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David E, Grazhdani H, Aliotta L, Gavazzi LM, Foti PV, Palmucci S, Inì C, Tiralongo F, Castiglione D, Renda M, Pacini P, Di Bella C, Solito C, Gigli S, Fazio A, Bella R, Basile A, Cantisani V. Imaging of Carotid Stenosis: Where Are We Standing? Comparison of Multiparametric Ultrasound, CT Angiography, and MRI Angiography, with Recent Developments. Diagnostics (Basel) 2024; 14:1708. [PMID: 39202195 PMCID: PMC11352936 DOI: 10.3390/diagnostics14161708] [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: 06/24/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024] Open
Abstract
Atherosclerotic disease of the carotid arteries is a crucial risk factor in predicting the likelihood of future stroke events. In addition, emerging studies suggest that carotid stenosis may also be an indicator of plaque load on coronary arteries and thus have a correlation with the risk of acute cardiovascular events. Furthermore, although in symptomatic patients the degree of stenosis is the main morphological parameter studied, recent evidence suggests, especially in asymptomatic patients, that plaque vulnerability should also be evaluated as an emerging and significant imaging parameter. The reference diagnostic methods for the evaluation of carotid stenosis are currently ultrasonography, magnetic resonance imaging (MRI), and computed tomography angiography (CTA). In addition, other more invasive methods such as 123I-metaiodobenzylguanidine (MIBG) scintigraphy and PET-CT, as well as digital subtraction angiography, can be used. Each method has advantages and disadvantages, and there is often some confusion in their use. For example, the usefulness of MRI is often underestimated. In addition, implementations for each method have been developed over the years and are already enabling a significant increase in diagnostic accuracy. The purpose of our study is to make an in-depth analysis of all the methods in use and in particular their role in the diagnostic procedure of carotid stenosis, also discussing new technologies.
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Affiliation(s)
- Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00185 Rome, Italy
| | | | - Lorenzo Aliotta
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Livio Maria Gavazzi
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Corrado Inì
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Francesco Tiralongo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Davide Castiglione
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Maurizio Renda
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Chiara Di Bella
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Carmen Solito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini, 385, 00157 Rome, Italy;
| | - Alessandro Fazio
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Rita Bella
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinic “G. Rodolico-San Marco”, 95125 Catania, Italy; (L.A.); (L.M.G.); (P.V.F.); (S.P.); (C.I.); (F.T.); (D.C.); (A.F.); (R.B.); (A.B.)
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.R.); (P.P.); (C.D.B.); (C.S.); (V.C.)
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Sun H, Li B, Zhang L, Zhang Y, Liu J, Huang S, Xi X, Liu Y. Numerical study of hemodynamic changes in the Circle of Willis after stenosis of the internal carotid artery. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107881. [PMID: 37950924 DOI: 10.1016/j.cmpb.2023.107881] [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: 09/05/2023] [Revised: 10/11/2023] [Accepted: 10/22/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND AND OBJECTIVES In clinical practice a large number of patients with ischemic stroke have internal carotid artery (ICA) stenosis accompanied by Circle of Willis (CoW) stenosis. In the presence of carotid artery stenosis, CoW atherosclerosis may cause cerebral blood flow decompensation and may promote the development of ischemic stroke. The reason for the concomitant stenosis at both sites is unknown. This study investigated the hemodynamic effects of ICA stenosis on the CoW. METHODS We developed a three-dimensional/zero-dimensional (3D/0D) closed-loop geometric multiscale model of the cerebral artery to quantify the hemodynamic indicators, including time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI). Mild (<50 %), moderate (50-69 %) and severe (>69 %) ICA stenoses were established based on 3D models of cerebral arteries in two volunteers. Geometric multiscale computing models were numerically evaluated to obtain local hemodynamic changes in the CoW in order to assess the risk of stenosis in the CoW. RESULTS Model calculations showed that for all 3D models the A1 segment of the anterior cerebral artery (ACA) or the posterior communicating artery (PCA) within the CoW exhibited a hemodynamic environment with high OSI (>0.2) and low TAWSS (<1 Pa) when the ICA had a moderate stenosis. While in the case of mild and severe stenosis in ICA, there is no such phenomenon. The proportion of the surface area possessing high OSI and low TAWSS in the A1 segment of the ACA or in the PCA was mostly greater than 60 %, which might potentially cause the formation and development of atherosclerosis in CoW and finally lead to CoW stenosis. CONCLUSIONS Therefore, although moderate carotid artery stenosis may not cause ischemic stroke, it may cause hemodynamic changes in the CoW, which in turn may promote CoW stenosis and cause CoW decompensation. In clinical treatment attention should be paid not only to stenosis of the carotid arteries but also to changes in the hemodynamic environment within the CoW, in order to prevent the adverse effects of CoW stenosis.
