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Vuong TNAM, Bartolf‐Kopp M, Andelovic K, Jungst T, Farbehi N, Wise SG, Hayward C, Stevens MC, Rnjak‐Kovacina J. Integrating Computational and Biological Hemodynamic Approaches to Improve Modeling of Atherosclerotic Arteries. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307627. [PMID: 38704690 PMCID: PMC11234431 DOI: 10.1002/advs.202307627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/12/2024] [Indexed: 05/07/2024]
Abstract
Atherosclerosis is the primary cause of cardiovascular disease, resulting in mortality, elevated healthcare costs, diminished productivity, and reduced quality of life for individuals and their communities. This is exacerbated by the limited understanding of its underlying causes and limitations in current therapeutic interventions, highlighting the need for sophisticated models of atherosclerosis. This review critically evaluates the computational and biological models of atherosclerosis, focusing on the study of hemodynamics in atherosclerotic coronary arteries. Computational models account for the geometrical complexities and hemodynamics of the blood vessels and stenoses, but they fail to capture the complex biological processes involved in atherosclerosis. Different in vitro and in vivo biological models can capture aspects of the biological complexity of healthy and stenosed vessels, but rarely mimic the human anatomy and physiological hemodynamics, and require significantly more time, cost, and resources. Therefore, emerging strategies are examined that integrate computational and biological models, and the potential of advances in imaging, biofabrication, and machine learning is explored in developing more effective models of atherosclerosis.
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Affiliation(s)
| | - Michael Bartolf‐Kopp
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
| | - Kristina Andelovic
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
| | - Tomasz Jungst
- Department of Functional Materials in Medicine and DentistryInstitute of Functional Materials and Biofabrication (IFB)KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI)University of WürzburgPleicherwall 297070WürzburgGermany
- Department of Orthopedics, Regenerative Medicine Center UtrechtUniversity Medical Center UtrechtUtrecht3584Netherlands
| | - Nona Farbehi
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydney2052Australia
- Tyree Institute of Health EngineeringUniversity of New South WalesSydneyNSW2052Australia
- Garvan Weizmann Center for Cellular GenomicsGarvan Institute of Medical ResearchSydneyNSW2010Australia
| | - Steven G. Wise
- School of Medical SciencesUniversity of SydneySydneyNSW2006Australia
| | - Christopher Hayward
- St Vincent's HospitalSydneyVictor Chang Cardiac Research InstituteSydney2010Australia
| | | | - Jelena Rnjak‐Kovacina
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydney2052Australia
- Tyree Institute of Health EngineeringUniversity of New South WalesSydneyNSW2052Australia
- Australian Centre for NanoMedicine (ACN)University of New South WalesSydneyNSW2052Australia
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Wu W, Oguz UM, Banga A, Zhao S, Thota AK, Gadamidi VK, Vasa CH, Harmouch KM, Naser A, Tieliwaerdi X, Chatzizisis YS. 3D reconstruction of coronary artery bifurcations from intravascular ultrasound and angiography. Sci Rep 2023; 13:13031. [PMID: 37563354 PMCID: PMC10415353 DOI: 10.1038/s41598-023-40257-8] [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: 04/09/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
Coronary bifurcation lesions represent a challenging anatomical subset, and the understanding of their 3D anatomy and plaque composition appears to play a key role in devising the optimal stenting strategy. This study proposes a new approach for the 3D reconstruction of coronary bifurcations and plaque materials by combining intravascular ultrasound (IVUS) and angiography. Three patient-specific silicone bifurcation models were 3D reconstructed and compared to micro-computed tomography (µCT) as the gold standard to test the accuracy and reproducibility of the proposed methodology. The clinical feasibility of the method was investigated in three diseased patient-specific bifurcations of varying anatomical complexity. The IVUS-based 3D reconstructed bifurcation models showed high agreement with the µCT reference models, with r2 values ranging from 0.88 to 0.99. The methodology successfully 3D reconstructed all the patient bifurcations, including plaque materials, in less than 60 min. Our proposed method is a simple, time-efficient, and user-friendly tool for accurate 3D reconstruction of coronary artery bifurcations. It can provide valuable information about bifurcation anatomy and plaque burden in the clinical setting, assisting in bifurcation stent planning and education.
