A Computational Analysis of the Influence of a Pressure Wire in Evaluating Coronary Stenosis

Impact of Pressure Guidewire on Model-Based FFR Prediction

INTRODUCTION

Fractional Flow Reserve (FFR) is used to characterize the functional significance of coronary artery stenoses. FFR is assessed under hyperemic conditions by invasive measurements of trans-stenotic pressure thanks to the insertion of a pressure guidewire across the coronary stenosis during catheterization. In order to overcome the potential risk related to the invasive procedure and to reduce the associated high costs, three-dimensional blood flow simulations that incorporate clinical imaging and patient-specific characteristics have been proposed.

PURPOSE

Most CCTA-derived FFR models neglect the potential influence of the guidewire on computed flow and pressure. Here we aim to quantify the impact of taking into account the presence of the guidewire in model-based FFR prediction.

METHODS

We adopt a CCTA-derived FFR model and perform simulations with and without the guidewire for 18 patients with suspected stable CAD.

RESULTS

Presented results show that the presence of the guidewire leads to a tendency to predict a lower FFR value. The FFR reduction is prominent in cases of severe stenoses, while the influence of the guidewire is less pronounced in cases of moderate stenoses.

CONCLUSION

From a clinical decision-making point of view, including of the pressure guidewire is potentially relevant only for intermediate stenosis cases.

Impact of Modelling Surface Roughness in an Arterial Stenosis

Arterial stenosis is a problem of immediate significance, as cardiovascular disease is the number one leading cause of death worldwide. Generally, the study of stenotic flow assumes a smooth, curved stenosis and artery. However, the real situation is unlikely to present an infinitely smooth-surfaced arterial stenosis. Here, the impact of surface roughness on the flow in an arterial stenosis was studied via a computational fluid dynamics analysis. A patient-specific geometry with a smooth surface was reconstructed, and a partially rough model was built by artificially adding random roughness only on the stenotic region of the smooth model. It was found that the flow was oscillatory downstream of the stenosis in the models. A slightly lower velocity near the wall and more oscillatory flows were observed due to the presence of the roughness in the stenotic region. However, the pressure distributions did not vary significantly between the smooth and rough models. The differences in the wall shear metrics were slight in the stenotic region and became larger in the downstream region of the models.

Characterizing and Optimizing Piezoelectric Response of ZnO Nanowire/PMMA Composite-Based Sensor

Due to the outstanding coupling between piezoelectric and semiconducting properties of zinc oxide nanowires, ZnO NW-based structures have been demonstrating promising potential with respect to their applicability in piezoelectric, piezotronic and piezo-phototronic devices. Particularly considering their biocompatibility and biosafety for applications regarding implantable medical detection, this paper proposed a new concept of piezoelectric composite, i.e., one consisting of vertically aligned ZnO NW arrays and an insulating polymer matrix. First, the finite element method (FEM) was employed to drive optimization strategies through adjustment of the key parameters such as Young’s modules and the dielectric constant of the dielectric constituents, together with the density and dimension of nanowire (NW) itself. Second, to investigate the functionality of each individual layer of composite, different designed structures were fabricated and characterized in terms of electrical and piezoelectric properties. Next, experimental and simulation tests were performed, indicating that the decreasing thickness of the top poly(methyl methacrylate) layer (PMMA) can substantially enhance the piezoelectric sensitivity of the ZnO NW composite. Besides the further benefit of no polarization being needed, our material has a comparable charge coefficient (d₃₃) with respect to other lead-free alternatives (e.g., BaTiO₃), confirming the high sensing abilities of the developed structure based on vertically aligned ZnO NW arrays. Finally, a time-varying model combining piezoelectricity and electric circuit modules was investigated in detail, giving rise to an estimation of the d₃₃ coefficient for ZnO NWs. Based on this study, the developed material is revealed to be highly promising in medical applications, particularly regarding the FFR technique, where coronary pressure can be measured through a piezoelectric sensor.