUVECs in the disturbed flow area exhibited random orientation, and morphological features were significantly distinct compared to cells in the physiological flow or stagnant condition after a two days of flow exposure. Furthermore, HUVECs exposed to disturbed flow underwent extensive remodeling of the adherens junctions and expressed higher levels of endothelial cell activation markers compared to other hemodynamic conditions. In conclusion, our in vitro bypass flow model provides a robust platform for investigating the associations between disturbed flow pattern and vascular diseases.
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Affiliation(s)
- Zhuotao Xiao
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Rudmer J. Postma
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
| | - Anton Jan van Zonneveld
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
| | - Bernard M. van den Berg
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
| | - Wendy M.P.J. Sol
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
| | - Nicholas A. White
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, 2628, CN, Netherlands
| | - Huybert J.F. van de Stadt
- Department of Medical Technology, Design & Prototyping, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
| | - Asad Mirza
- Department of Biomedical Engineering, Florida International University, Miami, FL, 33199, United States
| | - Jun Wen
- Department of Computer Science and Technology, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Roel Bijkerk
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
| | - Joris I. Rotmans
- Department of Internal Medicine (Nephrology) and the Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, 2333, ZA, Netherlands
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12
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Veeturi SS, Hall S, Fujimura S, Mossa-Basha M, Sagues E, Samaniego EA, Tutino VM. Imaging of Intracranial Aneurysms: A Review of Standard and Advanced Imaging Techniques. Transl Stroke Res 2024:10.1007/s12975-024-01261-w. [PMID: 38856829 DOI: 10.1007/s12975-024-01261-w] [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: 04/16/2024] [Revised: 04/16/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024]
Abstract
The treatment of intracranial aneurysms is dictated by its risk of rupture in the future. Several clinical and radiological risk factors for aneurysm rupture have been described and incorporated into prediction models. Despite the recent technological advancements in aneurysm imaging, linear length and visible irregularity with a bleb are the only radiological measure used in clinical prediction models. The purpose of this article is to summarize both the standard imaging techniques, including their limitations, and the advanced techniques being used experimentally to image aneurysms. It is expected that as our understanding of advanced techniques improves, and their ability to predict clinical events is demonstrated, they become an increasingly routine part of aneurysm assessment. It is important that neurovascular specialists understand the spectrum of imaging techniques available.
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Affiliation(s)
- Sricharan S Veeturi
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Samuel Hall
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Soichiro Fujimura
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- Division of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Elena Sagues
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | | | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA.
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA.
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13
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Pei Y, Song P, Zhang K, Dai M, He G, Wen J. Assessing the impact of tear direction in coronary artery dissection on thrombosis development: A hemodynamic computational study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 249:108144. [PMID: 38569255 DOI: 10.1016/j.cmpb.2024.108144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/11/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Iatrogenic coronary artery dissection is a complication of coronary intimal injury and dissection due to improper catheter manipulation. The impact of tear direction on the prognosis of coronary artery dissection (CAD) remains unclear. This study examines the hemodynamic effects of different tear directions (transverse and longitudinal) of CAD and evaluates the risk of thrombosis, rupture and further dilatation of CAD. METHODS Two types of CAD models (Type I: transverse tear, Type II: longitudinal tear) were reconstructed from the aorto-coronary CTA dataset of 8 healthy cases. Four WSS-based indicators were analyzed, including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and cross flow index (CFI). A thrombus growth model was also introduced to predict the trend of thrombus growth in CAD with two different tear directions. RESULTS For most of the WSS-based indicators, including TAWSS, RRT, and CFI, no statistically significant differences were observed across the CAD models with varying tear directions, except for OSI, where a significant difference was noted (p < 0.05). Meanwhile, in terms of thrombus growth, the thrombus growing at the tear of the Type I (transverse tear) CAD model extended into the true lumen earlier than that of the Type II (longitudinal tear) model. CONCLUSIONS Numerical simulations suggest that: (1) The CAD with transverse tear have a high risk of further tearing of the dissection at the distal end of the tear. (2) The CAD with longitudinal tear create a hemodynamic environment characterized by low TAWSS and high OSI in the false lumen, which may additionally increase the risk of vessel wall injury. (3) The CAD with transverse tear may have a higher risk of thrombosis and coronary obstruction and myocardial ischemia in the early phase of the dissection.
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Affiliation(s)
- Yan Pei
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China
| | - Pan Song
- Department of Cardiology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Kaiyue Zhang
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Gang He
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China
| | - Jun Wen
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China.
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14
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Boniforti MA, Vittucci G, Magini R. Endovascular Treatment of Intracranial Aneurysm: The Importance of the Rheological Model in Blood Flow Simulations. Bioengineering (Basel) 2024; 11:522. [PMID: 38927758 PMCID: PMC11200932 DOI: 10.3390/bioengineering11060522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
Hemodynamics in intracranial aneurysm strongly depends on the non-Newtonian blood behavior due to the large number of suspended cells and the ability of red blood cells to deform and aggregate. However, most numerical investigations on intracranial hemodynamics adopt the Newtonian hypothesis to model blood flow and predict aneurysm occlusion. The aim of this study was to analyze the effect of the blood rheological model on the hemodynamics of intracranial aneurysms in the presence or absence of endovascular treatment. A numerical investigation was performed under pulsatile flow conditions in a patient-specific aneurysm with and without the insertion of an appropriately reconstructed flow diverter stent (FDS). The numerical simulations were performed using Newtonian and non-Newtonian assumptions for blood rheology. In all cases, FDS placement reduced the intra-aneurysmal velocity and increased the relative residence time (RRT) on the aneurysmal wall, indicating progressive thrombus formation and aneurysm occlusion. However, the Newtonian model largely overestimated RRT values and consequent aneurysm healing with respect to the non-Newtonian models. Due to the non-Newtonian blood properties and the large discrepancy between Newtonian and non-Newtonian simulations, the Newtonian hypothesis should not be used in the study of the hemodynamics of intracranial aneurysm, especially in the presence of endovascular treatment.
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Affiliation(s)
- Maria Antonietta Boniforti
- Department of Civil, Building, and Environmental Engineering, Sapienza University, 00184 Rome, Italy; (G.V.); (R.M.)
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15
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Zingaro A, Ahmad Z, Kholmovski E, Sakata K, Dede' L, Morris AK, Quarteroni A, Trayanova NA. A comprehensive stroke risk assessment by combining atrial computational fluid dynamics simulations and functional patient data. Sci Rep 2024; 14:9515. [PMID: 38664464 PMCID: PMC11045804 DOI: 10.1038/s41598-024-59997-2] [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: 01/26/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like theCHA 2 DS 2 -VASc score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations. Our cohort, evenly split between control and stroke groups, comprises eight patients. Utilizing CINE CMR, we compute kinematic features, revealing smaller left atrial volumes for stroke patients. The incorporation of patient-specific atrial displacement into our hemodynamic simulations unveils the influence of atrial compliance on the flow fields, emphasizing the importance of LA motion in CFD simulations and challenging the conventional rigid wall assumption in hemodynamics models. Standardizing hemodynamic features with functional metrics enhances the differentiation between stroke and control cases. While standalone assessments provide limited clarity, the synergistic fusion of CMR-derived functional data and patient-informed CFD simulations offers a personalized and mechanistic understanding, distinctly segregating stroke from control cases. Specifically, our investigation reveals a crucial clinical insight: normalizing hemodynamic features based on ejection fraction fails to differentiate between stroke and control patients. Differently, when normalized with stroke volume, a clear and clinically significant distinction emerges and this holds true for both the left atrium and its appendage, providing valuable implications for precise stroke risk assessment in clinical settings. This work introduces a novel framework for seamlessly integrating hemodynamic and functional metrics, laying the groundwork for improved predictive models, and highlighting the significance of motion-informed, personalized risk assessments.
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Affiliation(s)
- Alberto Zingaro
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA.
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
- ELEM Biotech S.L., Pier07, Via Laietana, 26, 08003, Barcelona, Spain.
| | - Zan Ahmad
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, 100 Wyman Park Dr, Baltimore, MD, 21211, USA
| | - Eugene Kholmovski
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
- Department of Radiology, University of Utah, 30 N Mario Capecchi Dr., Salt Lake City, UT, 84112, USA
| | - Kensuke Sakata
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
| | - Luca Dede'
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Alan K Morris
- Scientific Computing and Imaging Institute, University of Utah, 72 Central Campus Dr., Salt Lake City, UT, 84112, USA
| | - Alfio Quarteroni
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Station 8, Av. Piccard, 1015, Lausanne, Switzerland
| | - Natalia A Trayanova
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
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16
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Li S, Huang Z, Chen H, Chen F. Proximal Clipping and Distal High-Flow Bypass in the Treatment of Giant/Complex Intracranial Aneurysm: An Opportunity or a Risk from a Fluid-Structural Interaction Analysis. Cardiovasc Eng Technol 2024; 15:159-170. [PMID: 38093146 DOI: 10.1007/s13239-023-00704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/21/2023] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Conventional clipping and endovascular treatment are difficult to apply for some giant intracranial aneurysms (GIAs), and sometimes extracranial-to-intracranial (EC-IC) bypass becomes the optional choice. However, not all GIA patients can benefit from it. This study aims to recognize the underlying problems. METHODS We included eligible patients in our care. Then, we researched from three levels: a retrospective review of clinical data, fluid-structural analysis from two representative patient-specific models, and fluid-structural interaction analysis for idealized models to investigate the hemodynamic and biomechanical mechanisms. RESULTS In this article, we report nine patients with GIA who underwent EC-IC surgery. Of them, three experienced dangerous postoperative hemorrhage, and one patient died. Among these three patients, two lacked the A1 segment of the anterior cerebral artery (ACA). The numerical simulation showed that after surgery, for the patient with an unruptured aneurysm and existence of ACA, the wall deformation, wall stress, pressure, and area of the oscillatory shear index (OSI) > 0.2 were decreased by 43%, 39%, 33%, and 13%, while the patient without A1 segment having postoperative hemorrhage showed 36%, 45%, 13%, and 55% increased, respectively. Thus, we postulated a dangerous "stump phenomenon" in such conditions and further demonstrated it from idealized models with different sizes of ACA. Finally, we found a larger anastomosis angle and smaller diameter of the graft can alleviate this effect. CONCLUSIONS Neurosurgeon should cautiously evaluate the opportunity and risk for such patients who have aplasia of the A1 segment of ACA when making clinical decisions.