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Affiliation(s)
- Wei Wu
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Usama M Oguz
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Akshat Banga
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Shijia Zhao
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Anjani Kumar Thota
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Vinay Kumar Gadamidi
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Charu Hasini Vasa
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Khaled M Harmouch
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Abdallah Naser
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Xiarepati Tieliwaerdi
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yiannis S Chatzizisis
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA.
- Division of Cardiovascular Medicine, Leonard M. Miller School of Medicine, University of Miami Health System, University of Miami, 1120 NW 14th Street, Suite 1124, Miami, FL, 33136, USA.
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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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Cai Y, Li Z. Mathematical modeling of plaque progression and associated microenvironment: How far from predicting the fate of atherosclerosis? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106435. [PMID: 34619601 DOI: 10.1016/j.cmpb.2021.106435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Mathematical modeling contributes to pathophysiological research of atherosclerosis by helping to elucidate mechanisms and by providing quantitative predictions that can be validated. In turn, the complexity of atherosclerosis is well suited to quantitative approaches as it provides challenges and opportunities for new developments of modeling. In this review, we summarize the current 'state of the art' on the mathematical modeling of the effects of biomechanical factors and microenvironmental factors on the plaque progression, and its potential help in prediction of plaque development. We begin with models that describe the biomechanical environment inside and outside the plaque and its influence on its growth and rupture. We then discuss mathematical models that describe the dynamic evolution of plaque microenvironmental factors, such as lipid deposition, inflammation, smooth muscle cells migration and intraplaque hemorrhage, followed by studies on plaque growth and progression using these modelling approaches. Moreover, we present several key questions for future research. Mathematical models can complement experimental and clinical studies, but also challenge current paradigms, redefine our understanding of mechanisms driving plaque vulnerability and propose future potential direction in therapy for cardiovascular disease.
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Affiliation(s)
- Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Zhiyong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China; School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4001, Australia
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Carpenter HJ, Gholipour A, Ghayesh MH, Zander AC, Psaltis PJ. In Vivo Based Fluid-Structure Interaction Biomechanics of the Left Anterior Descending Coronary Artery. J Biomech Eng 2021; 143:081001. [PMID: 33729476 DOI: 10.1115/1.4050540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Indexed: 12/25/2022]
Abstract
A fluid-structure interaction-based biomechanical model of the entire left anterior descending coronary artery is developed from in vivo imaging via the finite element method in this paper. Included in this investigation is ventricle contraction, three-dimensional motion, all angiographically visible side branches, hyper/viscoelastic artery layers, non-Newtonian and pulsatile blood flow, and the out-of-phase nature of blood velocity and pressure. The fluid-structure interaction model is based on in vivo angiography of an elite athlete's entire left anterior descending coronary artery where the influence of including all alternating side branches and the dynamical contraction of the ventricle is investigated for the first time. Results show the omission of side branches result in a 350% increase in peak wall shear stress and a 54% decrease in von Mises stress. Peak von Mises stress is underestimated by up to 80% when excluding ventricle contraction and further alterations in oscillatory shear indices are seen, which provide an indication of flow reversal and has been linked to atherosclerosis localization. Animations of key results are also provided within a video abstract. We anticipate that this model and results can be used as a basis for our understanding of the interaction between coronary and myocardium biomechanics. It is hoped that further investigations could include the passive and active components of the myocardium to further replicate in vivo mechanics and lead to an understanding of the influence of cardiac abnormalities, such as arrythmia, on coronary biomechanical responses.
