1
|
Suk J, de Haan P, Lippe P, Brune C, Wolterink JM. Mesh neural networks for SE(3)-equivariant hemodynamics estimation on the artery wall. Comput Biol Med 2024; 173:108328. [PMID: 38552282 DOI: 10.1016/j.compbiomed.2024.108328] [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: 07/24/2023] [Revised: 01/29/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024]
Abstract
Computational fluid dynamics (CFD) is a valuable asset for patient-specific cardiovascular-disease diagnosis and prognosis, but its high computational demands hamper its adoption in practice. Machine-learning methods that estimate blood flow in individual patients could accelerate or replace CFD simulation to overcome these limitations. In this work, we consider the estimation of vector-valued quantities on the wall of three-dimensional geometric artery models. We employ group-equivariant graph convolution in an end-to-end SE(3)-equivariant neural network that operates directly on triangular surface meshes and makes efficient use of training data. We run experiments on a large dataset of synthetic coronary arteries and find that our method estimates directional wall shear stress (WSS) with an approximation error of 7.6% and normalised mean absolute error (NMAE) of 0.4% while up to two orders of magnitude faster than CFD. Furthermore, we show that our method is powerful enough to accurately predict transient, vector-valued WSS over the cardiac cycle while conditioned on a range of different inflow boundary conditions. These results demonstrate the potential of our proposed method as a plugin replacement for CFD in the personalised prediction of hemodynamic vector and scalar fields.
Collapse
Affiliation(s)
- Julian Suk
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands.
| | - Pim de Haan
- Qualcomm AI Research, Qualcomm Technologies Netherlands B.V., Nijmegen, 6546 AS, The Netherlands; QUVA Lab, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Phillip Lippe
- QUVA Lab, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Christoph Brune
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands
| |
Collapse
|
2
|
Gherasie FA, Popescu MR, Bartos D. Acute Coronary Syndrome: Disparities of Pathophysiology and Mortality with and without Peripheral Artery Disease. J Pers Med 2023; 13:944. [PMID: 37373933 DOI: 10.3390/jpm13060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
There are a number of devastating complications associated with peripheral artery disease, including limb amputations and acute limb ischemia. Despite the overlap, atherosclerotic diseases have distinct causes that need to be differentiated and managed appropriately. In coronary atherosclerosis, thrombosis is often precipitated by rupture or erosion of fibrous caps around atheromatous plaques, which leads to acute coronary syndrome. Regardless of the extent of atherosclerosis, peripheral artery disease manifests itself as thrombosis. Two-thirds of patients with acute limb ischemia have thrombi associated with insignificant atherosclerosis. A local thrombogenic or remotely embolic basis of critical limb ischemia may be explained by obliterative thrombi in peripheral arteries of patients without coronary artery-like lesions. Studies showed that thrombosis of the above-knee arteries was more commonly due to calcified nodules, which are the least common cause of luminal thrombosis associated with acute coronary events in patients with acute coronary syndrome. Cardiovascular mortality was higher in peripheral artery disease without myocardial infarction/stroke than in myocardial infarction/stroke without peripheral artery disease. The aim of this paper is to gather published data regarding the disparities of acute coronary syndrome with and without peripheral artery disease in terms of pathophysiology and mortality.