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Affiliation(s)
- Hao Sun
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, China.
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, China
| | - Yanping Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, China
| | - Jincheng Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, China
| | - Suqin Huang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, China
| | - Xiaolu Xi
- Wuhan United Imaging Healthcare Surgical Technology Co., Ltd. Hubei 100124, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, China
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Hu Q, Fang Z, Ge J, Li H. Nanotechnology for cardiovascular diseases. Innovation (N Y) 2022; 3:100214. [PMID: 35243468 PMCID: PMC8866095 DOI: 10.1016/j.xinn.2022.100214] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases have become the major killers in today's world, among which coronary artery diseases (CADs) make the greatest contributions to morbidity and mortality. Although state-of-the-art technologies have increased our knowledge of the cardiovascular system, the current diagnosis and treatment modalities for CADs still have limitations. As an emerging cross-disciplinary approach, nanotechnology has shown great potential for clinical use. In this review, recent advances in nanotechnology in the diagnosis of CADs will first be elucidated. Both the sensitivity and specificity of biosensors for biomarker detection and molecular imaging strategies, such as magnetic resonance imaging, optical imaging, nuclear scintigraphy, and multimodal imaging strategies, have been greatly increased with the assistance of nanomaterials. Second, various nanomaterials, such as liposomes, polymers (PLGA), inorganic nanoparticles (AuNPs, MnO2, etc.), natural nanoparticles (HDL, HA), and biomimetic nanoparticles (cell-membrane coating) will be discussed as engineered as drug (chemicals, proteins, peptides, and nucleic acids) carriers targeting pathological sites based on their optimal physicochemical properties and surface modification potential. Finally, some of these nanomaterials themselves are regarded as pharmaceuticals for the treatment of atherosclerosis because of their intrinsic antioxidative/anti-inflammatory and photoelectric/photothermal characteristics in a complex plaque microenvironment. In summary, novel nanotechnology-based research in the process of clinical transformation could continue to expand the horizon of nanoscale technologies in the diagnosis and therapy of CADs in the foreseeable future.
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Affiliation(s)
- Qinqin Hu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Shanghai Xuhui District Central Hospital & Zhongshan-xuhui Hospital, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Zheyan Fang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Shanghai Xuhui District Central Hospital & Zhongshan-xuhui Hospital, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Shanghai Xuhui District Central Hospital & Zhongshan-xuhui Hospital, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Hua Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Shanghai Xuhui District Central Hospital & Zhongshan-xuhui Hospital, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
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Xu K, Li B, Liu J, Chen M, Zhang L, Mao B, Xi X, Sun H, Zhang Z, Liu Y. Model-based evaluation of local hemodynamic effects of enhanced external counterpulsation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106540. [PMID: 34848079 DOI: 10.1016/j.cmpb.2021.106540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The treatment benefits of enhanced external counterpulsation (EECP) heavily depends on hemodynamics. Global hemodynamics of EECP can cause blood flow redistribution in the circulatory system whereas local hemodynamic effects act on vascular endothelial cells (VECs). Local hemodynamic effects of EECP on VECs are important in the treatment of atherosclerosis, but currently cannot be not evaluated. Herein we aim to establish evaluation models of local hemodynamic effects based on the global hemodynamic indicators. METHODS We established 0D/3D geometric multi-scale hemodynamic models of the coronary and cerebral artery of two healthy individuals to calculate the global hemodynamic indicators and the local hemodynamic effects. Clinical EECP trials were performed to verify the accuracy of the multi-scale hemodynamic model. The global hemodynamic indicators included diastolic blood pressure/systolic blood pressure (Q = D/S), mean arterial pressure (MAP), internal carotid artery flow (ICAF) and cerebral blood flow (CBF), whereas local hemodynamic effects focused on time-averaged wall shear stress (TAWSS). The correlation between these indicators was analyzed via Pearson correlation coefficient. Significantly related indicators were selected for curve-fitting to establish evaluation models of the coronary and cerebral artery. Moreover, clinical data of a coronary heart disease patient and a cerebral ischemic stroke patient were collected to verify the effectiveness of the application of the established evaluation models to real patients. RESULTS For coronary artery, TAWSS was correlated to Q = D/S and ICAF (P < 0.05), whereas for cerebral artery, TAWSS was correlated to MAP and CBF (P < 0.05). The mean square error (MSE) between the evaluated values using evaluation model and the calculated values using 0D/3D model of TAWSS of the coronary and cerebral artery were 5.4% and 1.0%, respectively. The MSE of evaluation model applied to real patients was greater than that applied to healthy individuals, but within an acceptable range. CONCLUSIONS The presented error demonstrated validity and accuracy of the evaluation models in clinical patients. Based on the evaluation models, global hemodynamic indicators could be used to evaluate the local hemodynamic effects under the current counterpulsation mode. With TAWSS range of 4-7 Pa as the target range, EECP strategies can further be optimized.