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Affiliation(s)
- Harry J Carpenter
- School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Alireza Gholipour
- 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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Deng S, Zheng J, Wu Y, Yang D, Chen H, Sun B, Xue Y, Zhao X. Geometrical characteristics associated with atherosclerotic disease in the basilar artery: a magnetic resonance vessel wall imaging study. Quant Imaging Med Surg 2021; 11:2711-2720. [PMID: 34079735 DOI: 10.21037/qims-20-1291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Vascular geometry may play an important role in the development of atherosclerosis. This study aimed to investigate the relationships between the geometrical characteristics of basilar artery (BA) and the presence, burden, and distribution of BA plaques using magnetic resonance vessel wall imaging. Methods Patients with cerebrovascular symptoms in the posterior circulation were recruited and underwent magnetic resonance imaging. The BA's geometrical characteristics, including actual length, straightened length, tortuosity, lateral basilar artery-vertebral artery (VA) angle, lateral mid-BA angle, and BA convexity, were measured. The presence of plaques, stenosis, and plaque burden, including mean and maximal wall thickness, were evaluated. The BA's cross-sectional vessel wall was divided into 4 quadrants: dorsal, ventral, right, and left quadrant. The distribution of BA plaques was analyzed. Results Of 344 recruited patients (mean age: 68.1±11.1 years; 200 males), 100 (29.1%) had BA plaques. Patients with BA plaques had higher tortuosity of the BA (13.6±9.0 vs. 9.7±7.7, P<0.001) compared to those without BA plaques. Multivariate regression analysis showed that tortuosity of the BA was associated with the presence of BA plaques (OR, 1.641; 95% CI, 1.232 to 2.186; P=0.001) and mean wall thickness (β, 0.045; 95% CI, 0.008 to 0.081; P=0.017). The plaque distribution in the left wall and right wall of BA was more frequent in patients with right (P=0.006) and left (P<0.001) convex BA, respectively. Conclusions The BA's geometrical characteristics, particularly tortuosity and convexity, are independently associated with the presence, burden, and distribution of plaques in the BA.
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Affiliation(s)
- Shasha Deng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jinmei Zheng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuxin Wu
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dandan Yang
- Department of Biomedical Engineering, School of Medicine, Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Huajun Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xihai Zhao
- Department of Biomedical Engineering, School of Medicine, Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
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Polzer S, Polišenská A, Novák K, Burša J. Moderate thickness of lipid core in shoulder region of atherosclerotic plaque determines vulnerable plaque A parametric study. Med Eng Phys 2019; 69:140-146. [PMID: 31160196 DOI: 10.1016/j.medengphy.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Abstract
Peak stress in the fibrous cap of atherosclerotic plaque is largely determined by the cap thickness which cannot be accurately estimated in vivo. This parametric study investigates idealized atherosclerotic plaque geometries. Finite element modeling is applied to search for larger morphological features associated with high cap stresses. By varying seven geometrical and two loading parameters, 100 3D model geometries of atherosclerotic plaques in common iliac artery were generated. In each model peak cap stress was calculated, and statistical comparison of the geometries generating the highest and lowest peak cap stresses was performed. The analysis showed that, compared to geometries generating the lowest stresses, those with high peak cap stress had a significantly lower cap thickness, higher stenosis ratio, lower relative lipid core volume, and cap shoulder radius larger than lipid core radius. High cap stress was observed for cap thicknesses up to 0.13 mm. It can be concluded that vulnerable plaques contain thin fibrous cap, large stenosis ratio and only moderate small-radius lipid core which reaches the shoulder region of the fibrous cap.
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Affiliation(s)
- Stanislav Polzer
- Department of Applied Mechanics, VŠB-Technical University of Ostrava, 17. Listopadu 15, Ostrava Poruba 708 33, Czech Republic.
| | - Anna Polišenská
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Technicka 2896/2Brno, 616 00, Czech Republic
| | - Kamil Novák
- TRW Automotive Czech s.r.o., Na Roli 2405/26, Jablonec nad Nisou 466 01, Czech Republic.
| | - Jiří Burša
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Technicka 2896/2Brno, 616 00, Czech Republic.