Collapse
Affiliation(s)
| | - Mihaela-Roxana Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 011461 Bucharest, Romania
| | - Daniela Bartos
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Department of Internal Medicine, Clinical University Emergency Hospital, 014461 Bucharest, Romania
| |
Collapse
|
3
|
Zhang DQ, Xu YF, Dong YP, Yu SJ. Coronary computed tomography angiography study on the relationship between the Ramus Intermedius and Atherosclerosis in the bifurcation of the left main coronary artery. BMC Med Imaging 2023; 23:53. [PMID: 37041479 PMCID: PMC10091592 DOI: 10.1186/s12880-023-01009-2] [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: 01/18/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE This study aimed to explore the relationship between the ramus intermedius (RI) and atherosclerosis in the bifurcation of the left coronary artery (LCA). METHODS Screening patients who underwent CCTA from January to September 2021, 100 patients with RI (RI group) and 100 patients without RI (no-RI group) were randomly enrolled, Evaluation of RI distribution characteristics and left main coronary artery(LM),Left anterior descending branch(LAD),left circumflex branch(LCX) proximal segment plaque distribution, measurement of LAD-LCX bifurcation angle(∠LAD-LCX),Comparison of the three distribution characteristics with the incidence of plaques in the left main trunk bifurcation area (LM, LAD, LCX) between groups and within the RI group. RESULTS The difference in the incidence of plaques in the proximal LCX and the LM between the RI group and the no-RI group were not statistically significant (P > 0.05). The incidence of plaques in the proximal LAD in the RI group was significantly higher than that in the non-RI group (77% versus 53%, P < 0.05). However, there was no statistically significant difference between the two groups after PSM. A univariate logistic regression analysis revealed that an RI was a risk factor for plaque formation in the proximal LAD (P < 0.001), and a multivariate logistic regression analysis revealed that an RI was not an independent risk factor for plaque formation in the proximal LAD (P > 0.05). When compared within the RI group, the difference in the incidence of plaques in the proximal segment of LAD, the proximal segment of LCX, and the LM among the different distribution groups of RI was not statistically significant, respectively (P > 0.05). CONCLUSION RI is not an independent risk factor for atherosclerosis in the left coronary artery bifurcation zone, but it may indirectly increase the risk of atherosclerosis in the proximal segment of the LAD.
Collapse
Affiliation(s)
- Dan-Qing Zhang
- Hebei Medical University, 050000, Shijiazhuang, China
- Department of Diagnostic CT, Cangzhou Central Hospital, No.16 of Xinhua West Road, Canal District, 061000, Cangzhou, China
| | - Yan-Feng Xu
- Department of Diagnostic CT, Cangzhou Central Hospital, No.16 of Xinhua West Road, Canal District, 061000, Cangzhou, China
| | - Ya-Peng Dong
- Department of Diagnostic CT, Cangzhou Central Hospital, No.16 of Xinhua West Road, Canal District, 061000, Cangzhou, China
| | - Shu-Jing Yu
- Hebei Medical University, 050000, Shijiazhuang, China.
- Department of Diagnostic CT, Cangzhou Central Hospital, No.16 of Xinhua West Road, Canal District, 061000, Cangzhou, China.
| |
Collapse
|
4
|
Gharleghi R, Adikari D, Ellenberger K, Webster M, Ellis C, Sowmya A, Ooi S, Beier S. Annotated computed tomography coronary angiogram images and associated data of normal and diseased arteries. Sci Data 2023; 10:128. [PMID: 36899014 PMCID: PMC10006074 DOI: 10.1038/s41597-023-02016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/14/2023] [Indexed: 03/12/2023] Open
Abstract
Computed Tomography Coronary Angiography (CTCA) is a non-invasive method to evaluate coronary artery anatomy and disease. CTCA is ideal for geometry reconstruction to create virtual models of coronary arteries. To our knowledge there is no public dataset that includes centrelines and segmentation of the full coronary tree. We provide anonymized CTCA images, voxel-wise annotations and associated data in the form of centrelines, calcification scores and meshes of the coronary lumen in 20 normal and 20 diseased cases. Images were obtained along with patient information with informed, written consent as part of the Coronary Atlas. Cases were classified as normal (zero calcium score with no signs of stenosis) or diseased (confirmed coronary artery disease). Manual voxel-wise segmentations by three experts were combined using majority voting to generate the final annotations. Provided data can be used for a variety of research purposes, such as 3D printing patient-specific models, development and validation of segmentation algorithms, education and training of medical personnel and in-silico analyses such as testing of medical devices.
Collapse
Affiliation(s)
- R Gharleghi
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - D Adikari
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - K Ellenberger
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - M Webster
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - C Ellis
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - A Sowmya
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
| | - S Ooi
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - S Beier
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
| |
Collapse
|
5
|
Gharleghi R, Chen N, Sowmya A, Beier S. Towards automated coronary artery segmentation: A systematic review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107015. [PMID: 35914439 DOI: 10.1016/j.cmpb.2022.107015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Vessel segmentation is the first processing stage of 3D medical images for both clinical and research use. Current segmentation methods are tedious and time consuming, requiring significant manual correction and hence are infeasible to use in large data sets. METHODS Here, we review and analyse available coronary artery segmentation methods, focusing on fully automated methods capable of handling the rapidly growing medical images available. All manuscripts published since 2010 are systematically reviewed, categorised into different groups based on the approach taken, and characteristics of the different approaches as well as trends over the past decade are explored. RESULTS The manuscripts were divided intro three broad categories, consisting of region growing, voxelwise prediction and partitioning approaches. The most common approach overall was region growing, particularly using active contour models, however these have had a sharp fall in popularity in recent years with convolutional neural networks becoming significantly more popular. CONCLUSIONS The systematic review of current coronary artery segmentation methods shows interesting trends, with rising popularity of machine learning methods, a focus on efficient methods, and falling popularity of computationally expensive processing steps such as vesselness and multiplanar reformation.