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Affiliation(s)
- Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China
- Research Center for Cerebrovascular Diseases, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China
- Xiangya Hospital, Hypothalamic-Pituitary Research Center, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Research Center for Cerebrovascular Disease, Central South University, 87 Xiangya Road, 410008, changsha, China
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China
- Research Center for Cerebrovascular Diseases, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China
- Xiangya Hospital, Hypothalamic-Pituitary Research Center, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hua Chen
- Department of Neurosurgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, China.
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China.
- Research Center for Cerebrovascular Diseases, Central South University, 87 Xiangya Street, Changsha, 410008, Hunan, China.
- Xiangya Hospital, Hypothalamic-Pituitary Research Center, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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17
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De Nisco G, Hartman EM, Torta E, Daemen J, Chiastra C, Gallo D, Morbiducci U, Wentzel JJ. Predicting Lipid-Rich Plaque Progression in Coronary Arteries Using Multimodal Imaging and Wall Shear Stress Signatures. Arterioscler Thromb Vasc Biol 2024; 44:976-986. [PMID: 38328935 PMCID: PMC10965126 DOI: 10.1161/atvbaha.123.320337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Plaque composition and wall shear stress (WSS) magnitude act as well-established players in coronary plaque progression. However, WSS magnitude per se does not completely capture the mechanical stimulus to which the endothelium is subjected, since endothelial cells experience changes in the WSS spatiotemporal configuration on the luminal surface. This study explores WSS profile and lipid content signatures of plaque progression to identify novel biomarkers of coronary atherosclerosis. METHODS Thirty-seven patients with acute coronary syndrome underwent coronary computed tomography angiography, near-infrared spectroscopy intravascular ultrasound, and optical coherence tomography of at least 1 nonculprit vessel at baseline and 1-year follow-up. Baseline coronary artery geometries were reconstructed from intravascular ultrasound and coronary computed tomography angiography and combined with flow information to perform computational fluid dynamics simulations to assess the time-averaged WSS magnitude (TAWSS) and the variability in the contraction/expansion action exerted by WSS on the endothelium, quantifiable in terms of topological shear variation index (TSVI). Plaque progression was measured as intravascular ultrasound-derived percentage plaque atheroma volume change at 1-year follow-up. Plaque composition information was extracted from near-infrared spectroscopy and optical coherence tomography. RESULTS Exposure to high TSVI and low TAWSS was associated with higher plaque progression (4.00±0.69% and 3.60±0.62%, respectively). Plaque composition acted synergistically with TSVI or TAWSS, resulting in the highest plaque progression (≥5.90%) at locations where lipid-rich plaque is exposed to high TSVI or low TAWSS. CONCLUSIONS Luminal exposure to high TSVI, solely or combined with a lipid-rich plaque phenotype, is associated with enhanced plaque progression at 1-year follow-up. Where plaque progression occurred, low TAWSS was also observed. These findings suggest TSVI, in addition to low TAWSS, as a potential biomechanical predictor for plaque progression, showing promise for clinical translation to improve patient prognosis.
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Affiliation(s)
- Giuseppe De Nisco
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Eline M.J. Hartman
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (E.M.J.H., J.D., J.J.W.)
| | - Elena Torta
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Joost Daemen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (E.M.J.H., J.D., J.J.W.)
| | - Claudio Chiastra
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Diego Gallo
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Umberto Morbiducci
- PolitoMed Laboratory, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy (G.D.N., E.T., C.C., D.G., U.M.)
| | - Jolanda J. Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands (E.M.J.H., J.D., J.J.W.)
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18
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Lo SCY, McCullough JWS, Xue X, Coveney PV. Uncertainty quantification of the impact of peripheral arterial disease on abdominal aortic aneurysms in blood flow simulations. J R Soc Interface 2024; 21:20230656. [PMID: 38593843 PMCID: PMC11003782 DOI: 10.1098/rsif.2023.0656] [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: 11/07/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Peripheral arterial disease (PAD) and abdominal aortic aneurysms (AAAs) often coexist and pose significant risks of mortality, yet their mutual interactions remain largely unexplored. Here, we introduce a fluid mechanics model designed to simulate the haemodynamic impact of PAD on AAA-associated risk factors. Our focus lies on quantifying the uncertainty inherent in controlling the flow rates within PAD-affected vessels and predicting AAA risk factors derived from wall shear stress. We perform a sensitivity analysis on nine critical model parameters through simulations of three-dimensional blood flow within a comprehensive arterial geometry. Our results show effective control of the flow rates using two-element Windkessel models, although specific outlets need attention. Quantities of interest like endothelial cell activation potential (ECAP) and relative residence time are instructive for identifying high-risk regions, with ECAP showing greater reliability and adaptability. Our analysis reveals that the uncertainty in the quantities of interest is 187% of that of the input parameters. Notably, parameters governing the amplitude and frequency of the inlet velocity exert the strongest influence on the risk factors' variability and warrant precise determination. This study forms the foundation for patient-specific simulations involving PAD and AAAs which should ultimately improve patient outcomes and reduce associated mortality rates.
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Affiliation(s)
- Sharp C. Y. Lo
- Centre for Computational Science, University College London, London, UK
| | | | - Xiao Xue
- Centre for Computational Science, University College London, London, UK
| | - Peter V. Coveney
- Centre for Computational Science, University College London, London, UK
- Advanced Research Computing Centre, University College London, London, UK
- Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
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19
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Guo KK, Liu CY, Li GH, Xiang JP, Leng XC, Cai YK, Hu XB. Differences and Correlations of Morphological and Hemodynamic Parameters between Anterior Circulation Bifurcation and Side-wall Aneurysms. Curr Med Sci 2024; 44:391-398. [PMID: 38517676 DOI: 10.1007/s11596-024-2846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between sidewall and bifurcation aneurysms in anterior circulation arteries, utilizing computational fluid dynamics as a tool for analysis. METHODS In line with the designated inclusion criteria, this study covered 160 aneurysms identified in 131 patients who received treatment at Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, China, from January 2021 to September 2022. Utilizing follow-up digital subtraction angiography (DSA) data, these cases were classified into two distinct groups: the sidewall aneurysm group and the bifurcation aneurysm group. Morphological and hemodynamic parameters in the immediate preoperative period were meticulously calculated and examined in both groups using a three-dimensional DSA reconstruction model. RESULTS No significant differences were found in the morphological or hemodynamic parameters of bifurcation aneurysms at varied locations within the anterior circulation. However, pronounced differences were identified between sidewall and bifurcation aneurysms in terms of morphological parameters such as the diameter of the parent vessel (Dvessel), inflow angle (θF), and size ratio (SR), as well as the hemodynamic parameter of inflow concentration index (ICI) (P<0.001). Notably, only the SR exhibited a significant correlation with multiple hemodynamic parameters (P<0.001), while the ICI was closely related to several morphological parameters (R>0.5, P<0.001). CONCLUSIONS The significant differences in certain morphological and hemodynamic parameters between sidewall and bifurcation aneurysms emphasize the importance to contemplate variances in threshold values for these parameters when evaluating the risk of rupture in anterior circulation aneurysms. Whether it is a bifurcation or sidewall aneurysm, these disparities should be considered. The morphological parameter SR has the potential to be a valuable clinical tool for promptly distinguishing the distinct rupture risks associated with sidewall and bifurcation aneurysms.
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Affiliation(s)
- Kai-Kai Guo
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chang-Ya Liu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Gao-Hui Li
- Artery Flow Technology Co., Ltd., Hangzhou, 310051, China
| | | | | | - Yi-Ke Cai
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xue-Bin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Hyodo R, Takehara Y, Ishizu Y, Nishida K, Mizuno T, Ichikawa K, Horiguchi R, Kurata N, Ogura Y, Yokoyama S, Naganawa S, Jin N, Ichiba Y. Evaluation of 4D Flow MRI-Derived Relative Residence Time as a Marker for Cirrhosis Associated Portal Vein Thrombosis. J Magn Reson Imaging 2024. [PMID: 38490816 DOI: 10.1002/jmri.29357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) is thought to arise from stagnant blood flow, yet conclusive evidence is lacking. Relative residence time (RRT) assessed using 4D Flow MRI may offer insight into portal flow stagnation. PURPOSE To explore the relationship between RRT values and the presence of PVT in cirrhotic participants. STUDY TYPE Prospective. POPULATION Forty-eight participants with liver cirrhosis (27 males, median age 67 years [IQR: 57-73]) and 20 healthy control participants (12 males, median age 45 years [IQR: 40-54]). FIELD STRENGTH/SEQUENCE 3 T/4D Flow MRI. ASSESSMENT Laboratory (liver and kidney function test results and platelet count) and clinical data (presence of tumors and other imaging findings), and portal hemodynamics derived from 4D Flow MRI (spatiotemporally averaged RRT [RRT-mean], flow velocity, and flow rate) were analyzed. STATISTICAL TESTS We used multivariable logistic regression, adjusted by selected covariates through the Lasso method, to explore whether RRT-mean is an independent risk factor for PVT. The area under the ROC curve (AUC) was also calculated to assess the model's discriminative ability. P < 0.05 indicated statistical significance. RESULTS The liver cirrhosis group consisted of 16 participants with PVT and 32 without PVT. Higher RRT-mean values (odds ratio [OR] 11.4 [95% CI: 2.19, 118]) and lower platelet count (OR 0.98 per 1000 μL [95% CI: 0.96, 0.99]) were independent risk factors for PVT. The incorporation of RRT-mean (AUC, 0.77) alongside platelet count (AUC, 0.75) resulted in an AUC of 0.84. When including healthy control participants, RRT-mean had an adjusted OR of 12.4 and the AUC of the combined model (RRT-mean and platelet count) was 0.90. DATA CONCLUSION Prolonged RRT values and low platelet count were significantly associated with the presence of PVT in cirrhotic participants. RRT values derived from 4D Flow MRI may have potential clinical relevance in the management of PVT. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Nishida
- Center for Advanced Medicine and Clinical Research Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Mizuno
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Kazushige Ichikawa
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Ryota Horiguchi
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiko Kurata
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ning Jin
- Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, USA
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Trenti C, Fedak PWM, White JA, Garcia J, Dyverfeldt P. Oscillatory shear stress is elevated in patients with bicuspid aortic valve and aortic regurgitation: a 4D flow cardiovascular magnetic resonance cross-sectional study. Eur Heart J Cardiovasc Imaging 2024; 25:404-412. [PMID: 37878753 PMCID: PMC10883729 DOI: 10.1093/ehjci/jead283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
AIMS Patients with bicuspid aortic valve (BAV) and aortic regurgitation have higher rate of aortic complications compared with patients with BAV and stenosis, as well as BAV without valvular disease. Aortic regurgitation alters blood haemodynamics not only in systole but also during diastole. We therefore sought to investigate wall shear stress (WSS) during the whole cardiac cycle in BAV with aortic regurgitation. METHODS AND RESULTS Fifty-seven subjects that underwent 4D flow cardiovascular magnetic resonance imaging were included: 13 patients with BAVs without valve disease, 14 BAVs with aortic regurgitation, 15 BAVs with aortic stenosis, and 22 normal controls with tricuspid aortic valve. Peak and time averaged WSS in systole and diastole and the oscillatory shear index (OSI) in the ascending aorta were computed. Student's t-tests were used to compare values between the four groups where the data were normally distributed, and the non-parametric Wilcoxon rank sum tests were used otherwise. BAVs with regurgitation had similar peak and time averaged WSS compared with the patients with BAV without valve disease and with stenosis, and no regions of elevated WSS were found. BAV with aortic regurgitation had twice as high OSI as the other groups (P ≤ 0.001), and mainly in the outer mid-to-distal ascending aorta. CONCLUSION OSI uniquely characterizes altered WSS patterns in BAVs with aortic regurgitation, and thus could be a haemodynamic marker specific for this specific group that is at higher risk of aortic complications. Future longitudinal studies are needed to verify this hypothesis.