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Wang YY, Qiu CH, Jiang J, Xia SR. Detecting the Media-adventitia Border in Intravascular Ultrasound Images through a Classification-based Approach. ULTRASONIC IMAGING 2019; 41:78-93. [PMID: 30556484 DOI: 10.1177/0161734618820112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The detection of the media-adventitia (MA) border in intravascular ultrasound (IVUS) images is essential for vessel assessment and disease diagnosis. However, it remains a challenging task, considering the existence of plaque, calcification, and various artifacts. In this article, an effective method based on classification is proposed to extract the MA border in IVUS images. First, a novel morphologic feature describing the relative position of each structure relative to the MA border, called RPES for short, is proposed. Then, the RPES feature and other features are employed in a multiclass extreme learning machine (ELM) to classify IVUS images into nine classes including the MA border and other structures. At last, a modified snake model is employed to effectively detect the MA border in the rectangular domain, in which a modified external force field is constructed on the basis of local border appearances and classification results. The proposed method is evaluated on a public dataset with 77 IVUS images by three indicators in eight situations, such as calcification and a guide wire artifact. With the proposed RPES feature, detection performances are improved by more than 39 percent, which shows an apparent advantage in comparative experiments. Furthermore, compared with two other existing methods used on the same dataset, the proposed method achieves 18 of the best indicators among 24, demonstrating its higher capability in detecting the MA border.
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Affiliation(s)
- Yuan-Yuan Wang
- School of Information & Electrical Engineering, Zhejiang University City College, Hangzhou, China
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, China
| | - Chen-Hui Qiu
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, China
| | - Jun Jiang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shun-Ren Xia
- School of Information & Electrical Engineering, Zhejiang University City College, Hangzhou, China
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Cardio-Cerebral Vascular Detection Technology and Medicinal Effectiveness Appraisal, Zhejiang University, Hangzhou, China
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Liu X, Wu G, Xu C, He Y, Shu L, Liu Y, Zhang N, Lin C. Prediction of coronary plaque progression using biomechanical factors and vascular characteristics based on computed tomography angiography. Comput Assist Surg (Abingdon) 2017; 22:286-294. [PMID: 29032716 DOI: 10.1080/24699322.2017.1389407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Coronary atherosclerotic plaques progress in a highly individual manner. Accurately predicting plaque progression will promote clinical management of atherosclerosis. The purpose of this study was to investigate the role of local biomechanics factors and vascular characteristics in coronary plaque progression and arterial remodeling. METHODS Computed tomography angiography-based three-dimensional reconstruction of the native right coronary artery was performed in vivo in twelve patients with acute coronary syndrome at baseline and 12-month follow-up. The reconstructed arteries were divided into sequential 3-mm-long segments. Wall shear stress (WSS) and von Mises stress (VMS) were computed in all segments at baseline by applying fluid-structure interaction simulations. RESULTS In total, 365 segments 3-mm long were analyzed. The decrease in minimal lumen area was independently predicted by low baseline VMS (-0.73 ± 0.13 mm2), increase in plaque burden was independently predicted by small minimal lumen area and low baseline WSS (6.28 ± 0.96%), and decrease in plaque volume was independently predicted by low baseline VMS (-0.99 ± 0.49 mm3). Negative remodeling was more likely to occur in low- (55%) and moderate-VMS (40%) segments, but expansive remodeling was more likely to occur in high-VMS (44%) segments. CONCLUSIONS Local von Mises stress, wall shear stress, minimal lumen area, and plaque burden provide independent and additive prediction in identifying coronary plaque progression and arterial remodeling.