Collapse
Affiliation(s)
- Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia.
| | - Nanway Chen
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia
| | - Arcot Sowmya
- School of Computer Science and Engineering, UNSW, Sydney NSW 2053, Australia; Tyree Foundation Institute of Health Engineering (Tyree IHealthE), Sydney, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia
| |
Collapse
|
6
|
Gharleghi R, Sowmya A, Beier S. Transient wall shear stress estimation in coronary bifurcations using convolutional neural networks. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107013. [PMID: 35901629 DOI: 10.1016/j.cmpb.2022.107013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Haemodynamic metrics, such as blood flow induced shear stresses at the inner vessel lumen, are associated with the development and progression of coronary artery disease. Understanding these metrics may therefore improve the assessment of an individual's coronary disease risk. However, the calculation of such luminal Wall Shear Stress (WSS) using traditional Computational Fluid Dynamics (CFD) methods is relatively slow and computationally expensive. As a result, CFD based haemodynamic computation is not suitable for integrated and large-scale use in clinical settings. METHODS In this work, deep learning techniques are proposed as an alternative method to CFD, whereby luminal WSS magnitude can be predicted in coronary bifurcations throughout the cardiac cycle based on the steady state solution (which takes <120 seconds to calculate including preprocessing), vessel geometry and additional global features. The deep learning model is trained on a dataset of 101 patient-specific and 2626 synthetic left main bifurcation models with 26 separate patient-specific cases used as the test set. RESULTS The model showed high fidelity predictions with <5% (normalised against mean WSS magnitude) deviation to CFD derived values as the gold-standard method, while being orders of magnitude faster with on average <2 minutes versus 3 hours computation for transient CFD. CONCLUSIONS This method therefore offers a new approach to substantially reduce the computational cost involved in, for example, large-scale population studies of coronary haemodynamic metrics, and may therefore open the pathway for future clinical integration.
Collapse
Affiliation(s)
- Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, NSW 2052, Australia.
| | - Arcot Sowmya
- School of Computer Science and Engineering, UNSW, Sydney, NSW 2052, Australia; Tyree Foundation Institute of Health Engineering (Tyree IHealthE), Sydney, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, NSW 2052, Australia
| |
Collapse
|
7
|
Murasato Y, Meno K, Mori T, Tanenaka K. Impact of coronary bifurcation angle on the pathogenesis of atherosclerosis and clinical outcome of coronary bifurcation intervention–A scoping review. PLoS One 2022; 17:e0273157. [PMID: 35976920 PMCID: PMC9385039 DOI: 10.1371/journal.pone.0273157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background A coronary bifurcation stenting is still a challenging issue due to frequent restenosis and stent thrombosis even with drug-eluting stents. The bifurcation angle (BA) between a main vessel and a side branch is one of the crucial determinants of coronary flow and shear stress that affect the plaque distribution. Previous bench and clinical studies have evaluated the impact of the BA between the proximal main vessel and the side branch (Angle A) and the BA between the distal main vessel and the side branch (Angle B) on the clinical outcomes of bifurcation stenting. However, the impact has not yet been fully elucidated due to a lack of statistical power or different manner of the assessment of BA. Objectives To analyze the published studies on coronary artery BA, the modalities used for assessment, and the impact of BA on interventions and attempt to define the pre-procedural protocols. Data sources A scoping review was performed using the Joanna Briggs Institute Methodology. A total of 52 relevant references were selected from PubMed, Cochrane Library, and CINAHL databases and categorized into three topic areas. Results and conclusions A wider Angle A is associated with the increased likelihood of carina shift and a wider Angle B, with that of side branch occlusion. A wider Angle B promotes stent malapposition and deformation in the side branch ostium and has been reported as an independent predictor of major adverse cardiac events after bifurcation stenting; however, improvement of the drug-eluting stent, refinement of the stenting technique, and accurate 3-dimensional assessment may attenuate the adverse clinical impact of a wider BA. Implications of key findings Assessment of the BA is necessary to predict the effect of bifurcation intervention procedure on the stent configuration and coronary flow at the bifurcated vessels. This will help to optimize stent selection and the stenting technique.