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Affiliation(s)
- Chiara Trenti
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
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Peng T, Zhong Y, Lin X, Jiang B, Wang P, Jia Y. Analysis and numerical investigation of bile flow dynamics within the strictured biliary duct. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3790. [PMID: 37997039 DOI: 10.1002/cnm.3790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
The mechanics of bile flow in the biliary system plays an important role in studying bile stasis and gallstone formation. Bile duct stricture is an abnormal phenomenon that refers to the bile duct getting smaller or narrower. The main objective of this study is to study the influence of stricture on bile flow dynamics using numerical methods. We employed a numerical Computational Fluid Dynamics model of the bile flow within a strictured hepatic duct. We studied and compared the influence of stricture severity, stricture length, eccentricity, and bile flow property on the bile flow dynamics. The bile flow velocity, pressure distribution, pressure drop, and wall shear stress are provided in detail. The stricture alters the normal bile flow pattern and increases flow resistance. At the location upstream and downstream of the stricture, bile flow slows down. In the area of the stricture throat, bile flow is accelerated, and recirculation forms behind the stricture. The maximum pressure drop of the biliary system increases with the stricture length. The eccentricity makes the flow deflect away from the duct's centerline. The behavior of the deflected flow is significantly altered downstream of the stricture. Such bile flow behavior as deceleration and recirculation may lead to cholestasis. Stricture alters bile flow in the biliary tract, causing changes in biliary hydrodynamic indexes, which could potentially serve as an omen for gallstone formation and other related diseases. The consideration of the bile duct stricture could lead to better patient stratification.
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Affiliation(s)
- Tao Peng
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Yunlong Zhong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaodong Lin
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
| | - Bingyan Jiang
- State Key Laboratory of High Performance Complex Manufacturing, College of Mechanical and Electrical Engineering, Central South University, Hunan, China
| | - Ping Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanwei Jia
- Zhuhai UM Science & Technology Research Institute, Zhuhai, China
- State Key Laboratory of Analog and Mixed-Signal VLSI, Institute of Microelectronics, University of Macau, Macao, China
- Faculty of Science and Technology - Electrical and Computer Engineering, University of Macau, Macau, China
- MoE Frontiers Science Center for Precision Oncology, University of Macau, Macau, China
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Zingaro A, Ahmad Z, Kholmovski E, Sakata K, Dede’ L, Morris AK, Quarteroni A, Trayanova NA. A comprehensive stroke risk assessment by combining atrial computational fluid dynamics simulations and functional patient data. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.11.575156. [PMID: 38293150 PMCID: PMC10827064 DOI: 10.1101/2024.01.11.575156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like the CHA2DS2-VASc score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations. Our cohort, evenly split between control and stroke groups, comprises eight patients. Utilizing CINE CMR, we compute kinematic features, revealing smaller left atrial volumes for stroke patients. The incorporation of patient-specific atrial displacement into our hemodynamic simulations unveils the influence of atrial compliance on the flow fields, emphasizing the importance of LA motion in CFD simulations and challenging the conventional rigid wall assumption in hemodynamics models. Standardizing hemodynamic features with functional metrics enhances the differentiation between stroke and control cases. While standalone assessments provide limited clarity, the synergistic fusion of CMR-derived functional data and patient-informed CFD simulations offers a personalized and mechanistic understanding, distinctly segregating stroke from control cases. Specifically, our investigation reveals a crucial clinical insight: normalizing hemodynamic features based on ejection fraction fails to differentiate between stroke and control patients. Differently, when normalized with stroke volume, a clear and clinically significant distinction emerges and this holds true for both the left atrium and its appendage, providing valuable implications for precise stroke risk assessment in clinical settings. This work introduces a novel framework for seamlessly integrating hemodynamic and functional metrics, laying the groundwork for improved predictive models, and highlighting the significance of motion-informed, personalized risk assessments.
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Affiliation(s)
- Alberto Zingaro
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
- ELEM Biotech S.L., Pier07, Via Laietana, 26, 08003, Barcelona, Spain
| | - Zan Ahmad
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, 100 Wyman Park Dr, 21211, Baltimore, MD, USA
| | - Eugene Kholmovski
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
- Department of Radiology, University of Utah, 30 N Mario Capecchi Dr., 84112, Salt Lake City, UT, USA
| | - Kensuke Sakata
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
| | - Luca Dede’
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Alan K. Morris
- Scientific Computing and Imaging Institute, University of Utah, 72 Central Campus Dr., 84112, Salt Lake City, UT, USA
| | - Alfio Quarteroni
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Station 8, Av. Piccard, CH-1015 Lausanne, Switzerland (Professor Emeritus)
| | - Natalia A. Trayanova
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
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24
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Liu X, Song P, Gao Q, Dai M, Rao J, Wen J. Impact on hemodynamics in carotid arteries with carotid webs at different locations: A Numerical Study Integrating Thrombus Growth Model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107926. [PMID: 37984097 DOI: 10.1016/j.cmpb.2023.107926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Carotid webs (CWs), lesions in the carotid arteries, are gaining research interest due to the unclear link to ischemic stroke. Similarity to atherosclerosis in lesion location adds the complexity. The main purpose of study is to investigate the hemodynamic effects of CWs at different locations in carotid arteries. METHODS Three types of models with CWs were reconstructed from the CTA dataset of 8 healthy carotid arteries (Models A: CWs at the common carotid artery; B: at the origin of internal carotid artery; C: at the carotid sinus). Wall shear stress (WSS)-based parameters, including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and endothelial cell activation potential (ECAP) were analyzed. A thrombus growth model was also incorporated to assess long-term thrombus formation across different carotid webs locations. RESULTS Models A exhibited helical flow, whereas models B and C showed disturbed flow in the carotid sinus. Recirculation in Models A and B was mainly downstream of CWs, while Models C had both upstream and downstream recirculation. In addition, models A had higher overall TAWSS levels, with the smallest region of TAWSS < 0.4 pa (7.78 ± 8.35%). In contrast, Models C had larger areas with TAWSS < 0.4 pa, RRT > 100, and ECAP > 1.5, accounting for 14.18 ± 5.28%, 1.51 ± 1.17%, and 10.36 ± 4.10%, respectively. Noting that thrombus volume was highest in Models C (7.20 ± 3.95%). CONCLUSIONS Numerical simulations indicate that: 1) CWs have less hemodynamic impact when located in the CCA, but may increase flow resistance leading to distal branch ischemia; 2) CWs contribute to thrombus formation, primarily downstream in the common carotid artery and internal carotid artery origin, and both upstream and downstream in the sinus; 3) CWs at the origin of the ICA are more likely to result in disturbed blood flow patterns and thrombus aggregation than the other two locations, which may increase the risk of ischemic stroke in distal cerebral arteries.
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Affiliation(s)
- Xinhui Liu
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Pan Song
- Department of Cardiology, Mianyang Central Hospital, Mianyang 621000, China
| | - Qi Gao
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, Mianyang 621000, China
| | - Junjie Rao
- Office of the Commission for Discipline Inspection, Mianyang Central Hospital, Mianyang 621000, China
| | - Jun Wen
- Department of Computer Science and Technology, Southwest University of Science and Technology, Mianyang 621010, China.