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Affiliation(s)
- Xiujian Liu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Guanghui Wu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Chuangye Xu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Yuna He
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Lixia Shu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Yuyang Liu
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Nan Zhang
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
| | - Changyan Lin
- a Beijing Institute of Heart, Lung, and Blood Vessel Diseases , Beijing Anzhen Hospital, Capital Medical University , Beijing , China
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10
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High shear stress on the background of clinical restenosis at the site of step-down phenomenon after drug eluting stent implantation. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Huang X, Yang C, Zheng J, Bach R, Muccigrosso D, Woodard PK, Tang D. 3D MRI-based multicomponent thin layer structure only plaque models for atherosclerotic plaques. J Biomech 2016; 49:2726-2733. [PMID: 27344199 DOI: 10.1016/j.jbiomech.2016.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/22/2016] [Accepted: 06/01/2016] [Indexed: 01/13/2023]
Abstract
MRI-based fluid-structure interactions (FSI) models for atherosclerotic plaques have been developed to perform mechanical analysis to investigate the association of plaque wall stress (PWS) with cardiovascular disease. However, the time consuming 3D FSI model construction process is a great hinder for its clinical implementations. In this study, a 3D thin-layer structure only (TLS) plaque model was proposed as an approximation with much less computational cost to 3D FSI models for better clinical implementation potential. 192 TLS models were constructed based on 192 ex vivo MRI Images of 12 human coronary atherosclerotic plaques. Plaque stresses were extracted from all lumen nodal points. The maximum value of Plaque wall stress (MPWS) and average value of plaque wall stress (APWS) of each slice were used to compare with those from corresponding FSI models. The relative errors for MPWS and APWS were 9.76% and 9.89%, respectively. Both MPWS and APWS values obtained from TLS models showed very good correlation with those from 3D FSI models. Correlation results from TLS models were in consistent with FSI models. Our results indicated that the proposed 3D TLS plaque models may be used as a good approximation to 3D FSI models with much less computational cost. With further validation, 3D TLS models may be possibly used to replace FSI models to save time and perform mechanical analysis for atherosclerotic plaques for clinical implementation.
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Affiliation(s)
- Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, China; Fujian Provincial Key Laboratory of Mathematical Modeling and High-Performance Scientific Computation, Xiamen University, Xiamen, Fujian 361005 China; Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA.
| | - Chun Yang
- Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA; Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing, China
| | - Jie Zheng
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Richard Bach
- Cardiovascular Division, Washington University, St. Louis, MO 63110, USA
| | - David Muccigrosso
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Dalin Tang
- Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA; School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
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12
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Abstract
Atherosclerosis remains a major cause of morbidity and mortality worldwide, and a thorough understanding of the underlying pathophysiological mechanisms is crucial for the development of new therapeutic strategies. Although atherosclerosis is a systemic inflammatory disease, coronary atherosclerotic plaques are not uniformly distributed in the vascular tree. Experimental and clinical data highlight that biomechanical forces, including wall shear stress (WSS) and plaque structural stress (PSS), have an important role in the natural history of coronary atherosclerosis. Endothelial cell function is heavily influenced by changes in WSS, and longitudinal animal and human studies have shown that coronary regions with low WSS undergo increased plaque growth compared with high WSS regions. Local alterations in WSS might also promote transformation of stable to unstable plaque subtypes. Plaque rupture is determined by the balance between PSS and material strength, with plaque composition having a profound effect on PSS. Prospective clinical studies are required to ascertain whether integrating mechanical parameters with medical imaging can improve our ability to identify patients at highest risk of rapid disease progression or sudden cardiac events.