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Affiliation(s)
- Ke Xu
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China
| | - Bao Li
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China.
| | - Jincheng Liu
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China
| | - Mingyan Chen
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China
| | - Boyan Mao
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiaolu Xi
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China
| | - Hao Sun
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China
| | - Zhe Zhang
- Peking University Third Hospital, Beijing 100080, China
| | - Youjun Liu
- Department of Biomedical Engineering, Beijing University of Technology, Beijing 100124, China
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Goudot G, Poree J, Pedreira O, Khider L, Julia P, Alsac JM, Laborie E, Mirault T, Tanter M, Messas E, Pernot M. Wall Shear Stress Measurement by Ultrafast Vector Flow Imaging for Atherosclerotic Carotid Stenosis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:297-305. [PMID: 31856281 DOI: 10.1055/a-1060-0529] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Carotid plaque vulnerability assessment could guide the decision to perform endarterectomy. Ultrafast ultrasound imaging (UF) can evaluate local flow velocities over an entire 2D image, allowing measurement of the wall shear stress (WSS). We aimed at evaluating the feasibility of WSS measurement in a prospective series of patients with carotid stenosis. METHODS UF acquisitions, performed with a linear probe, had an effective frame rate of 5000 Hz. The flow velocity was imaged over the entire plaque area. WSS was computed with the vector field speed using the formula: with the blood velocity and μ, the blood viscosity. The WSS measurement method was validated using a calibrated phantom. In vivo, WSS was analyzed in 5 areas of the carotid wall: common carotid artery, plaque ascent, plaque peak, plaque descent, internal carotid artery. RESULTS Good correlation was found between in vitro measurement and the theoretical WSS values (R2 = 0.95; p < 0.001). 33 patients were prospectively evaluated, with a median carotid stenosis degree of 80 % [75-85]. The maximum WSS value over the cardiac cycle follows the shape of the plaque with an increase during the ascent, reaching its maximum value of 3.25 Pa [2.26-4.38] at the peak of the plaque, and a decrease after passing of the peak (0.93 Pa [0.80-1.19]) lower than the WSS values in the non-stenotic areas (1.47 Pa [1.12-1.77] for the common carotid artery). CONCLUSION UF allowed local and direct evaluation of the plaque's WSS, thus better characterizing local hemodynamics to identify areas of vulnerability. KEY POINTS · Ultrafast vector Doppler allows calculation of the wall shear stress (WSS) by measuring velocity vectors over the entire 2D image.. · The setup to measure the WSS has been validated in vitro on a linear flow phantom by comparing measurements to in silico calculations.. · Applying this method to carotid plaque allows us to better describe the hemodynamic constraints that apply along the entire length of the plaque..
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Affiliation(s)
- Guillaume Goudot
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Jonathan Poree
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Olivier Pedreira
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Lina Khider
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Pierre Julia
- Georges-Pompidou European Hospital, vascular surgery department, APHP, Paris, France
| | - Jean-Marc Alsac
- Georges-Pompidou European Hospital, vascular surgery department, APHP, Paris, France
| | - Emeline Laborie
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Tristan Mirault
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Mickael Tanter
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Emmanuel Messas
- Georges-Pompidou European Hospital, vascular medicine department, APHP, Paris, France
- INSERM U970, PARCC, Paris University, Paris, France
| | - Mathieu Pernot
- INSERM U1273, Physics for Medicine, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
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Li B, Xu K, Liu J, Mao B, Li N, Sun H, Zhang Z, Zhao X, Yang H, Zhang L, Du T, Du J, Liu Y. A Numerical Model for Simulating the Hemodynamic Effects of Enhanced External Counterpulsation on Coronary Arteries. Front Physiol 2021; 12:656224. [PMID: 33912072 PMCID: PMC8072480 DOI: 10.3389/fphys.2021.656224] [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: 01/20/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022] Open
Abstract
Traditional enhanced external counterpulsation (EECP) used for the clinical treatment of patients with coronary heart disease only assesses diastolic/systolic blood pressure (Q = D/S > 1.2). However, improvement of the hemodynamic environment surrounding vascular endothelial cells of coronary arteries after long-term application of EECP is the basis of the treatment. Currently, the quantitative hemodynamic mechanism is not well understood. In this study, a standard 0D/3D geometric multi-scale model of the coronary artery was established to simulate the hemodynamic effects of different counterpulsation modes on the vascular endothelium. In this model, the neural regulation caused by counterpulsation was thoroughly considered. Two clinical trials were carried out to verify the numerical calculation model. The results demonstrated that the increase in counterpulsation pressure amplitude and pressurization duration increased coronary blood perfusion and wall shear stress (WSS) and reduced the oscillatory shear index (OSI) of the vascular wall. However, the impact of pressurization duration was the predominant factor. The results of the standard model and the two real individual models indicated that a long pressurization duration would cause more hemodynamic risk areas by resulting in excessive WSS, which could not be reflected by the change in the Q value. Therefore, long-term pressurization during each cardiac cycle therapy is not recommended for patients with coronary heart disease and clinical treatment should not just pay attention to the change in the Q value. Additional physiological indicators can be used to evaluate the effects of counterpulsation treatment.
