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Feng Y, Fu R, Sun H, Wang X, Yang Y, Wen C, Hao Y, Sun Y, Li B, Li N, Yang H, Feng Q, Liu J, Liu Z, Zhang L, Liu Y. Non-invasive fractional flow reserve derived from reduced-order coronary model and machine learning prediction of stenosis flow resistance. Artif Intell Med 2024; 147:102744. [PMID: 38184351 DOI: 10.1016/j.artmed.2023.102744] [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: 10/05/2022] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND OBJECTIVE Recently, computational fluid dynamics enables the non-invasive calculation of fractional flow reserve (FFR) based on 3D coronary model, but it is time-consuming. Currently, machine learning technique has emerged as an efficient and reliable approach for prediction, which allows saving a lot of analysis time. This study aimed at developing a simplified FFR prediction model for rapid and accurate assessment of functional significance of stenosis. METHODS A reduced-order lumped parameter model (LPM) of coronary system and cardiovascular system was constructed for rapidly simulating coronary flow, in which a machine learning model was embedded for accurately predicting stenosis flow resistance at a given flow from anatomical features of stenosis. Importantly, the LPM was personalized in both structures and parameters according to coronary geometries from computed tomography angiography and physiological measurements such as blood pressure and cardiac output for personalized simulations of coronary pressure and flow. Coronary lesions with invasive FFR ≤ 0.80 were defined as hemodynamically significant. RESULTS A total of 91 patients (93 lesions) who underwent invasive FFR were involved in FFR derived from machine learning (FFRML) calculation. Of the 93 lesions, 27 lesions (29.0%) showed lesion-specific ischemia. The average time of FFRML simulation was about 10 min. On a per-vessel basis, the FFRML and FFR were significantly correlated (r = 0.86, p < 0.001). The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.4%, 92.6%, 90.9%, 80.6% and 96.8%, respectively. The area under the receiver-operating characteristic curve of FFRML was 0.984. CONCLUSION In this selected cohort of patients, the FFRML improves the computational efficiency and ensures the accuracy. The favorable performance of FFRML approach greatly facilitates its potential application in detecting hemodynamically significant coronary stenosis in future routine clinical practice.
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Affiliation(s)
- Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Hao Sun
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Xue Wang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; Department of Equipment and Materials, Tianjin First Central Hospital, Tianjin, China
| | - Yang Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Chuanqi Wen
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yaodong Hao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yutong Sun
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Na Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Quansheng Feng
- Department of Cardiology, The First People's Hospital of Guangshui, Hubei 432700, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Zhuo Liu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
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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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3
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Zhao Y, Wang H, Chen W, Sun W, Yu X, Sun C, Hua G. Time-resolved simulation of blood flow through left anterior descending coronary artery: effect of varying extent of stenosis on hemodynamics. BMC Cardiovasc Disord 2023; 23:156. [PMID: 36973644 PMCID: PMC10041719 DOI: 10.1186/s12872-023-03190-2] [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: 01/03/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Real-time blood flow variation is crucial for understanding the dynamic development of coronary atherosclerosis. The main objective of this study is to investigate the effect of varying extent of stenosis on the hemodynamic features in left anterior descending coronary artery. METHODS Various Computational fluid dynamics (CFD) models were constructed with patient-specific CT image data, using actual fractional flow reserve (FFR) as boundary conditions to provide a real-time quantitative description of hemodynamic properties. The hemodynamic parameters, such as the local and instantaneous wall shear stress (WSS), oscillating shear index (OSI) and relative residence time (RRT), blood flow velocity and pressure drop during various phases of cardiac cycle were provided in detail. RESULTS There was no evident variation in hemodynamic parameters in the cases of less than 50% stenosis while there were abrupt and dramatic changes in hemodynamics when the stenosis aggravated from 60 to 70%. Furthermore, when the stenosis was beyond 70%, there existed substantial pressure difference, WSS, and blood flow velocity in the center of the stenosis. Although OSI and RRT increased along with the aggravation of stenosis, they appeared with obvious abnormalities across all cases, even in mild stenosis. CONCLUSION The simulation could present a dynamic and comprehensive profile of how hemodynamic parameters vary in accordance with divergent severities of stenosis, which could serve as an effective reference for the clinicians to have a deeper insight into the pathological mechanism of coronary atherosclerosis and stenosis.