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25
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Tzirakis K, Kontopodis N, Ioannou CV. A hemodynamic study of blood flow models on various stent graft configurations during aorto-iliac reconstruction. Clin Hemorheol Microcirc 2024; 87:199-219. [PMID: 38363603 DOI: 10.3233/ch-232058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To compare the hemodynamic performance of three (Bottom Up non-ballet, Top-Down non-ballet, Top Down ballet) idealized stent graft configurations used during endovascular repair of abdominal aortic aneurysms, under the influence of various rheological models. METHODS Ten rheological models are assumed and a commercial finite volume solver is employed for the simulation of blood flow under realistic boundary conditions. An appropriate mesh convergence study is performed and five hemodynamic variables are computed: the time average wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), endothelial cell activation potential (ECAP) and displacement force (DF) for all three configurations. RESULTS The choice of blood flow model may affect results, but does not constitute a significant determinant on the overall performance of the assumed stent grafts. On the contrary, stent graft geometry has a major effect. Specifically, the Bottom Up non-ballet type is characterized by the least favorable performance presenting the lowest TAWSS and the highest OSI, RRT and ECAP values. On the other hand, the Top Down ballet type presents hemodynamic advantages yielding the highest TAWSS and lowest OSI, RRT and ECAP average values. Furthermore, the ballet type is characterized by the lowest DF, although differences observed are small and their clinical relevance uncertain. CONCLUSIONS The effect of the assumed rheological model on the overall performance of the grafts is not significant. It is thus relatively safe to claim that it is the type of stent graft that determines its overall performance rather than the adopted blood flow model.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, School of Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
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26
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Noël C, Settembre N. Near-wall hemodynamic parameters of finger arteries altered by hand-transmitted vibration. Comput Biol Med 2024; 168:107709. [PMID: 37992469 DOI: 10.1016/j.compbiomed.2023.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/05/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Sustained exposure to high-level hand-transmitted vibrations may result in angioneurotic disorders, which partly originate from vibration-altered hemodynamics in the finger arteries when repeating these disturbances throughout working life. Hence, the aim of this study is to assess the most relevant hemodynamic descriptors in the digital arteries, determine the relationship between the latter and vibration features, and gain better understanding of the physiological mechanisms involved. METHODS An experimental setup, mainly comprised of an ultra-high frequency ultrasound scanner and a vibration shaker, was used to image the digital proper volar arteries of the forefinger. Raw ultrasound data were post-processed by custom-made numerical routines to supply a pulsatile fluid mechanics model for computing the hemodynamic descriptors. Twenty-four healthy volunteers participated in the measurement campaign. Classical statistical methods were then applied to the dataset and also the wavelet transform for calculating the signal power in the frequency bands matching cardiac, respiratory, myogenic and neurogenic activities. RESULTS The artery diameter, the wall shear stress - WSS - and the WSS temporal gradient - WSSTG - were found to be the most relevant descriptors. Vibration-induced WSS was divided by three compared to its basal value whatever the vibration frequency and it was proportional to log2 of the acceleration level. Marked increases in WSSTG when stopping vibration might also lead to adverse health effects. Vibration caused a drop in WSS power for the frequency band associated with the neurogenic activity of the sympathetic nervous system. CONCLUSION This study may pave the way for a new framework to prevent vibration-induced vascular risk.
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Affiliation(s)
- Christophe Noël
- Electromagnetism, Vibration, Optics laboratory, Institut national de recherche et de sécurité (INRS), Vandœuvre-lès-Nancy, France.
| | - Nicla Settembre
- Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, France.
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Bennati L, Giambruno V, Renzi F, Di Nicola V, Maffeis C, Puppini G, Luciani GB, Vergara C. Turbulent blood dynamics in the left heart in the presence of mitral regurgitation: a computational study based on multi-series cine-MRI. Biomech Model Mechanobiol 2023; 22:1829-1846. [PMID: 37400622 PMCID: PMC10613156 DOI: 10.1007/s10237-023-01735-0] [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: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023]
Abstract
In this work, we performed a computational image-based study of blood dynamics in the whole left heart, both in a healthy subject and in a patient with mitral valve regurgitation. We elaborated multi-series cine-MRI with the aim of reconstructing the geometry and the corresponding motion of left ventricle, left atrium, mitral and aortic valves, and aortic root of the subjects. This allowed us to prescribe such motion to computational blood dynamics simulations where, for the first time, the whole left heart motion of the subject is considered, allowing us to obtain reliable subject-specific information. The final aim is to investigate and compare between the subjects the occurrence of turbulence and the risk of hemolysis and of thrombi formation. In particular, we modeled blood with the Navier-Stokes equations in the arbitrary Lagrangian-Eulerian framework, with a large eddy simulation model to describe the transition to turbulence and a resistive method to manage the valve dynamics, and we used a finite element discretization implemented in an in-house code for the numerical solution.
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Affiliation(s)
- Lorenzo Bennati
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Vincenzo Giambruno
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Francesca Renzi
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Venanzio Di Nicola
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Caterina Maffeis
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134, Verona, Italy
| | - Giovanni Puppini
- Department of Radiology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy
| | - Christian Vergara
- LaBS, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
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De Nisco G, Lodi Rizzini M, Verardi R, Chiastra C, Candreva A, De Ferrari G, D'Ascenzo F, Gallo D, Morbiducci U. Modelling blood flow in coronary arteries: Newtonian or shear-thinning non-Newtonian rheology? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107823. [PMID: 37757568 DOI: 10.1016/j.cmpb.2023.107823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The combination of medical imaging and computational hemodynamics is a promising technology to diagnose/prognose coronary artery disease (CAD). However, the clinical translation of in silico hemodynamic models is still hampered by assumptions/idealizations that must be introduced in model-based strategies and that necessarily imply uncertainty. This study aims to provide a definite answer to the open question of how to properly model blood rheological properties in computational fluid dynamics (CFD) simulations of coronary hemodynamics. METHODS The geometry of the right coronary artery (RCA) of 144 hemodynamically stable patients with different stenosis degree were reconstructed from angiography. On them, unsteady-state CFD simulations were carried out. On each reconstructed RCA two different simulation strategies were applied to account for blood rheological properties, implementing (i) a Newtonian (N) and (ii) a shear-thinning non-Newtonian (non-N) rheological model. Their impact was evaluated in terms of wall shear stress (WSS magnitude, multidirectionality, topological skeleton) and helical flow (strength, topology) profiles. Additionally, luminal surface areas (SAs) exposed to shear disturbances were identified and the co-localization of paired N and non-N SAs was quantified in terms of similarity index (SI). RESULTS The comparison between paired N vs. shear-thinning non-N simulations revealed remarkably similar profiles of WSS-based and helicity-based quantities, independent of the adopted blood rheology model and of the degree of stenosis of the vessel. Statistically, for each paired N and non-N hemodynamic quantity emerged negligible bias from Bland-Altman plots, and strong positive linear correlation (r > 0.94 for almost all the WSS-based quantities, r > 0.99 for helicity-based quantities). Moreover, a remarkable co-localization of N vs. non-N luminal SAs exposed to disturbed shear clearly emerged (SI distribution 0.95 [0.93, 0.97]). Helical flow topology resulted to be unaffected by blood rheological properties. CONCLUSIONS This study, performed on 288 angio-based CFD simulations on 144 RCA models presenting with different degrees of stenosis, suggests that the assumptions on blood rheology have negligible impact both on WSS and helical flow profiles associated with CAD, thus definitively answering to the question "is Newtonian assumption for blood rheology adequate in coronary hemodynamics simulations?".
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Affiliation(s)
- Giuseppe De Nisco
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio Lodi Rizzini
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Roberto Verardi
- 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
| | - Alessandro Candreva
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Gaetano De Ferrari
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Aalbregt E, Rijken L, Nederveen A, van Ooij P, Yeung KK, Jongkind V. Quantitative Magnetic Resonance Imaging to Assess Progression and Rupture Risk of Aortic Aneurysms: A Scoping Review. J Endovasc Ther 2023:15266028231204830. [PMID: 37853734 DOI: 10.1177/15266028231204830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE In current practice, the diameter of an aortic aneurysm is utilized to estimate the rupture risk and decide upon timing of elective repair, although it is known to be imprecise and not patient-specific. Quantitative magnetic resonance imaging (MRI) enables the visualization of several biomarkers that provide information about processes within the aneurysm and may therefore facilitate patient-specific risk stratification. We performed a scoping review of the literature on quantitative MRI techniques to assess aortic aneurysm progression and rupture risk, summarized these findings, and identified knowledge gaps. METHODS Literature concerning primary research was of interest and the medical databases PubMed, Scopus, Embase, and Cochrane were systematically searched. This study used the PRISMA protocol extension for scoping reviews. Articles published between January 2010 and February 2023 involving animals and/or humans were included. Data were extracted by 2 authors using a predefined charting method. RESULTS A total of 1641 articles were identified, of which 21 were included in the scoping review. Quantitative MRI-derived biomarkers were categorized into hemodynamic (8 studies), wall (5 studies) and molecular biomarkers (8 studies). Fifteen studies included patients and/or healthy human subjects. Animal models were investigated in the other 6 studies. A cross-sectional study design was the most common, whereas 5 animal studies had a longitudinal component and 2 studies including patients had a prospective design. A promising hemodynamic biomarker is wall shear stress (WSS), which is estimated based on 4D-flow MRI. Molecular biomarkers enable the assessment of inflammatory and wall deterioration processes. The ADAMTS4-specific molecular magnetic resonance (MR) probe showed potential to predict abdominal aortic aneurysm (AAA) formation and rupture in a murine model. Wall biomarkers assessed using dynamic contrast-enhanced (DCE) MRI showed great potential for assessing AAA progression independent of the maximum diameter. CONCLUSION This scoping review provides an overview of quantitative MRI techniques studied and the biomarkers derived from them to assess aortic aneurysm progression and rupture risk. Longitudinal studies are needed to validate the causal relationships between the identified biomarkers and aneurysm growth, rupture, or repair. In the future, quantitative MRI could play an important role in the personalized risk assessment of aortic aneurysm rupture. CLINICAL IMPACT The currently used maximum aneurysm diameter fails to accurately assess the multifactorial pathology of an aortic aneurysm and precisely predicts rupture in a patient-specific manner. Quantitative magnetic resonance imaging (MRI) enables the detection of various quantitative parameters involved in aneurysm progression and subsequent rupture. This scoping review provides an overview of the studied quantitative MRI techniques, the biomarkers derived from them, and recommendations for future research needed for the implementation of these biomarkers. Ultimately, quantitative MRI could facilitate personalized risk assessment for patients with aortic aneurysms, thereby reducing untimely repairs and improving rupture prevention.