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Affiliation(s)
- Bao Li
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Ke Xu
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Jincheng Liu
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Boyan Mao
- The School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Na Li
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Hao Sun
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Zhe Zhang
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Xi Zhao
- Philips (China) Investment Company, Shanghai, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Tianming Du
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
| | - Jianhang Du
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Youjun Liu
- Department of Biomedical Engineering, Beijing University of Technology, Beijing, China
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Long-term hemodynamic mechanism of enhanced external counterpulsation in the treatment of coronary heart disease: a geometric multiscale simulation. Med Biol Eng Comput 2019; 57:2417-2433. [PMID: 31522354 DOI: 10.1007/s11517-019-02028-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 08/09/2019] [Indexed: 12/12/2022]
Abstract
Enhanced external counterpulsation (EECP) is a noninvasive treatment method for coronary artery atherosclerosis that acts on the vascular endothelial cells. The intracoronary hemodynamic parameters that influence long-term treatment effect are the fundamental factors for the inhibition of intimal hyperplasia, which cannot be measured in real time. In order to optimize the long-term treatment effect of coronary heart disease, it is necessary to establish a method for quantified calculation of intracoronary hemodynamic parameters during counterpulsation to research the long-term hemodynamic mechanism of EECP. A geometric multiscale model coupled by the zero-dimensional (0D) lumped parameter model and the three-dimensional (3D) model of narrow coronary artery was established for the simulation of intracoronary hemodynamic environment. The 3D model was used to calculate the hemodynamic parameters such as wall shear stress (WSS) and oscillatory shear index (OSI), while the 0D model was used to simulate the blood circulatory system. Sequential pressure was applied to calves, thighs, and buttocks module in 0D model with the consideration of vessel collapse. Hemodynamic performance was compared with clinical reports to verify the effectiveness of the method. There were significant increases of the diastolic blood pressure (DBP), coronary flow, and the area-averaged WSS during application of EECP, while OSI behind stenosis has some decrease. The waveforms of coronary flow has good similarity with the clinical measured waveforms, and the differences between calculated mean arterial pressures (MAPs) and clinical measurements were within 1%. The fundamental factor in the cure of coronary heart disease by EECP is the improvement of WSS and the decrease of OSI. Comparing with the clinical reports, the immediate hemodynamic changes demonstrate the effectiveness of model. Intracoronary hemodynamic parameters during EECP could be acquired and the method could be used to simulate the long-term treatment effect of EECP. Graphical abstract.