Collapse
Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
- * E-mail:
| | - Kyohei Meno
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takahiro Mori
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Katsuhiko Tanenaka
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| |
Collapse
|
8
|
Adikari D, Gharleghi R, Zhang S, Jorm L, Sowmya A, Moses D, Ooi SY, Beier S. A new and automated risk prediction of coronary artery disease using clinical endpoints and medical imaging-derived patient-specific insights: protocol for the retrospective GeoCAD cohort study. BMJ Open 2022; 12:e054881. [PMID: 35725256 PMCID: PMC9214399 DOI: 10.1136/bmjopen-2021-054881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is the leading cause of death worldwide. More than a quarter of cardiovascular events are unexplained by current absolute cardiovascular disease risk calculators, and individuals without clinical risk factors have been shown to have worse outcomes. The 'anatomy of risk' hypothesis recognises that adverse anatomical features of coronary arteries enhance atherogenic haemodynamics, which in turn mediate the localisation and progression of plaques. We propose a new risk prediction method predicated on CT coronary angiography (CTCA) data and state-of-the-art machine learning methods based on a better understanding of anatomical risk for CAD. This may open new pathways in the early implementation of personalised preventive therapies in susceptible individuals as a potential key in addressing the growing burden of CAD. METHODS AND ANALYSIS GeoCAD is a retrospective cohort study in 1000 adult patients who have undergone CTCA for investigation of suspected CAD. It is a proof-of-concept study to test the hypothesis that advanced image-derived patient-specific data can accurately predict long-term cardiovascular events. The objectives are to (1) profile CTCA images with respect to variations in anatomical shape and associated haemodynamic risk expressing, at least in part, an individual's CAD risk, (2) develop a machine-learning algorithm for the rapid assessment of anatomical risk directly from unprocessed CTCA images and (3) to build a novel CAD risk model combining traditional risk factors with these novel anatomical biomarkers to provide a higher accuracy CAD risk prediction tool. ETHICS AND DISSEMINATION The study protocol has been approved by the St Vincent's Hospital Human Research Ethics Committee, Sydney-2020/ETH02127 and the NSW Population and Health Service Research Ethics Committee-2021/ETH00990. The project outcomes will be published in peer-reviewed and biomedical journals, scientific conferences and as a higher degree research thesis.
Collapse
Affiliation(s)
- Dona Adikari
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Cardiology Department, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shisheng Zhang
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Arcot Sowmya
- School of Computer Science and Engineering, The University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Moses
- School of Computer Science and Engineering, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Imaging, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sze-Yuan Ooi
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Cardiology Department, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Toth GG, Achim A, Kafka M, Wu X, Lunardi M, Biswas S, Shahzad A, Thury A, Ruzsa Z, Johnson TW, Wijns W. Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation. EUROINTERVENTION 2022; 18:83-90. [PMID: 34930716 PMCID: PMC9904376 DOI: 10.4244/eij-d-21-00824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND While radial stent deformation has been thoroughly investigated, data on longitudinal deformation are scarce. AIMS The aim of the study was to describe longitudinal stent deformation associated with the proximal optimisation technique (POT). METHODS Longitudinal stent deformation was assessed by bench testing and by clinical evaluation. Bench testing was performed in silicone models using 3.00 (n=15) and 3.50 mm (n=14) stent platforms. After deployment, stents were sequentially post-dilated in the proximal main branch up to 5.50 mm, in increments of 0.50 mm, in order to simulate a spectrum of overexpansion. Stent length was redefined by optical coherence tomography (OCT) after each step. Clinical data were collected retrospectively from OCT-guided bifurcation percutaneous coronary intervention cases. RESULTS In bench tests, POT has led to significant stent elongation in all cases. The magnitude of elongation was comparable between the 3.00 and the 3.50 mm stent platforms, with 0.86±0.74 mm vs 0.86±0.73 mm, respectively (p=0.71), per 0.5 mm overexpansion. For 3.00 mm stent platforms, maximal elongation was 4.31±1.47 mm after up to 5.5 mm overexpansion. For 3.50 mm platforms, maximal elongation was 2.87±0.94 mm after up to 5.5 mm overexpansion. Thirty-six clinical cases were analysed, of which 22 (61%) were performed in the distal left main. Post-dilation was performed with 0.98±0.36 mm absolute overexpansion, resulting in 2.22±1.35 mm elongation, as compared to nominal stent length. CONCLUSIONS Overexpansion by POT results in proximal stent elongation. This has to be considered once the stent length is selected and the stent is positioned, especially in the left main stem, where proximal overexpansion is marked and accurate ostial landing is critical.