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13
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Zhao X, Liu Y, Li L, Wang W, Xie J, Zhao Z. Hemodynamics of the string phenomenon in the internal thoracic artery grafted to the left anterior descending artery with moderate stenosis. J Biomech 2015; 49:983-991. [PMID: 26972762 DOI: 10.1016/j.jbiomech.2015.11.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/15/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The internal thoracic artery is the choice of graft for coronary artery bypass grafting due to the excellent long-term patency. However internal thoracic artery graft failures still occur due to diffuse narrowing, known as the string phenomenon. Studies suggest that the string phenomenon is caused by competitive flow when the coronary stenosis is not serious, but the hemodynamics of the string phenomenon are still unclear. The purpose of this study is to clarify the hemodynamic characteristics of the string phenomenon. MATERIALS A patient-specific 3-dimensional model of the aortic arch and coronary arteries was reconstructed. A moderate stenosis was applied to the left anterior descending artery. The internal thoracic artery was used to bypass the stenosis. Two further 3D models were built to study the hemodynamics of the string phenomenon. METHODS A numerical study was performed by coupling the 3D artery model with 0-dimensional lumped parameter model of the cardiovascular system. RESULTS The graft flow, native coronary flow, wall shear stress and oscillatory shear index were calculated and illustrated. Inverse flow and high oscillatory shear index appeared on the internal thoracic artery graft when the stenosis was moderate. CONCLUSION High oscillatory shear index might be the major hemodynamic characteristic of the string phenomenon in internal thoracic artery graft. The inverse graft flow and the difference in graft flow caused by clamping the stenosis can be used to evaluate the probability of observing the string phenomenon.
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Affiliation(s)
- Xi Zhao
- College of Life Science and Bio-engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, PR China
| | - Youjun Liu
- College of Life Science and Bio-engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, PR China.
| | - Lanlan Li
- College of Life Science and Bio-engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, PR China
| | - Wenxin Wang
- College of Life Science and Bio-engineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, PR China
| | - Jinsheng Xie
- Beijing An Zhen Hospital affiliated to Capital Medical University, No. 2 Anzhen Road Chaoyang District, Beijing 100029, PR China
| | - Zhou Zhao
- Peking University People׳s Hospital, No. 11 Xizhimen South Street Xicheng District, Beijing 100044, PR China
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14
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Liu B, Zheng J, Bach R, Tang D. Influence of model boundary conditions on blood flow patterns in a patient specific stenotic right coronary artery. Biomed Eng Online 2015; 14 Suppl 1:S6. [PMID: 25602370 PMCID: PMC4306119 DOI: 10.1186/1475-925x-14-s1-s6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background In literature, the effect of the inflow boundary condition was investigated by examining the impact of the waveform and the shape of the spatial profile of the inlet velocity on the cardiac hemodynamics. However, not much work has been reported on comparing the effect of the different combinations of the inlet/outlet boundary conditions on the quantification of the pressure field and flow distribution patterns in stenotic right coronary arteries. Method Non-Newtonian models were used to simulate blood flow in a patient-specific stenotic right coronary artery and investigate the influence of different boundary conditions on the phasic variation and the spatial distribution patterns of blood flow. The 3D geometry of a diseased artery segment was reconstructed from a series of IVUS slices. Five different combinations of the inlet and the outlet boundary conditions were tested and compared. Results The temporal distribution patterns and the magnitudes of the velocity, the wall shear stress (WSS), the pressure, the pressure drop (PD), and the spatial gradient of wall pressure (WPG) were different when boundary conditions were imposed using different pressure/velocity combinations at inlet/outlet. The maximum velocity magnitude in a cardiac cycle at the center of the inlet from models with imposed inlet pressure conditions was about 29% lower than that from models using fully developed inlet velocity data. Due to the fact that models with imposed pressure conditions led to blunt velocity profile, the maximum wall shear stress at inlet in a cardiac cycle from models with imposed inlet pressure conditions was about 29% higher than that from models with imposed inlet velocity boundary conditions. When the inlet boundary was imposed by a velocity waveform, the models with different outlet boundary conditions resulted in different temporal distribution patterns and magnitudes of the phasic variation of pressure. On the other hand, the type of different boundary conditions imposed at the inlet and the outlet did not have significant effect on the spatial distribution patterns of the PD, the WPG and the WSS on the lumen surface, regarding the locations of the maximum and the minimum of each quantity. Conclusions The observations from this study indicated that the ways how pressure and velocity boundary conditions are imposed in computational models have considerable impact on flow velocity and shear stress predictions. Accuracy of in vivo measurements of blood pressure and velocity is of great importance for reliable model predictions.