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Affiliation(s)
- Yinghong Zhao
- China University of Mining and Technology, No.1, Daxue Road, Xuzhou, Jiangsu, China.
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China.
| | - Huihui Wang
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China
| | | | - Wenyue Sun
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China
| | - Xianchao Yu
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Cunjie Sun
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Gang Hua
- China University of Mining and Technology, No.1, Daxue Road, Xuzhou, Jiangsu, China.
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Alzhanov N, Ng EYK, Su X, Zhao Y. CFD Computation of Flow Fractional Reserve (FFR) in Coronary Artery Trees Using a Novel Physiologically Based Algorithm (PBA) Under 3D Steady and Pulsatile Flow Conditions. Bioengineering (Basel) 2023; 10:bioengineering10030309. [PMID: 36978700 PMCID: PMC10045432 DOI: 10.3390/bioengineering10030309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
A novel physiologically based algorithm (PBA) for the computation of fractional flow reserve (FFR) in coronary artery trees (CATs) using computational fluid dynamics (CFD) is proposed and developed. The PBA was based on an extension of Murray’s law and additional inlet conditions prescribed iteratively and was implemented in OpenFOAM v1912 for testing and validation. 3D models of CATs were created using CT scans and computational meshes, and the results were compared to invasive coronary angiographic (ICA) data to validate the accuracy and effectiveness of the PBA. The discrepancy between the calculated and experimental FFR was within 2.33–5.26% in the steady-state and transient simulations, respectively, when convergence was reached. The PBA was a reliable and physiologically sound technique compared to a current lumped parameter model (LPM), which is based on empirical scaling correlations and requires nonlinear iterative computing for convergence. The accuracy of the PBA method was further confirmed using an FDA nozzle, which demonstrated good alignment with the CFD-validated values.
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Affiliation(s)
- Nursultan Alzhanov
- Mechanical and Aerospace Engineering Department, School of Engineering, Nazarbayev University, Asana 010000, Kazakhstan
| | - Eddie Y. K. Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Xiaohui Su
- School of Mechanical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Yong Zhao
- Mechanical and Aerospace Engineering Department, School of Engineering, Nazarbayev University, Asana 010000, Kazakhstan
- Correspondence:
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5
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Computing intracoronary blood flow rate under incomplete boundary conditions: Combing coronary anatomy and fractional flow reserve. Med Eng Phys 2023; 111:103942. [PMID: 36792237 DOI: 10.1016/j.medengphy.2022.103942] [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: 08/01/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Accurate measurement of intracoronary blood flow rate is of great significance for the diagnosis of ischemic heart disease (IHD). Computational fluid dynamic (CFD) method, combining coronary angiography images and fractional flow reserve (FFR), provides a new way to calculate the mean flow rate. However, due to the incomplete boundary conditions obtained by FFR, side branches were ignored which was likely to have a significant impact on the accuracy. In this paper, a novel CFD based method for calculating the mean intracoronary flow rate under incomplete pressure boundary conditions was proposed, in order to improve the accuracy by including the side branches. METHODS A pressure-flow curve based flow resistance model was employed to model resistance of the epicardial arteries. A series of steady flow simulations were performed to extract the parameters of the flow resistance model, which implicitly specified constraints for splitting flow between branches and thus enabled the mean intracoronary blood flow rate to be calculated in two or more branches under incomplete pressure boundary conditions. Simulation experiments were designed to validate the proposed method in both idealized and reconstructed 3D models of coronary branches, and the impact of the assumed coefficient of the Murray's Law for splitting flow between branches was also investigated. RESULTS The mean percentage error of the proposed method was +2.05%±0.04% for idealized models and +2.24%±0.01% for reconstructed models, and it was much lower than that of the method ignoring side branches (+38.48%±10.45% for idealized models and +30.54%±6.12% for reconstructed models). When the assumed coefficient of the Murray's Law was inconsistent with the real blood flow condition, the percentage errors still maintained less than about 3.00%. CONCLUSIONS The proposed method provided an easy and accurate way to measure the mean intracoronary flow rate and would facilitate the accurate diagnosis of IHD.