Collapse
Affiliation(s)
- Gabor G. Toth
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Alexandru Achim
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria,Second Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Marcel Kafka
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Xinlei Wu
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland
| | - Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland
| | - Sinjini Biswas
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Atif Shahzad
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland,Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| | - Attila Thury
- Second Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Zoltan Ruzsa
- Second Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Thomas W. Johnson
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland
| |
Collapse
|
10
|
Gharleghi R, Adikari D, Ellenberger K, Ooi SY, Ellis C, Chen CM, Gao R, He Y, Hussain R, Lee CY, Li J, Ma J, Nie Z, Oliveira B, Qi Y, Skandarani Y, Wang X, Yang S, Sowmya A, Beier S. Automated Segmentation of Normal and Diseased Coronary Arteries - The ASOCA Challenge. Comput Med Imaging Graph 2022; 97:102049. [DOI: 10.1016/j.compmedimag.2022.102049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
|
11
|
Kashyap V, Gharleghi R, Li DD, McGrath-Cadell L, Graham RM, Ellis C, Webster M, Beier S. Accuracy of vascular tortuosity measures using computational modelling. Sci Rep 2022; 12:865. [PMID: 35039557 PMCID: PMC8764056 DOI: 10.1038/s41598-022-04796-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
Severe coronary tortuosity has previously been linked to low shear stresses at the luminal surface, yet this relationship is not fully understood. Several previous studies considered different tortuosity metrics when exploring its impact of on the wall shear stress (WSS), which has likely contributed to the ambiguous findings in the literature. Here, we aim to analyze different tortuosity metrics to determine a benchmark for the highest correlating metric with low time-averaged WSS (TAWSS). Using Computed Tomography Coronary Angiogram (CTCA) data from 127 patients without coronary artery disease, we applied all previously used tortuosity metrics to the left main coronary artery bifurcation, and to its left anterior descending and left circumflex branches, before modelling their TAWSS using computational fluid dynamics (CFD). The tortuosity measures included tortuosity index, average absolute-curvature, root-mean-squared (RMS) curvature, and average squared-derivative-curvature. Each tortuosity measure was then correlated with the percentage of vessel area that showed a < 0.4 Pa TAWSS, a threshold associated with altered endothelial cell cytoarchitecture and potentially higher disease risk. Our results showed a stronger correlation between curvature-based versus non-curvature-based tortuosity measures and low TAWSS, with the average-absolute-curvature showing the highest coefficient of determination across all left main branches (p < 0.001), followed by the average-squared-derivative-curvature (p = 0.001), and RMS-curvature (p = 0.002). The tortuosity index, the most widely used measure in literature, showed no significant correlation to low TAWSS (p = 0.86). We thus recommend the use of average-absolute-curvature as a tortuosity measure for future studies.
Collapse
Affiliation(s)
- Vishesh Kashyap
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, USA
| | - Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia.