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Hemodynamic effects of enhanced external counterpulsation on cerebral arteries: a multiscale study. Biomed Eng Online 2019; 18:91. [PMID: 31462269 PMCID: PMC6714389 DOI: 10.1186/s12938-019-0710-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/16/2019] [Indexed: 12/01/2022] Open
Abstract
Background Enhanced external counterpulsation (EECP) is an effective method for treating patients with cerebral ischemic stroke, while hemodynamics is the major contributing factor in the treatment of EECP. Different counterpulsation modes have the potential to lead to different acute and long-term hemodynamic changes, resulting in different treatment effects. However, various questions about appropriate counterpulsation modes for optimizing hemodynamic effects remain unanswered in clinical treatment. Methods A zero-dimensional/three-dimensional (0D/3D) geometric multiscale model of the cerebral artery was established to obtain acute hemodynamic indicators, including mean arterial pressure (MAP) and cerebral blood flow (CBF), as well as localized hemodynamic details for the cerebral artery, which includes wall shear stress (WSS) and oscillatory shear index (OSI). Counterpulsation was achieved by applying pressure on calf, thigh and buttock modules in the 0D model. Different counterpulsation modes including various pressure amplitudes and pressurization durations were applied to investigate hemodynamic responses, which impact acute and long-term treatment effects. Both vascular collapse and cerebral autoregulation were considered during counterpulsation. Results Variations of pressure amplitude and pressurization duration have different impacts on hemodynamic effects during EECP treatment. There were small differences in the hemodynamics when similar or different pressure amplitudes were applied to calves, thighs and buttocks. When increasing pressure amplitude was applied to the three body parts, MAP and CBF improved slightly. When pressure amplitude exceeded 200 mmHg, hemodynamic indicators almost never changed, demonstrating consistency with clinical data. However, hemodynamic indicators improved significantly with increasing pressurization duration. For pressurization durations of 0.5, 0.6 and 0.7 s, percentage increases for MAP during counterpulsation were 1.5%, 23.5% and 39.0%, for CBF were 1.2%, 23.4% and 41.6% and for time-averaged WSS were 0.2%, 43.5% and 85.0%, respectively. Conclusions When EECP was applied to patients with cerebral ischemic stroke, pressure amplitude applied to the three parts may remain the same. Patients may not gain much more benefit from EECP treatment by excessively increasing pressure amplitude above 200 mmHg. However, during clinical procedures, pressurization duration could be increased to 0.7 s during the cardiac circle to optimize the hemodynamics for possible superior treatment outcomes.
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Holzapfel GA, Ogden RW. Biomechanical relevance of the microstructure in artery walls with a focus on passive and active components. Am J Physiol Heart Circ Physiol 2018; 315:H540-H549. [DOI: 10.1152/ajpheart.00117.2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The microstructure of arteries, consisting, in particular, of collagen, elastin, and vascular smooth muscle cells, plays a very significant role in their biomechanical response during a cardiac cycle. In this article, we highlight the microstructure and the contributions of each of its components to the overall mechanical behavior. We also describe the changes of the microstructure that occur as a result of abdominal aortic aneurysms and disease, such as atherosclerosis. We also focus on how the passive and active constituents are incorporated into a mathematical model without going into detail of the mathematical formulation. We conclude by mentioning open problems toward a better characterization of the biomechanical aspects of arteries that will be beneficial for a better understanding of cardiovascular pathophysiology.
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Affiliation(s)
- Gerhard A. Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- Norwegian University of Science and Technology, Faculty of Engineering Science and Technology, Trondheim, Norway
| | - Ray W. Ogden
- School of Mathematics and Statistics, University of Glasgow, Scotland, United Kingdom
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10
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Pereira T, Betriu A, Alves R. Non-invasive imaging techniques and assessment of carotid vasa vasorum neovascularization: Promises and pitfalls. Trends Cardiovasc Med 2018; 29:71-80. [PMID: 29970286 DOI: 10.1016/j.tcm.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
Carotid adventitia vasa vasorum neovascularization (VVn) is associated with the initial stages of arteriosclerosis and with the formation of unstable plaque. However, techniques to accurately quantify that neovascularization in a standard, fast, non-invasive, and efficient way are still lacking. The development of such techniques holds the promise of enabling wide, inexpensive, and safe screening programs that could stratify patients and help in personalized preventive cardiovascular medicine. In this paper, we review the recent scientific literature pertaining to imaging techniques that could set the stage for the development of standard methods for quantitative assessment of atherosclerotic plaque and carotid VVn. We present and discuss the alternative imaging techniques being used in clinical practice and we review the computational developments that are contributing to speed up image analysis and interpretation. We conclude that one of the greatest upcoming challenges will be the use of machine learning techniques to develop automated methods that assist in the interpretation of images to stratify patients according to their risk.
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Affiliation(s)
- T Pereira
- Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, Catalonia, Spain; Departament de Ciències Mèdiques Bàsiques, University of Lleida, Catalonia, Spain.
| | - A Betriu
- Unit for the Detection and Treatment of Atherothrombotic Diseases, Hospital Universitari Arnau de Vilanova de Lleida, Catalonia, Spain; Vascular and Renal Translational Research Group - IRBLleida, Catalonia, Spain
| | - R Alves
- Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, Catalonia, Spain; Departament de Ciències Mèdiques Bàsiques, University of Lleida, Catalonia, Spain
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11
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Evans PC, Gijsen FJH, Wentzel JJ, van der Heiden K. Biomechanics in vascular biology and cardiovascular disease. Thromb Haemost 2016; 115:465-6. [PMID: 26864973 DOI: 10.1160/th16-01-0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Paul C Evans
- Paul Evans, Sheffield University, Sheffield S10 2RX, UK, Tel.: +44 1142712052, Fax: +44 1142712052, E-mail:
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