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6
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Wlasitsch-Nagy Z, Bálint A, Kőnig-Péter A, Varga P, Várady E, Bogner P, Gasz B. New CFD-based method for morphological and functional assessment in cardiovascular skill training. J Vasc Surg Cases Innov Tech 2022; 8:770-778. [DOI: 10.1016/j.jvscit.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
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7
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Geng Y, Liu H, Wang X, Zhang J, Gong Y, Zheng D, Jiang J, Xia L. Effect of microcirculatory dysfunction on coronary hemodynamics: A pilot study based on computational fluid dynamics simulation. Comput Biol Med 2022; 146:105583. [DOI: 10.1016/j.compbiomed.2022.105583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/21/2022] [Accepted: 04/30/2022] [Indexed: 01/09/2023]
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8
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Abuouf Y, AlBadawi M, Ookawara S, Ahmed M. Effect of guidewire insertion in fractional flow reserve procedure for real geometry using computational fluid dynamics. Biomed Eng Online 2021; 20:95. [PMID: 34583689 PMCID: PMC8479905 DOI: 10.1186/s12938-021-00935-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coronary artery disease is an abnormal contraction of the heart supply blood vessel. It limits the oxygenated blood flow to the heart. Thus, diagnosing its severity helps physicians to select the appropriate treatment plan. Fractional flow reserve (FFR) is the most accurate method to pinpoint the stenosis severity. However, inserting the guidewire across stenosis may cause a false overestimation of severity. METHODS To estimate the errors due to guidewire insertion, reconstructed three-dimensional coronary artery geometry from a patient-specific scan is used. A comprehensive three-dimensional blood flow model is developed. Blood is considered non-Newtonian and the flow is pulsatile. The model is numerically simulated using realistic boundary conditions. RESULTS The FFR value is calculated and compared with the actual flow ratio. Additionally, the ratio between pressure drop and distal dynamic pressure (CDP) is studied. The obtained results for each case are compared and analyzed with the case without a guidewire. It was found that placing the guidewire leads to overestimating the severity of moderate stenosis. It reduces the FFR value from 0.43 to 0.33 with a 23.26% error compared to 0.44 actual flow ratio and the CDP increases from 5.31 to 7.2 with a 35.6% error. FFR value in mild stenosis does not have a significant change due to placing the guidewire. The FFR value decreases from 0.83 to 0.82 compared to the 0.83 actual flow ratio. CONCLUSION Consequently, physicians should consider these errors while deciding the treatment plan.
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Affiliation(s)
- Yasser Abuouf
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), Postal Code 21934, New Borg El-Arab City, P.O. Box 179, Alexandria, Egypt. .,Mechanical Engineering Department, Faculty of Engineering, Alexandria University, Alexandria, Egypt.