| | - Darson D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Lucy McGrath-Cadell
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Robert M Graham
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | | | | | - Susann Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
12
|
Blanco PJ, dos Santos GHV, Bulant CA, Alvarez AM, Oliveira FA, Cunha-Lima G, Lemos PA. Scaling laws and the left main coronary artery bifurcation. A combination of geometric and simulation analyses. Med Eng Phys 2022; 99:103701. [DOI: 10.1016/j.medengphy.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
|
13
|
Shen C, Gharleghi R, Li DD, Stevens M, Dokos S, Beier S. Secondary flow in bifurcations - Important effects of curvature, bifurcation angle and stents. J Biomech 2021; 129:110755. [PMID: 34601214 DOI: 10.1016/j.jbiomech.2021.110755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
Coronary bifurcations have complex flow patterns including secondary flow zones and helical flow, which directly affect pathophysiological mechanisms such as the development of atherosclerosis. The objective of this study was to generate insights into the effects of curvature, bifurcation angle and the presence of stents on flow patterns and resulting haemodynamics in coronary left main bifurcations. The blood flow and associated metrics were modelled in both idealised and patient-specific bifurcations with varying curvature and bifurcation angles with and without stents, resulting in a total of 128 geometries considered. The results showed that larger curvature of bifurcating vessels has a significant influence on secondary flow, especially with distance to the bifurcation region, causing a skew, spin and asymmetry of Dean vortices, an increase in helical flow intensity with symmetry loss, and a decrease in adversely low time-average wall shear stress (TAWSS). Generally, asymmetric flow patterns coincided with adversely low TAWSS regions. In identical stented geometries, the presence of the stents induced local recirculation immediately adjacent to the stent struts, thus generating adversely low TAWSS in these areas, with some effect on the overall secondary flow. Overall, the effect of stents outweighed the effect of curvature and BA. This new knowledge contributes to a better understanding of the joint effects of curvature, bifurcation angle, and stents on flow patterns and haemodynamics in coronary bifurcations.
Collapse
Affiliation(s)
- C Shen
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia.
| | - R Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - D D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - M Stevens
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| |
Collapse
|
14
|
Li Q, Zhang Y, Wang C, Dong S, Mao Y, Tang Y, Zeng Y. Diagnostic performance of CT-derived resting distal to aortic pressure ratio (resting Pd/Pa) vs. CT-derived fractional flow reserve (CT-FFR) in coronary lesion severity assessment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1390. [PMID: 34733942 PMCID: PMC8506529 DOI: 10.21037/atm-21-4325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022]
Abstract
Background Computed tomography-derived fractional flow reserve (CT-FFR) has emerged as a promising non-invasive substitute for fractional flow reserve (FFR) measurement. Normally, CT-FFR providing functional significance of coronary artery disease (CAD) by using a simplified total coronary resistance index (TCRI) model. Yet the error or discrepancy caused by this simplified model remains unclear. Methods A total of 20 consecutive patients with suspected CAD who underwent CTA and invasive FFR measurement were retrospectively analyzed. CT-FFR and CT-(Pd/Pa)rest values derived from the coronary CTA images. The diagnostic performance of CT-FFR and CT-(Pd/Pa)rest were evaluated on a per-vessel level using C statistics with invasive FFR<0.80 as the reference standard. Results Of the 25 vessels eventually analyzed, the prevalence of functionally significant CAD were 64%. The Youden index of the ROC curve indicated that the best cutoff value of invasive resting Pd/Pa was 0.945 for identifying functionally significant lesions. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy were 85%, 91%, 92%, 83% and 88% for CT-(Pd/Pa)rest and 85%, 58% 69%, 78% and 72% for CT-FFR. Area under the receiver-operating characteristic curve (AUC) to detect functionally significant stenoses of CT-(Pd/Pa)rest and CT-FFR were 0.87 and 0.90. Conclusions In this study, the results suggest CT-derived resting Pd/Pa has a potential advantage over CT-FFR in triaging patients for revascularization.
Collapse
Affiliation(s)
- Quan Li
- Center for Coronary Artery Disease, Division of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Center for Coronary Artery Disease, Division of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunliang Wang
- Departement of Biomedical Engineering and Health Systems, KTH - Royal Institute of Technology, Stockholm, Sweden.,Shenzhen Escope Tech Inc., China
| | - Shiming Dong
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | | | - Yida Tang
- Department of Cardiovascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yong Zeng
- Center for Coronary Artery Disease, Division of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
15
|
Lyras KG, Lee J. An improved reduced-order model for pressure drop across arterial stenoses. PLoS One 2021; 16:e0258047. [PMID: 34597313 PMCID: PMC8486142 DOI: 10.1371/journal.pone.0258047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022] Open
Abstract
Quantification of pressure drop across stenotic arteries is a major element in the functional assessment of occlusive arterial disease. Accurate estimation of the pressure drop with a numerical model allows the calculation of Fractional Flow Reserve (FFR), which is a haemodynamic index employed for guiding coronary revascularisation. Its non-invasive evaluation would contribute to safer and cost-effective diseases management. In this work, we propose a new formulation of a reduced-order model of trans-stenotic pressure drop, based on a consistent theoretical analysis of the Navier-Stokes equation. The new formulation features a novel term that characterises the contribution of turbulence effect to pressure loss. Results from three-dimensional computational fluid dynamics (CFD) showed that the proposed model produces predictions that are significantly more accurate than the existing reduced-order models, for large and small symmetric and eccentric stenoses, covering mild to severe area reductions. FFR calculations based on the proposed model produced zero classification error for three classes comprising positive (≤ 0.75), negative (≥ 0.8) and intermediate (0.75 − 0.8) classes.