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Affiliation(s)
- Eva Aalbregt
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lotte Rijken
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Aart Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Uchikawa H, Kin T, Koizumi S, Sato K, Uchida T, Takeda Y, Koike T, Kiyofuji S, Yamashiro S, Mukasa A, Saito N. Aneurysmal Inflow Rate Coefficient Predicts Ultra-early Rebleeding in Ruptured Intracranial Aneurysms: Preliminary Report of a Computational Fluid Dynamics Study. Neurol Med Chir (Tokyo) 2023; 63:450-456. [PMID: 37612121 PMCID: PMC10687667 DOI: 10.2176/jns-nmc.2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/25/2023] [Indexed: 08/25/2023] Open
Abstract
Rebleeding from a ruptured intracranial aneurysm has poor outcomes. Although numerous factors are associated with rebleeding, studies on computational fluid dynamics (CFD) on hemodynamic parameters associated with early rebleeding are scarce. In particular, no report of rebleeding in ultra-early phase exists. We aimed to elucidate the specific hemodynamic parameters associated with ultra-early rebleeding using CFD. In this study, the rebleeding group included patients with aneurysmal subarachnoid hemorrhage (aSAH) that rebled within 6 h from the onset. The control group included patients without rebleeding, observed for >10 h following the initial rupture. Clinical images after initial rupture and before rebleeding were used to build 3D vessel models for hemodynamic analysis focusing on the following parameters: time-averaged wall shear stress (WSS), normalized WSS, low shear area, oscillatory shear index, relative residence time, pressure loss coefficient, and aneurysmal inflow rate coefficient (AIRC). Five and 15 patients in the rebleeding and control groups, respectively, met the inclusion criteria. The World Federation of Neurosurgical Surgeons grade was significantly higher in the rebleeding group (p = 0.0088). Hemodynamic analysis showed significantly higher AIRC in the rebleeding group (p = 0.042). The other parameters were not significantly different between groups. There were no significant differences or correlations between SAH severity and AIRC. AIRC was identified as a hemodynamic parameter associated with ultra-early rebleeding of ruptured intracranial aneurysms. Thus, AIRC calculation may enable the prediction of ultra-early rebleeding.
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Affiliation(s)
- Hiroki Uchikawa
- Department of Neurosurgery, The University of Tokyo
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo
| | | | - Katsuya Sato
- Department of Neurosurgery, The University of Tokyo
| | | | | | | | | | | | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
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Wild NC, Bulusu KV, Plesniak MW. Vortical Structures Promote Atheroprotective Wall Shear Stress Distributions in a Carotid Artery Bifurcation Model. Bioengineering (Basel) 2023; 10:1036. [PMID: 37760138 PMCID: PMC10525770 DOI: 10.3390/bioengineering10091036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Carotid artery diseases, such as atherosclerosis, are a major cause of death in the United States. Wall shear stresses are known to prompt plaque formation, but there is limited understanding of the complex flow structures underlying these stresses and how they differ in a pre-disposed high-risk patient cohort. A 'healthy' and a novel 'pre-disposed' carotid artery bifurcation model was determined based on patient-averaged clinical data, where the 'pre-disposed' model represents a pathological anatomy. Computational fluid dynamic simulations were performed using a physiological flow based on healthy human subjects. A main hairpin vortical structure in the internal carotid artery sinus was observed, which locally increased instantaneous wall shear stress. In the pre-disposed geometry, this vortical structure starts at an earlier instance in the cardiac flow cycle and persists over a much shorter period, where the second half of the cardiac cycle is dominated by perturbed secondary flow structures and vortices. This coincides with weaker favorable axial pressure gradient peaks over the sinus for the 'pre-disposed' geometry. The findings reveal a strong correlation between vortical structures and wall shear stress and imply that an intact internal carotid artery sinus hairpin vortical structure has a physiologically beneficial role by increasing local wall shear stresses. The deterioration of this beneficial vortical structure is expected to play a significant role in atherosclerotic plaque formation.
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Affiliation(s)
- Nora C. Wild
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA; (N.C.W.); (K.V.B.)
| | - Kartik V. Bulusu
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA; (N.C.W.); (K.V.B.)
| | - Michael W. Plesniak
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA; (N.C.W.); (K.V.B.)
- Department of Biomedical Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA
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Ong CW, Wee IJY, Toma M, Cui F, Xu XY, Richards AM, Leo HL, Choong AMTL. Haemodynamic changes in visceral hybrid repairs of type III and type V thoracoabdominal aortic aneurysms. Sci Rep 2023; 13:13760. [PMID: 37612440 PMCID: PMC10447573 DOI: 10.1038/s41598-023-40323-1] [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: 01/16/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
The visceral hybrid procedure combining retrograde visceral bypass grafting and completion endovascular stent grafting is a feasible alternative to conventional open surgical or wholly endovascular repairs of thoracoabdominal aneurysms (TAAA). However, the wide variability in visceral hybrid configurations means that a priori prediction of surgical outcome based on haemodynamic flow profiles such as velocity pattern and wall shear stress post repair remain challenging. We sought to appraise the clinical relevance of computational fluid dynamics (CFD) analyses in the setting of visceral hybrid TAAA repairs. Two patients, one with a type III and the other with a type V TAAA, underwent successful elective and emergency visceral hybrid repairs, respectively. Flow patterns and haemodynamic parameters were analysed using reconstructed pre- and post-operative CT scans. Both type III and type V TAAAs showed highly disturbed flow patterns with varying helicity values preoperatively within their respective aneurysms. Low time-averaged wall shear stress (TAWSS) and high endothelial cell action potential (ECAP) and relative residence time (RRT) associated with thrombogenic susceptibility was observed in the posterior aspect of both TAAAs preoperatively. Despite differing bypass configurations in the elective and emergency repairs, both treatment options appear to improve haemodynamic performance compared to preoperative study. However, we observed reduced TAWSS in the right iliac artery (portending a theoretical risk of future graft and possibly limb thrombosis), after the elective type III visceral hybrid repair, but not the emergency type V repair. We surmise that this difference may be attributed to the higher neo-bifurcation of the aortic stent graft in the type III as compared to the type V repair. Our results demonstrate that CFD can be used in complicated visceral hybrid repair to yield potentially actionable predictive insights with implications on surveillance and enhanced post-operative management, even in patients with complicated geometrical bypass configurations.
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Affiliation(s)
- Chi Wei Ong
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Ian J Y Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Milan Toma
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, New York, USA
| | - Fangsen Cui
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, New Zealand, New Zealand
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Andrew M T L Choong
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.
- Asian Aortic & Vascular Centre, Singapore, Singapore.
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Ding J, Du Y, Zhao R, Yang Q, Zhu L, Tong Y, Wen C, Wang M. Detection of Abnormal Wall Shear Stress and Oscillatory Shear Index via Ultrasound Vector Flow Imaging as Possible Indicators for Arteriovenous Fistula Stenosis in Hemodialysis. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1830-1836. [PMID: 37270353 DOI: 10.1016/j.ultrasmedbio.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The arteriovenous fistula (AVF) is an essential vascular access for hemodialysis patients. AVF stenosis may occur at sites with abnormal wall shear stress (WSS) and oscillatory shear index (OSI), which are caused by the complex flow in the AVF. At present, an effective method for rapid determination of the WSS and OSI of the AVF is lacking. The objective of this study was to apply an ultrasound-based method for determination of the WSS and OSI to explore the risk sites of the AVF. METHODS In this study, the ultrasound vector flow imaging technique V Flow was applied to measure the WSS and OSI at four different regions of the AVF to detect and analyze the risk sites: (i) anastomosis region, (ii) curved region, (iii) proximal vein and (iv) distal vein. Twenty-one patients were included in this study. The relative residence time was calculated based on the measured WSS and OSI. RESULTS The curved region had the lowest WSS; the anastomosis region had a significantly higher OSI (p < 0.05) compared with the venous regions, and the curved region had a significantly higher RRT (p < 0.05) compared with the proximal vein region. CONCLUSION V Flow is a feasible tool for studying WSS variations in AVF. The possible risk site in the AVF may be located in the anastomosis and curved regions, where the latter could present a higher risk for AVF stenosis.
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Affiliation(s)
- Jiaxiang Ding
- Peking University International Hospital, Beijing, China.
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Rui Zhao
- Peking University International Hospital, Beijing, China
| | - Qinghua Yang
- Peking University International Hospital, Beijing, China
| | - Lei Zhu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Yisha Tong
- Department of Vascular Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Chaoyang Wen
- Peking University International Hospital, Beijing, China
| | - Mei Wang
- Peking University International Hospital, Beijing, China
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Uddin MJ, Bangalee M, Ferdows M. Numerical computation of pulsatile hemodynamics and diagnostic concern of coronary bifurcated artery flow for Newtonian and non-Newtonian fluid. Heliyon 2023; 9:e17533. [PMID: 37456052 PMCID: PMC10344714 DOI: 10.1016/j.heliyon.2023.e17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Atherosclerotic with the high occurrence of plaque formation due to stenosis has attracted wide attention among researchers. The left coronary artery has been studied in two-dimensional and in three-dimensional (3D) bifurcation as the models of blood flow through Newtonian and non-Newtonian fluids to better understand the physical mechanism. The computational Fluid Dynamics (CFD) technique is incorporated in COMSOL Multiphysics and then it is justified by satisfactory validation. It is found that the Newtonian model shows larger recirculation zones than non-Newtonian does. The present study also focuses on the evaluations of the lesion of diagnostic and the coefficient of pressure drop assessments on the basis of the diagnostic parameter's critical values affected by the rheological model. Nevertheless, the leading concentration of the subsisting investigation works is confined to the change of importance factor (IFc) affected by arterial blockage. But the IFc of non-Newtonian fluid for 3D left coronary artery bifurcation model decreases with increasing bifurcation angle and the time-averaged inlet pressure is the least for smaller bifurcation angles. The current research further concentrates that the flow separation length reduces with developing bifurcation angle in bifurcated geometry. It is significant to mention that non-Newtonian blood flow model incorporating hemodynamic and diagnostic parameters has great impacts on instantaneous flow systems.