| | - Muhamed AlBadawi
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), Postal Code 21934, New Borg El-Arab City, P.O. Box 179, Alexandria, Egypt.,Engineering Mathematics and Physics Department, Faculty of Engineering, Alexandria University, Alexandria, Egypt
| | - Shinichi Ookawara
- Department of Chemical Engineering, Graduate School of Science and Engineering, Tokyo Institute of Technology, O-okayama, Meguro-ku, Tokyo, 152-8552, Japan
| | - Mahmoud Ahmed
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), Postal Code 21934, New Borg El-Arab City, P.O. Box 179, Alexandria, Egypt.,Mechanical Engineering Department, Assiut University, Assiut, 71516, Egypt
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9
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Vardhan M, Randles A. Application of physics-based flow models in cardiovascular medicine: Current practices and challenges. BIOPHYSICS REVIEWS 2021; 2:011302. [PMID: 38505399 PMCID: PMC10903374 DOI: 10.1063/5.0040315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 03/21/2024]
Abstract
Personalized physics-based flow models are becoming increasingly important in cardiovascular medicine. They are a powerful complement to traditional methods of clinical decision-making and offer a wealth of physiological information beyond conventional anatomic viewing using medical imaging data. These models have been used to identify key hemodynamic biomarkers, such as pressure gradient and wall shear stress, which are associated with determining the functional severity of cardiovascular diseases. Importantly, simulation-driven diagnostics can help researchers understand the complex interplay between geometric and fluid dynamic parameters, which can ultimately improve patient outcomes and treatment planning. The possibility to compute and predict diagnostic variables and hemodynamics biomarkers can therefore play a pivotal role in reducing adverse treatment outcomes and accelerate development of novel strategies for cardiovascular disease management.
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Affiliation(s)
- M. Vardhan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
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10
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Rosalia L, Ozturk C, Van Story D, Horvath MA, Roche ET. Object‐Oriented Lumped‐Parameter Modeling of the Cardiovascular System for Physiological and Pathophysiological Conditions. ADVANCED THEORY AND SIMULATIONS 2021. [DOI: 10.1002/adts.202000216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Luca Rosalia
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - David Van Story
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Markus A. Horvath
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Ellen T. Roche
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
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11
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Xiong Z, Yuan D, Wang J, Zheng T, Fan Y. Influence of renal artery stenosis morphology on hemodynamics. Comput Methods Biomech Biomed Engin 2021; 24:1294-1301. [PMID: 33565336 DOI: 10.1080/10255842.2021.1883592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Currently, the clinical classification of the severity of renal artery stenosis (RAS) solely depends on the degree of stenosis. In addition, when the stenosis degree is between 50% and 70%, the clinical strategy is decided based on whether the RAS is hemodynamically significant. In this study, the influence of RAS morphological parameters on hemodynamics was numerically analyzed to provide a theoretical basis for clinical treatment. METHODS Idealized RAS models were established to investigate the hemodynamic effects of the stenosis length, asymmetric stenosis, and direction of the opening of the renal artery. RESULTS The longer the stenosis length, the greater is the ratio of the low time-averaged wall shear stress (WSS) and high oscillatory shear index (OSI) area distal stenosis (when the stenosis area is the same). In addition, asymmetric stenosis leads to a significant increase in the ratio of the renal artery peak systolic velocity (R-PSV) and the abdominal aorta peak systolic velocity (A-PSV) when the stenosis area is 60-70%. Furthermore, the fraction flow reserve (FFR) of the RAS model with 12 mm stenosis length, upward eccentricity and upward direction of renal artery opening was approximately equal to the cumulative value of the influence of different stenosis morphologies on FFR. CONCLUSION An assessment of the severity of RAS should consider the stenosis area and other morphological parameters, including the length and asymmetry of RAS as well as the direction of the opening of renal artery, particularly when the stenosis degree of RAS is between 50% and 70%.