Collapse
Affiliation(s)
- Konstantinos G. Lyras
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- * E-mail: (KGL); (JL)
| | - Jack Lee
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- * E-mail: (KGL); (JL)
| |
Collapse
|
16
|
Kovacevic M, Burzotta F, Elharty S, Besis G, Aurigemma C, Romagnoli E, Trani C. Left Main Trifurcation and Its Percutaneous Treatment: What Is Known So Far? Circ Cardiovasc Interv 2021; 14:e009872. [PMID: 33685210 DOI: 10.1161/circinterventions.120.009872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In humans, the most common anatomic variation of the left main (LM) stem is represented by its distal division in 3 branches (LM trifurcation) instead of 2. LM trifurcation disease accounts for ≈10% to 15% of all LM diseases and is often managed by cardiac surgery. Over the last decades, due to the improvement of interventional material and techniques, percutaneous coronary intervention started gaining acceptance to treat patients with LM disease including those with trifurcated anatomy. Yet, LM trifurcation stenosis with its intrinsic anatomic complexity (3 branches, at least 4 angles, wide variability in branch size and disease) is recognized as a challenging lesion subset for percutaneous coronary intervention. In this review, we summarize available data about LM trifurcation anatomy, its influence on percutaneous coronary intervention feasibility, and the evidence collected regarding the different technical options (including trissing balloon inflation).
Collapse
Affiliation(s)
- Mila Kovacevic
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.).,Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy (M.K., F.B., S.E., G.B., C.T.)
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.).,Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy (M.K., F.B., S.E., G.B., C.T.)
| | - Sameh Elharty
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.).,Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy (M.K., F.B., S.E., G.B., C.T.)
| | - George Besis
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.).,Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy (M.K., F.B., S.E., G.B., C.T.)
| | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.)
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.)
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.).,Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy (M.K., F.B., S.E., G.B., C.T.)
| |
Collapse
|
17
|
Kim Y, Bray JJH, Waterhouse B, Gall A, Connolly GM, Sammut E, Bruno VD, Tulloh R, Adlam D, Johnson TW. Quantitative evaluation and comparison of coronary artery characteristics by 3D coronary volume reconstruction. Sci Rep 2021; 11:1170. [PMID: 33441962 PMCID: PMC7806746 DOI: 10.1038/s41598-020-80928-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
Non-atherosclerotic abnormalities of vessel calibre, aneurysm and ectasia, are challenging to quantify and are often overlooked in qualitative reporting. Utilising a novel 3-dimensional (3D) quantitative coronary angiography (QCA) application, we have evaluated the characteristics of normal, diabetic and aneurysmal or ectatic coronary arteries. We selected 131 individuals under 50 years-of-age, who had undergone coronary angiography for suspected myocardial ischaemia between 1st January 2011 and 31st December 2015, at the Bristol Heart Institute, Bristol, UK. This included 42 patients with angiographically normal coronary arteries, 36 diabetic patients with unobstructed coronaries, and 53 patients with abnormal coronary dilatation (aneurysm and ectasia). A total of 1105 coronary segments were analysed using QAngio XA 3D (Research Edition, Medis medical imaging systems, Leiden, The Netherlands). The combined volume of the major coronary arteries was significantly different between each group (1240 ± 476 mm3 diabetic group, 1646 ± 391 mm3 normal group, and 2072 ± 687 mm3 abnormal group). Moreover, the combined coronary artery volumes correlated with patient body surface area (r = 0.483, p < 0.01). Inter-observer variability was assessed and intraclass correlation coefficient of the total coronary artery volume demonstrated a low variability of 3D QCA (r = 0.996, p < 0.001). Dedicated 3D QCA facilitates reproducible coronary artery volume estimation and allows discrimination of normal and diseased vessels.