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Affiliation(s)
- Md. Jashim Uddin
- Department of Applied Mathematics, University of Dhaka, Dhaka-1000, Bangladesh
- Research Group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka-1000, Bangladesh
- Department of Applied Mathematics, Noakhali Science and Technology University, Noakhali-3814, Bangladesh
| | - M.Z.I. Bangalee
- Department of Applied Mathematics, University of Dhaka, Dhaka-1000, Bangladesh
- Research Group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka-1000, Bangladesh
| | - M. Ferdows
- Department of Applied Mathematics, University of Dhaka, Dhaka-1000, Bangladesh
- Research Group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka-1000, Bangladesh
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Tzirakis K, Kamarianakis Y, Kontopodis N, Ioannou CV. Selection of Bifurcated Grafts' Dimensions during Aorto-Iliac Vascular Reconstruction Based on Their Hemodynamic Performance. Bioengineering (Basel) 2023; 10:776. [PMID: 37508803 PMCID: PMC10376214 DOI: 10.3390/bioengineering10070776] [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: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
During the vascular surgical reconstruction of aorto-iliac occlusive/aneurysmal disease, bifurcated grafts are used where vascular surgeons intra-operatively select the size and the relative lengths of the parent and daughter portions of the graft. Currently, clinical practice regarding the selection of the most favorable geometric configuration of the graft is an understudied research subject: decisions are solely based on the clinical experience of the operating surgeon. This manuscript aims to evaluate the hemodynamic performance of various diameters, D, of bifurcated aortic grafts and relate those with proximal/distal part length ratios (the angle φ between the limbs is used as a surrogate marker of the main body-to-limb length ratio) in order to provide insights regarding the effects of different geometries on the hemodynamic environment. To this end, a computationally intensive set of simulations is conducted, and the resulting data are analyzed with modern statistical regression tools. A negative curvilinear relationship of TAWSS with both φ and D is recorded. It is shown that the angle between limbs is a more important predictor for the variability of TAWSS, while the graft's diameter is an important determinant for the variability of OSI. Large percentages of the total graft area with TAWSS < 0.4 Pa, which correspond to thrombogenic stimulating environments, are only observed for large values of φ and D > 20 mm. This variable ranges from 10% (for the smallest values of φ and D) to 55% (for the largest φ and D values). Our findings suggest that grafts with the smallest possible angle between the limbs (i.e., smallest parent-to-daughter length ratio) present the most favorable hemodynamic performance, yielding the smallest percentage of total graft area under thrombogenic simulating environments. Similarly, grafts with the smallest acceptable diameter should be preferred for the same reason. Especially, grafts with diameters greater than 20 mm should be avoided, given the abrupt increase in estimated thrombogenic areas.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Crete, Greece
| | - Yiannis Kamarianakis
- Data Science Group, Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, 70013 Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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Xiao M, Wu J, Chen D, Wang C, Wu Y, Sun T, Chen J. Ascending Aortic Volume: A Feasible Indicator for Ascending Aortic Aneurysm Elective Surgery? Acta Biomater 2023:S1742-7061(23)00353-7. [PMID: 37356784 DOI: 10.1016/j.actbio.2023.06.026] [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: 03/01/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
Diameter-based criterion have been widely adopted for preventive surgery of ascending thoracic aortic aneurysm (ATAA). However, recent and growing evidence has shown that diameter-based methods may not be sufficient for identifying patients who are at risk of an ATAA. In this study, fluid-structure interaction (FSI) analysis was performed on one-hundred ATAA geometries reconstructed from clinical data to examine the relationship between hemodynamic conditions, ascending aortic volume (AAV), ascending aortic curvature, and aortic ratios measured from the reconstructed 3D models. The simulated hemodynamic and biomechanical parameters were compared among different groups of ATAA geometries classified based on AAV. The ATAAs with enlarged AAV showed significantly compromised hemodynamic conditions and higher mechanical wall stress. The maximum oscillatory shear index (OSI), particle residence time (PRT) and wall stress (WS) were significantly higher in enlarged ATAAs compared with controls (0.498 [0.497, 0.499] vs 0.499 [0.498, 0.499], p = 0.002, 312.847 [207.445, 519.391] vs 996.047 [640.644, 1573.140], p < 0.001, 769.680 [668.745, 879.795] vs 1072.000 [873.060, 1280.000] kPa, p < 0.001, respectively). Values were reported as median with interquartile range (IQR). AAV was also found to be more strongly correlated with these parameters compared to maximum diameter. The correlation coefficient between AAV and average WS was as high as 0.92 (p < 0.004), suggesting that AAV might be a feasible risk identifier for ATAAs. STATEMENT OF SIGNIFICANCE: Ascending thoracic aortic aneurysm is associated with the risk of dissection or rupture, creating life-threatening conditions. Current surgical intervention guidelines are purely diameter based. Recently, many studies proposed to incorporate other morphological parameters into the current clinical guidelines to better prevent severe adverse aortic events like rupture or dissection. The purpose of this study is to gain a better understanding of the relationship between morphological parameters and hemodynamic parameters in ascending aortic aneurysms using fluid-solid-interaction analysis on patient-specific geometries. Our results suggest that ascending aortic volume may be a better indicator for surgical intervention as it shows a stronger association with pathogenic hemodynamic conditions.
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Affiliation(s)
- Meng Xiao
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000.; Department of Electrical and Computer Engineering, University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada, T6G 2R3..
| | - Jinlin Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Duanduan Chen
- Department of Biomedical Engineering, Beijing Institute of Technology, No. 5, South Street, Zhongguancun, Beijing, China..
| | - Chenghu Wang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Yanfen Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Tucheng Sun
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou, China, 510000..
| | - Jie Chen
- Department of Electrical and Computer Engineering, University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada, T6G 2R3..
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Zalud NC, Bulusu KV, Plesniak MW. Shear stress metrics associated with pro-atherogenic high-risk anatomical features in a carotid artery bifurcation model. Clin Biomech (Bristol, Avon) 2023; 105:105956. [PMID: 37098301 DOI: 10.1016/j.clinbiomech.2023.105956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Diseases associated with atherosclerotic plaques in the carotid artery are a major cause of deaths in the United States. Blood-flow-induced shear-stresses are known to trigger plaque formation. Prior literature suggests that the internal carotid artery sinus is prone to atherosclerosis, but there is limited understanding of why only certain patients are predisposed towards plaque formation. METHODS We computationally investigate the effect of vessel geometry on wall-shear-stress distribution by comparing flowfields and wall-shear-stress-metrics between a low-risk and a novel predisposed high-risk carotid artery bifurcation anatomy. Both models were developed based on clinical risk estimations and patient-averaged anatomical features. The high-risk geometry has a larger internal carotid artery branching angle and a lower internal-to-carotid-artery-diameter-ratio. A patient-averaged physiological carotid artery inflow waveform is used. FINDINGS The high-risk geometry experiences stronger flow separation in the sinus. Furthermore, it experiences a more equal flow split at the bifurcation, thereby reducing internal carotid artery flowrate and increasing atherosclerosis-prone low-velocity areas. Lowest time-averaged-wall-shear-stresses are present at the sinus outer wall, where plaques are often found, for both geometries. The high-risk geometry has significantly high, unfavorable oscillatory-shear-index values not found in the low-risk geometry. High oscillatory-shear-index areas are located at the vessels outside walls distal to the bifurcation and on the sinus wall. INTERPRETATION These results highlight the effectiveness of oscillatory-shear-index, to augment classical time-averaged-wall-shear-stress, in evaluating pro-atherogenic geometry features. Furthermore, the flow split at the bifurcation is a promising clinical indicator for atherosclerosis risk as it can be directly accessed using clinical imaging, whereas shear-stress-metrics cannot.
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Affiliation(s)
- Nora C Zalud
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, United States
| | - Kartik V Bulusu
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, United States
| | - Michael W Plesniak
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, United States; Department of Biomedical Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 5000, Washington, DC 20052, United States.
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Belkacemi D, Tahar Abbes M, Al-Rawi M, Al-Jumaily AM, Bachene S, Laribi B. Intraluminal Thrombus Characteristics in AAA Patients: Non-Invasive Diagnosis Using CFD. Bioengineering (Basel) 2023; 10:bioengineering10050540. [PMID: 37237609 DOI: 10.3390/bioengineering10050540] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Abdominal aortic aneurysms (AAA) continue to pose a high mortality risk despite advances in medical imaging and surgery. Intraluminal thrombus (ILT) is detected in most AAAs and may critically impact their development. Therefore, understanding ILT deposition and growth is of practical importance. To assist in managing these patients, the scientific community has been researching the relationship between intraluminal thrombus (ILT) and hemodynamic parameters wall shear stress (WSS) derivatives. This study analyzed three patient-specific AAA models reconstructed from CT scans using computational fluid dynamics (CFD) simulations and a pulsatile non-Newtonian blood flow model. The co-localization and relationship between WSS-based hemodynamic parameters and ILT deposition were examined. The results show that ILT tends to occur in regions of low velocity and time-averaged WSS (TAWSS) and high oscillation shear index (OSI), endothelial cell activation potential (ECAP), and relative residence time (RRT) values. ILT deposition areas were found in regions of low TAWSS and high OSI independently of the nature of flow near the wall characterized by transversal WSS (TransWSS). A new approach is suggested which is based on the estimation of CFD-based WSS indices specifically in the thinnest and thickest ILT areas of AAA patients; this approach is promising and supports the effectiveness of CFD as a decision-making tool for clinicians. Further research with a larger patient cohort and follow-up data are needed to confirm these findings.