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15
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The study on hemodynamic effect of varied support models of BJUT-II VAD on coronary artery: a primary CFD study. ASAIO J 2014; 60:643-51. [PMID: 25373559 DOI: 10.1097/mat.0000000000000137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BJUT-II VAD (Beijing University of Technology ventricular assist device II) is a novel left ventricular assist device. Because of the special connection between the pump and native heart, the hemodynamic effects of BJUT-II VAD on coronary artery are still unclear. Hence, numerical simulations have been conducted to clarify changes in hemodynamic effects of different support modes. A patient-specific left coronary arterial geometric model is reconstructed based on the computed tomography (CT) data. Three support modes, "constant speed mode," "co-pulse mode," and "counter pulse mode," are used in this study. The wall shear stress (WSS), wall shear stress gradient (WSSG), cycle-averaged wall shear stress (avWSS), oscillatory shear index (OSI), and the flow pattern are calculated to evaluate the hemodynamic states of coronary artery. The computational results demonstrate that the hemodynamic states of coronary artery are directly affected by the support modes. The co-pulse modes could achieve the highest blood perfusion (constant speed: 153 ml/min vs. co-pulse: 775 ml/min vs. counter pulse: 140 ml/min) and the highest avWSS (constant speed: 18.1 Pa vs. co-pulse: 42.6 Pa vs. counter pulse: 22.6 Pa). In addition, both the WSS and WSSG at the time of peak blood velocity under the constant speed mode are lower than those under other two support modes. In contrast, the counter pulse mode generates the highest OSI value (constant speed: 0.365 vs. co-pulse: 0.379 vs. counter pulse: 0.426). BJUT-II VAD under co-pulse mode may have benefits for improving coronary perfusion and preventing the development of atherosclerosis; however, the constant speed mode may have benefit for preventing the development of plaque vulnerability.
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Pedrigi RM, de Silva R, Bovens SM, Mehta VV, Petretto E, Krams R. Thin-Cap Fibroatheroma Rupture Is Associated With a Fine Interplay of Shear and Wall Stress. Arterioscler Thromb Vasc Biol 2014; 34:2224-31. [DOI: 10.1161/atvbaha.114.303426] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review, we summarized the effect of mechanical factors (shear and wall stress) on thin-cap fibroatheroma formation and rupture. To make this review understandable for a biology-oriented audience, we start with detailed definitions of relevant mechanical metrics. We then describe how biomechanics has supported histopathologic efforts to understand the basis of plaque rupture. In addition to plaque rupture, biomechanics also contributes toward the progression of thin-cap fibroatheroma through a multitude of reported mechanobiological mechanisms. We thus propose a new mechanism whereby both shear stress and wall stress interact to create thin-cap fibroatheromas. Specifically, when regions of certain blood flow and wall mechanical stimuli coincide, they synergistically create inflammation within the cellular environment that can lead to thin-cap fibroatheroma rupture. A consequence of this postulate is that local shear stress is not sufficient to cause rupture, but it must coincide with regions of local tissue stiffening and stress concentrations that can occur during plaque progression. Because such changes to the wall mechanics occur over a micrometer scale, high spatial resolution imaging techniques will be necessary to evaluate this hypothesis and ultimately predict plaque rupture in a clinical environment.
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Affiliation(s)
- Ryan M. Pedrigi
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Ranil de Silva
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Sandra M. Bovens
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Vikram V. Mehta
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Enrico Petretto
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
| | - Rob Krams
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (R.M.P., S.M.B., V.V.M., R.K.); NHLI, Imperial College London and NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (R.d.S.); and MRC-Clinical Sciences Centre, Imperial College London, London, United Kingdom (E.P.)
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