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Affiliation(s)
- Zhuxiang Xiong
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Yubo Fan
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing
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12
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Lu Q, Lin W, Zhang R, Chen R, Wei X, Li T, Du Z, Xie Z, Yu Z, Xie X, Liu H. Validation and Diagnostic Performance of a CFD-Based Non-invasive Method for the Diagnosis of Aortic Coarctation. Front Neuroinform 2020; 14:613666. [PMID: 33362500 PMCID: PMC7756015 DOI: 10.3389/fninf.2020.613666] [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: 10/03/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: The clinical diagnosis of aorta coarctation (CoA) constitutes a challenge, which is usually tackled by applying the peak systolic pressure gradient (PSPG) method. Recent advances in computational fluid dynamics (CFD) have suggested that multi-detector computed tomography angiography (MDCTA)-based CFD can serve as a non-invasive PSPG measurement. The aim of this study was to validate a new CFD method that does not require any medical examination data other than MDCTA images for the diagnosis of CoA. Materials and methods: Our study included 65 pediatric patients (38 with CoA, and 27 without CoA). All patients underwent cardiac catheterization to confirm if they were suffering from CoA or any other congenital heart disease (CHD). A series of boundary conditions were specified and the simulated results were combined to obtain a stenosis pressure-flow curve. Subsequently, we built a prediction model and evaluated its predictive performance by considering the AUC of the ROC by 5-fold cross-validation. Results: The proposed MDCTA-based CFD method exhibited a good predictive performance in both the training and test sets (average AUC: 0.948 vs. 0.958; average accuracies: 0.881 vs. 0.877). It also had a higher predictive accuracy compared with the non-invasive criteria presented in the European Society of Cardiology (ESC) guidelines (average accuracies: 0.877 vs. 0.539). Conclusion: The new non-invasive CFD-based method presented in this work is a promising approach for the accurate diagnosis of CoA, and will likely benefit clinical decision-making.
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Affiliation(s)
- Qiyang Lu
- College of Automation Science and Technology, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weiyuan Lin
- College of Automation Science and Technology, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruichen Zhang
- Department of Information Engineering, Northwestern Polytechnical University, Xi'an, China
| | - Rui Chen
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoyu Wei
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tingyu Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhicheng Du
- Guangdong Key Laboratory of Medicine, Department of Medical Statistics and Epidemiology, Health Information Research Center, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhaofeng Xie
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhuliang Yu
- College of Automation Science and Technology, South China University of Technology, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinzhou Xie
- Department of Information Engineering, Northwestern Polytechnical University, Xi'an, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
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13
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Abuouf Y, Ookawara S, Ahmed M. Analysis of the effect of guidewire position on stenosis diagnosis using computational fluid dynamics. Comput Biol Med 2020; 121:103777. [PMID: 32568672 DOI: 10.1016/j.compbiomed.2020.103777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fractional flow reserve is an accurate method for diagnosing stenosis. The difficulty in using this procedure lies in placing the guidewire precisely at the blood vessel centerline. Owing to the long distance between the insertion point and the stenosis, a guidewire inclination can occur. Therefore, the main objective of this study is to investigate how the measured pressure in a blood vessel varies with the guidewire position. METHODS A three-dimensional model of blood flow is developed and numerically simulated. Two positions and two inclination angles from the blood vessel centerline and three throat diameters are investigated. The predicted results are validated using the available experimental data. The predicted results and actual measurements are observed to agree well with each other. RESULTS The pressure drop coefficient (CDP) increases because of guidewire insertion. When the guidewire is placed at inclined positions in moderate stenosis, the values of CDP are 66 and 68, depending on the inclination angle; the errors in CDP are 69% and 76%, respectively. At a high flow rate, the errors are reduced to 67% and 70%, respectively. The error in the CDP ranges from 42% to 61% when the guidewire is placed parallel to the centerline. For severe stenosis, the CDP is nearly the same at all positions and varies between 240 and 250; without a guidewire, the CDP is 163. CONCLUSIONS The findings confirmed that practitioners should be aware of the guidewire position during the operation. The displacement of the guidewire should be estimated, and the corresponding error must be considered.
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Affiliation(s)
- Yasser Abuouf
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City, Postal Code 21934, Alexandria, Egypt.
| | - Shinichi Ookawara
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City, Postal Code 21934, Alexandria, Egypt; Department of Chemical Engineering, Graduate School of Science and Engineering, Tokyo Institute of Technology, O-okayama, Meguro-ku, Tokyo, 152-8552, Japan.
| | - Mahmoud Ahmed
- Department of Energy Resources Engineering, Egypt-Japan University of Science and Technology (E-JUST), P.O. Box 179, New Borg El-Arab City, Postal Code 21934, Alexandria, Egypt; Mechanical Engineering Department, Assiut University, Assiut, 71516, Egypt.