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Affiliation(s)
- Djelloul Belkacemi
- Mechanics and Energetics Laboratory, Hassiba Ben Bouali University, Chlef 02000, Algeria
- Unité de Développement des Equipements Solaires UDES, CDER, Bousmail, Tipaza 42415, Algeria
| | - Miloud Tahar Abbes
- Mechanics and Energetics Laboratory, Hassiba Ben Bouali University, Chlef 02000, Algeria
| | - Mohammad Al-Rawi
- Center for Engineering and Industrial Design, Waikato Institute of Technology, Hamilton 3240, New Zealand
| | - Ahmed M Al-Jumaily
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland 1010, New Zealand
| | - Sofiane Bachene
- Radiologie, Centre d'Imagerie Médicale, Cheraga, Algiers 16000, Algeria
| | - Boualem Laribi
- FIMA Laboratory, Department of Technology, Djilali Bounaama University, Khemis Miliana 44225, Algeria
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Carpenter HJ, Ghayesh MH, Zander AC, Psaltis PJ. On the nonlinear relationship between wall shear stress topology and multi-directionality in coronary atherosclerosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 231:107418. [PMID: 36842347 DOI: 10.1016/j.cmpb.2023.107418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE In this paper we investigate twelve multi-directional/topological wall shear stress (WSS) derived metrics and their relationships with the formation of coronary plaques in both computational fluid dynamics (CFD) and dynamic fluid-structure interaction (FSI) frameworks. While low WSS is one of the most established biomechanical markers associated with coronary atherosclerosis progression, alone it is limited. Multi-directional and topological WSS derived metrics have been shown to be important in atherosclerosis related mechanotransduction and near-wall transport processes. However, the relationships between these twelve WSS metrics and the influence of both FSI simulations and coronary dynamics is understudied. METHODS We first investigate the relationships between these twelve WSS derived metrics, stenosis percentage and lesion length through a parametric, transient CFD study. Secondly, we extend the parametric study to FSI, both with and without the addition of coronary dynamics, and assess their correlations. Finally, we present the case of a patient who underwent invasive coronary angiography and optical coherence tomography imaging at two time points 18 months apart. Associations between each of the twelve WSS derived metrics in CFD, static FSI and dynamic FSI simulations were assessed against areas of positive/negative vessel remodelling, and changes in plaque morphology. RESULTS 22-32% stenosis was the threshold beyond which adverse multi-directional/topological WSS results. Each metric produced a different relationship with changing stenoses and lesion length. Transient haemodynamics was impacted by coronary dynamics, with the topological shear variation index suppressed by up to 94%. These changes appear more critical at smaller stenosis levels, suggesting coronary dynamics could play a role in the earlier stages of atherosclerosis development. In the patient case, both dynamics and FSI vs CFD changes altered associations with measured changes in plaque morphology. An appendix of the linear fits between the various FSI- and CFD-based simulations is provided to assist in scaling CFD-based results to resemble the compliant walled characteristics of FSI more accurately. CONCLUSIONS These results highlight the potential for coronary dynamics to alter multi-directional/topological WSS metrics which could impact associations with changes in coronary atherosclerosis over time. These results warrant further investigation in a wider range of morphological settings and longitudinal cohort studies in the future.
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Affiliation(s)
- Harry J Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Mergen H Ghayesh
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Anthony C Zander
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia
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40
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Classification of Blood Rheological Models through an Idealized Symmetrical Bifurcation. Symmetry (Basel) 2023. [DOI: 10.3390/sym15030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
The assumed rheological behavior of blood influences the hemodynamic characteristics of numerical blood flow simulations. Until now, alternative rheological specifications have been utilized, with uncertain implications for the results obtained. This work aims to group sixteen blood rheological models in homogeneous clusters, by exploiting data generated from numerical simulations on an idealized symmetrical arterial bifurcation. Blood flow is assumed to be pulsatile and is simulated using a commercial finite volume solver. An appropriate mesh convergence study is performed, and all results are collected at three different time instants throughout the cardiac cycle: at peak systole, early diastole, and late diastole. Six hemodynamic variables are computed: the time average wall shear stress, oscillatory shear index, relative residence time, global and local non-Newtonian importance factor, and non-Newtonian effect factor. The resulting data are analyzed using hierarchical agglomerative clustering algorithms, which constitute typical unsupervised classification methods. Interestingly, the rheological models can be partitioned into three homogeneous groups, whereas three specifications appear as outliers which do not belong in any partition. Our findings suggest that models which are defined in a similar manner from a mathematical perspective may behave substantially differently in terms of the data they produce. On the other hand, models characterized by different mathematical formulations may belong to the same statistical group (cluster) and can thus be considered interchangeably.
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Tzirakis K, Kontopodis N, Kehagias E, Ioannou CV. Effect of Sac Asymmetry, Neck and Iliac Angle on the Hemodynamic Behavior of Idealized Abdominal Aortic Aneurysm Geometries. Ann Vasc Surg 2023:S0890-5096(23)00126-7. [PMID: 36868463 DOI: 10.1016/j.avsg.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are currently treated based on the universal maximum diameter criterion, but other geometric variables may play a role in the risk of rupture. The hemodynamic environment inside the AAA sac has been shown to interact with several biologic processes which can affect prognosis. AAA geometric configuration has a significant impact in the hemodynamic conditions that develop, which has only been recently realized, with implications for rupture risk estimations. We aim to perform a parametric study to evaluate the effect of aortic neck angulation, angle between the iliac arteries, and sac asymmetry (SA) on the hemodynamic variables of AAAs. METHODS This study uses idealized AAA models and it is parametrized in terms of 3 quantities as follows: the neck angle, φ (°), iliac angle, θ (°), and SA (%), each of which accepts 3 different values, specifically φ = (0°, 30°, 60°), θ = (40°, 60°, 80°), and SA = (S, °SS, °OS), where the SA can either be on the same side with respect to neck (SS) or on the opposite side (OS). Time average wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and the velocity profile are calculated for different geometric configurations, while the percentage of the total surface area under thrombogenic conditions, using thresholds previously reported in the literature, is also recorded. RESULTS In case of an angulated neck and a higher angle between iliac arteries, favorable hemodynamic conditions are predicted with higher TAWSS and lower OSI and RRT values. The area under thrombogenic conditions reduces by 16-46% as the neck angle increases from 0° to 60°, depending on the hemodynamic variable under consideration. The effect of iliac angulation is present but less pronounced with 2.5-7.5% change between the lower and the higher angle. The effect of SA seems to be significant for OSI, with a nonsymmetrical configuration being hemodynamically favorable, which in the presence of an angulated neck is more pronounced for the OS outline. CONCLUSIONS Favorable hemodynamic conditions develop inside the sac of idealized AAAs with increasing neck and iliac angles. Regarding the SA parameter, asymmetrical configurations most often appear advantageous. Concerning the velocity profile the triplet (φ, θ, SA) may affect outcomes under certain conditions and thus should be taken into account when parametrizing the geometric characteristics of AAAs.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece.
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
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Mutlu O, Salman HE, Al-Thani H, El-Menyar A, Qidwai UA, Yalcin HC. How does hemodynamics affect rupture tissue mechanics in abdominal aortic aneurysm: Focus on wall shear stress derived parameters, time-averaged wall shear stress, oscillatory shear index, endothelial cell activation potential, and relative residence time. Comput Biol Med 2023; 154:106609. [PMID: 36724610 DOI: 10.1016/j.compbiomed.2023.106609] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/24/2023]
Abstract
An abdominal aortic aneurysm (AAA) is a critical health condition with a risk of rupture, where the diameter of the aorta enlarges more than 50% of its normal diameter. The incidence rate of AAA has increased worldwide. Currently, about three out of every 100,000 people have aortic diseases. The diameter and geometry of AAAs influence the hemodynamic forces exerted on the arterial wall. Therefore, a reliable assessment of hemodynamics is crucial for predicting the rupture risk. Wall shear stress (WSS) is an important metric to define the level of the frictional force on the AAA wall. Excessive levels of WSS deteriorate the remodeling mechanism of the arteries and lead to abnormal conditions. At this point, WSS-related hemodynamic parameters, such as time-averaged WSS (TAWSS), oscillatory shear index (OSI), endothelial cell activation potential (ECAP), and relative residence time (RRT) provide important information to evaluate the shear environment on the AAA wall in detail. Calculation of these parameters is not straightforward and requires a physical understanding of what they represent. In addition, computational fluid dynamics (CFD) solvers do not readily calculate these parameters when hemodynamics is simulated. This review aims to explain the WSS-derived parameters focusing on how these represent different characteristics of disturbed hemodynamics. A representative case is presented for spatial and temporal formulation that would be useful for interested researchers for practical calculations. Finally, recent hemodynamics investigations relating WSS-related parameters with AAA rupture risk assessment are presented. This review will be useful to understand the physical representation of WSS-related parameters in cardiovascular flows and how they can be calculated practically for AAA investigations.
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Affiliation(s)
- Onur Mutlu
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Huseyin Enes Salman
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Uvais Ahmed Qidwai
- Department of Computer Science Engineering, Qatar University, Doha, Qatar
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Wen J, Liu X, Lei J, Wang J, Chen X, Zheng T, Yuan D. Hemodynamics in renal arteries with partial coverage after endovascular aneurysm repair affected by renal orientations. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023. [DOI: 10.1016/j.medntd.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Tzirakis K, Kamarianakis Y, Kontopodis N, Ioannou CV. The Effect of Blood Rheology and Inlet Boundary Conditions on Realistic Abdominal Aortic Aneurysms under Pulsatile Flow Conditions. Bioengineering (Basel) 2023; 10:bioengineering10020272. [PMID: 36829766 PMCID: PMC9953019 DOI: 10.3390/bioengineering10020272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The effects of non-Newtonian rheology and boundary conditions on various pathophysiologies have been studied quite extensively in the literature. The majority of results present qualitative and/or quantitative conclusions that are not thoroughly assessed from a statistical perspective. METHODS The finite volume method was employed for the numerical simulation of seven patient-specific abdominal aortic aneurysms. For each case, five rheological models and three inlet velocity boundary conditions were considered. Outlier- and heteroscedasticity-robust ANOVA tests assessed the simultaneous effect of rheological specifications and boundary conditions on fourteen variables that capture important characteristics of vascular flows. RESULTS The selection of inlet velocity profiles appears as a more critical factor relative to rheological specifications, especially regarding differences in the oscillatory characteristics of computed flows. Response variables that relate to the average tangential force on the wall over the entire cycle do not differ significantly across alternative factor levels, as long as one focuses on non-Newtonian specifications. CONCLUSIONS The two factors, namely blood rheological models and inlet velocity boundary condition, exert additive effects on variables that characterize vascular flows, with negligible interaction effects. Regarding thrombus-prone conditions, the Plug inlet profile offers an advantageous hemodynamic configuration with respect to the other two profiles.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Crete, Greece
- Correspondence:
| | - Yiannis Kamarianakis
- Data Science Group, Institute of Applied and Computational Mathematics, Foundation for Research & Technology-Hellas, 70013 Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Christos V. Ioannou
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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Computer Modeling of Carotid Endarterectomy With the Different Shape Patches and Prediction of the Atherosclerotic Plaque Formation Zones. Curr Probl Cardiol 2023; 48:101505. [PMID: 36402216 DOI: 10.1016/j.cpcardiol.2022.101505] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
The article describes a method for constructing geometric models of the carotid bifurcation and computer simulation of endarterectomy surgery with the patches of various configurations. The purpose of this work is to identify the areas of the greatest risk of restenosis in the constructed models and to conduct a comparative analysis of risk factors when using the patches of different widths and shapes. The method is demonstrated on a reconstructed model of a healthy vessel. Its building is based on a preoperative computed tomography study of a particular patient's affected vessel. The flow in the vessel is simulated by computational fluid dynamics using data from the patient's ultrasound Doppler velocimetry. Risk factors are assessed through the hemodynamic indices on the vessel wall associated with Wall Shear Stress. The distribution of risk zones in the healthy vessel, presumably leading to its observed lesion (plaque), is analyzed. Comparative evaluation of 10 various patches implantation results is carried out and the optimal variant is determined. The proposed method can be used to predict the hemodynamic results of surgery using patches of various sizes and shapes.
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46
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Wen J, Wang J, Peng L, Yuan D, Zheng T. Hemodynamic analysis of hybrid treatment for thoracoabdominal aortic aneurysm based on Newtonian and non-Newtonian models in a patient-specific model. Comput Methods Biomech Biomed Engin 2023; 26:209-221. [PMID: 35414317 DOI: 10.1080/10255842.2022.2053683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The accuracy of the Newtonian model used in retrograde visceral revascularization (RVR) of hybrid surgery for thoracoabdominal aortic aneurysm (TAAA) hemodynamic simulation remains unclear. Noting that an appropriate blood viscosity model is a significant factor to capture hemodynamic changes in numerical studies. Therefore, both Newtonian and non-Newtonian blood viscosity models were adopted in this study to investigate the importance of hemodynamics when non-Newtonian blood property was accounted for in a patient-specific RVR simulation. The results revealed that disturbed flow and unfavorable WSS distribution can be observed in the anastomosis region under both blood viscosity models due to the retrograde flow pattern in the RVR model. However, although the non-Newtonian blood model has negligible effect on flow pattern and pressure drop, there were of significance quantitative and qualitative difference of local normalized helicity and wall shear stress distribution under pulsatile flow condition. In particular, the unfavorable WSS indicators distribution was better matched with a patient-specific follow-up report when non-Newtonian blood viscosity was accounted for. To conclude, the use of a Newtonian blood model is a reasonable approximation to obtain the general features of the flow field under steady flow condition. However, to study the hemodynamic parameters within retrograde flow under pulsatile flow condition, a non-Newtonian model may be more appropriate.
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Affiliation(s)
- Jun Wen
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
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Wang J, Fang R, Wu H, Xiang Y, Mendieta JB, Paritala PK, Fan Z, Anbananthan H, Amaya Catano JA, Raffel OC, Li Z. Impact of cyclic bending on coronary hemodynamics. Biomech Model Mechanobiol 2023; 22:729-738. [PMID: 36602717 DOI: 10.1007/s10237-022-01677-z] [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: 06/11/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023]
Abstract
It remains unknown that the degree of bias in computational fluid dynamics results without considering coronary cyclic bending. This study aims to investigate the influence of different rates of coronary cyclic bending on coronary hemodynamics. To model coronary bending, a multi-ring-controlled fluid-structural interaction model was designed. A coronary artery was simulated with various cyclic bending rates (0.5, 0.75 and 1 s, corresponding to heart rates of 120, 80 and 60 bpm) and compared against a stable model. The simulated results show that the hemodynamic parameters of vortex Q-criterion, temporal wall shear stress (WSS), time-averaged WSS (TaWSS) and oscillatory shear index (OSI) were sensitive to the changes in cyclic rate. A higher heart rate resulted in higher magnitude and larger variance in the hemodynamic parameters. Whereas, the values and distributions of flow velocity and relative residence time (RRT) did not show significant differences between different bending periods. This study suggests that a stable coronary model is not sufficient to represent the hemodynamics in a bending coronary artery. Different heart rate conditions were found to have significant impact on the hemodynamic parameters. Thus, cyclic bending should be considered to mimic the realistic hemodynamics in future patient-specific coronary hemodynamics studies.
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Affiliation(s)
- Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
| | - Runxin Fang
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, Jiangsu, China
| | - Hao Wu
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, Jiangsu, China
| | - Yuqiao Xiang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Zhenya Fan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Jorge Alberto Amaya Catano
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia.,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Owen Christopher Raffel
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.,School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia. .,Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia. .,School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, Jiangsu, China. .,Faculty of Sports Science, Ningbo University, Ningbo, 315211, Zhejiang, China.
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Lampropoulos DS, Boutopoulos ID, Bourantas GC, Miller K, Zampakis PE, Loukopoulos VC. Hemodynamics of anterior circulation intracranial aneurysms with daughter blebs: investigating the multidirectionality of blood flow fields. Comput Methods Biomech Biomed Engin 2023; 26:113-125. [PMID: 35297711 DOI: 10.1080/10255842.2022.2048374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent advances in diagnostic neuroradiological imaging, allowed the detection of unruptured intracranial aneurysms (IAs). The shape - irregular or multilobular - of the aneurysmal dome, is considered as a possible rupture risk factor, independently of the size, the location and patient medical background. Disturbed blood flow fields in particular is thought to play a key role in IAs progression. However, there is an absence of widely-used hemodynamic indices to quantify the extent of a multi-directional disturbed flow. We simulated blood flow in twelve patient-specific anterior circulation unruptured intracranial aneurysms with daughter blebs utilizing the spectral/hp element framework Nektar++. We simulated three cardiac cycles using a volumetric flow rate waveform while we considered blood as a Newtonian fluid. To investigate the multidirectionality of the blood flow fields, besides the time-averaged wall shear stress (TAWSS), we calculated the oscillatory shear index (OSI), the relative residence time (RRT) and the time-averaged cross flow index (TACFI). Our CFD simulations suggest that in the majority of our vascular models there is a formation of complex intrasaccular flow patterns, resulting to low and highly oscillating WSS, especially in the area of the daughter blebs. The existence of disturbed multi-directional blood flow fields is also evident by the distributions of the RRT and the TACFI. These findings further support the theory that IAs with daughter blebs are linked to a potentially increased rupture risk.
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Affiliation(s)
| | | | - George C Bourantas
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Perth, Western Australia, Australia
| | - Karol Miller
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Perth, Western Australia, Australia.,Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Petros E Zampakis
- Department of Diagnostic and Interventional Neuroradiology, University of Patras, Patras, Greece
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Aneurysm Neck Overestimation has a Relatively Modest Impact on Simulated Hemodynamics. Cardiovasc Eng Technol 2022; 14:252-263. [PMID: 36517696 DOI: 10.1007/s13239-022-00652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Overestimation of intracranial aneurysm neck width by 3D angiography is a recognized clinical problem, and has long been a concern for image-based computational fluid dynamics (CFD). Recently, it was demonstrated that neck overestimation in 3D rotational angiography (3DRA) could be corrected via segmentation with upsampled resolution and gradient enhancement (SURGE). Our aim was to leverage this approach to determine whether and how neck overestimation actually impacts CFD-derived hemodynamics. MATERIALS AND METHODS A subset of 17 cases having the largest neck errors from a consecutive clinical sample of 60 was segmented from 3DRA using both standard watershed and SURGE methods. High-fidelity, pulsatile CFD was performed, and a variety of scalar hemodynamic parameters that have been associated with aneurysm growth and/or rupture status were derived. RESULTS With a few exceptions, flow and wall shear stress (WSS) patterns were qualitatively similar between neck-overestimated and corrected models. Sac-averaged WSS values were significantly lower after neck correction (p = 0.0005) but were highly correlated with their neck-overestimated counterparts (R2 = 0.98). Jet impingement was significantly more concentrated in the neck-corrected vs. -uncorrected models (p = 0.0011), and only moderately correlated (R2 = 0.61). Parameters quantifying velocity or WSS fluctuations were not significantly different after neck correction, but this reflected their poorer correlations (R2 < 0.4). Nevertheless, for all hemodynamic parameters, median absolute differences were < 26%, and no parameter had more than 5/17 cases with absolute differences > 50%. CONCLUSION Differences in hemodynamics due to neck width overestimation were found to be at most equal to, and often less than, those reported for other sources of error/uncertainty in intracranial aneurysm CFD, such as solver settings or assumed inflow rates.
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Chee AJY, Ho CK, Yiu BYS, Yu ACH. Time-Resolved Wall Shear Rate Mapping Using High-Frame-Rate Ultrasound Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:3367-3381. [PMID: 36343007 DOI: 10.1109/tuffc.2022.3220560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In atherosclerosis, low wall shear stress (WSS) is known to favor plaque development, while high WSS increases plaque rupture risk. To improve plaque diagnostics, WSS monitoring is crucial. Here, we propose wall shear imaging (WASHI), a noninvasive contrast-free framework that leverages high-frame-rate ultrasound (HiFRUS) to map the wall shear rate (WSR) that relates to WSS by the blood viscosity coefficient. Our method measures WSR as the tangential flow velocity gradient along the arterial wall from the flow vector field derived using a multi-angle vector Doppler technique. To improve the WSR estimation performance, WASHI semiautomatically tracks the wall position throughout the cardiac cycle. WASHI was first evaluated with an in vitro linear WSR gradient model; the estimated WSR was consistent with theoretical values (an average error of 4.6% ± 12.4 %). The framework was then tested on healthy and diseased carotid bifurcation models. In both scenarios, key spatiotemporal dynamics of WSR were noted: 1) oscillating shear patterns were present in the carotid bulb and downstream to the internal carotid artery (ICA) where retrograde flow occurs; and 2) high WSR was observed particularly in the diseased model where the measured WSR peaked at 810 [Formula: see text] due to flow jetting. We also showed that WASHI could consistently track arterial wall motion to map its WSR. Overall, WASHI enables high temporal resolution mapping of WSR that could facilitate investigations on causal effects between WSS and atherosclerosis.
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