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14
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Pressure-flow curve derived from coronary CT angiography for detection of significant hemodynamic stenosis. Eur Radiol 2020; 30:4347-4355. [DOI: 10.1007/s00330-020-06821-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 01/06/2023]
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15
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Zhou S, Xu L, Hao L, Xiao H, Yao Y, Qi L, Yao Y. A review on low-dimensional physics-based models of systemic arteries: application to estimation of central aortic pressure. Biomed Eng Online 2019; 18:41. [PMID: 30940144 PMCID: PMC6446386 DOI: 10.1186/s12938-019-0660-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/26/2019] [Indexed: 12/16/2022] Open
Abstract
The physiological processes and mechanisms of an arterial system are complex and subtle. Physics-based models have been proven to be a very useful tool to simulate actual physiological behavior of the arteries. The current physics-based models include high-dimensional models (2D and 3D models) and low-dimensional models (0D, 1D and tube-load models). High-dimensional models can describe the local hemodynamic information of arteries in detail. With regard to an exact model of the whole arterial system, a high-dimensional model is computationally impracticable since the complex geometry, viscosity or elastic properties and complex vectorial output need to be provided. For low-dimensional models, the structure, centerline and viscosity or elastic properties only need to be provided. Therefore, low-dimensional modeling with lower computational costs might be a more applicable approach to represent hemodynamic properties of the entire arterial system and these three types of low-dimensional models have been extensively used in the study of cardiovascular dynamics. In recent decades, application of physics-based models to estimate central aortic pressure has attracted increasing interest. However, to our best knowledge, there has been few review paper about reconstruction of central aortic pressure using these physics-based models. In this paper, three types of low-dimensional physical models (0D, 1D and tube-load models) of systemic arteries are reviewed, the application of three types of models on estimation of central aortic pressure is taken as an example to discuss their advantages and disadvantages, and the proper choice of models for specific researches and applications are advised.
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Affiliation(s)
- Shuran Zhou
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110819 China
| | - Lisheng Xu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110819 China
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, 110167 China
| | - Liling Hao
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110819 China
| | - Hanguang Xiao
- Chongqing Key Laboratory of Modern Photoelectric Detection Technology and Instrument, School of Optoelectronic Information, Chongqing University of Technology, Chongqing, 400054 China
| | - Yang Yao
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110819 China
| | - Lin Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110819 China
| | - Yudong Yao
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, 110819 China
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, 110167 China
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16
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Liu M, Sun A, Deng X. Hemodynamic performance within crossed stent grafts: computational and experimental study on the effect of cross position and angle. Biomed Eng Online 2018; 17:85. [PMID: 29921281 PMCID: PMC6009958 DOI: 10.1186/s12938-018-0517-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 12/31/2022] Open
Abstract
Background and aims The crossed limbs stent graft technique is regularly employed to treat abdominal aortic aneurysm patients with unfavorable aneurysm necks or widely splayed common iliac arteries. This article numerically evaluates the hemodynamic performance of the crossed limbs strategy by analyzing numerical simulations and conducting experiments using two series of idealized bifurcated stent grafts with different cross angles and cross positions. Results Results demonstrated that the absolute helicity at outlets decreased with increased cross angles and increased with decreased cross positions. The time-averaged wall shear stress remained approximately unchanged, whereas the oscillating shear index and relative resident time decreased slightly when the cross angle increased and cross position decreased in iliac grafts. Additionally, both numerical and in vitro experimental results indicate the displacement force acting on the stent graft gradually increased as cross angles increased and cross positions decreased. Results further indicated that strip areas with a high oscillating shear index and high relative resident time, which may be vulnerable to thrombosis formation, exist along the outer surface of the iliac artery grafts. Conclusion Given this information, the optimal crossed limbs configuration may contain a small cross angle and low cross position; however, low cross positions may increase the risk of migration.
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Affiliation(s)
- Ming Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing, 100083, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing, 100083, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 102402, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing, 100083, China. .,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 102402, China.
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