Collapse
Affiliation(s)
- Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea.,Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | | | - Benjamin Waterhouse
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Alexander Gall
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Georgia May Connolly
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.,University of Bristol, Bristol, UK
| | - Eva Sammut
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.,University of Bristol, Bristol, UK
| | - Vito Domenico Bruno
- University of Bristol Medical School - Translational Health Science, Bristol, UK
| | - Robert Tulloh
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.,University of Bristol, Bristol, UK
| | - David Adlam
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
| |
Collapse
|
18
|
Masoud-Ansari S, Ormiston J, Webster M, Pontre B, Cowan B, Beier S. Towards validating stent induced micro flow patterns in left main coronary artery bifurcations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5749-5752. [PMID: 31947158 DOI: 10.1109/embc.2019.8856419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We investigated if blood flow changes induced through the presence of a stent could be detected using in vitro dynamically scaled 4D Phase-Contrast Magnetic Resonance Imaging (PC-MRI). Using idealized and patient-specific left main coronary artery bifurcations, we 3D-printed the dynamically large scaled geometries and incorporated them into a flow circuit for non-invasive acquisition with a higher effective spatial resolution. We tested the effects of using non-Newtonian and Newtonian fluids for the experiment. We also numerically simulated the same geometries in true scale for comparison using computational fluid dynamics (CFD). We found that the experimental setup increased the effective spatial resolution enough to reveal stent induced blood flow changes close to the vessel wall. Non-Newtonian fluid replicated all of the flow field well with a strong agreement with the computed flow field (R2 > 0.9). Fine flow structures were not as prominent for the Newtonian compared to non-Newtonian fluid consideration. In the patient-specific geometry, arterial non-planarity increased the difficulty to capture the near wall slow velocity changes. Findings demonstrate the potential to dynamically scale in vitro 4D MRI flow acquisition for micro blood flow considerations.
Collapse
|
19
|
Hakim R, Rangé G. [Left main PCI: Current treatment]. Ann Cardiol Angeiol (Paris) 2019; 68:333-340. [PMID: 31542200 DOI: 10.1016/j.ancard.2019.08.003] [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: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Abstract
Percutaneous coronary intervention (PCI) of left main coronary artery has become a strong alternative to coronary artery bypass surgery in selected patients. The treatment decision must be validated by the Heart Team. Several PCI techniques of distal left main PCI have been described but the KISSS (Keep it simple, swift and safe) principle recommended by the European Bifurcation Club must be kept in mind. Provisional stenting is the first-line technique. A two-stent strategy may be needed in the presence of≥2.5mm side branch diameter and significant ostial stenosis as well as in presumably difficult rewiring. In all cases, POT (Proximal Optimisation Technique) is mandatory. Intracoronary imaging can be of great help in perfecting the result or even to improve outcomes.
Collapse
Affiliation(s)
- R Hakim
- Hôpitaux de Chartres, 4, rue Claude-Bernard, 28630 Le Coudray, France
| | - G Rangé
- Hôpitaux de Chartres, 4, rue Claude-Bernard, 28630 Le Coudray, France.
| |
Collapse
|
20
|
Xu Y, Shi J, Zhao R, Zhang C, He Y, Lin J, Zhang Q, Shu X, Cheng L. Anthracycline induced inconsistent left ventricular segmental systolic function variation in patients with lymphoma detected by three-dimensional speckle tracking imaging. Int J Cardiovasc Imaging 2019; 35:771-779. [DOI: 10.1007/s10554-018-1510-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/24/2018] [Indexed: 01/08/2023]
|
21
|
Wolterink JM, van Hamersvelt RW, Viergever MA, Leiner T, Išgum I. Coronary artery centerline extraction in cardiac CT angiography using a CNN-based orientation classifier. Med Image Anal 2019; 51:46-60. [DOI: 10.1016/j.media.2018.10.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 10/05/2018] [Accepted: 10/18/2018] [Indexed: 01/16/2023]
|
22
|
Burzotta F, Lassen JF, Banning AP, Lefèvre T, Hildick-Smith D, Chieffo A, Darremont O, Pan M, Chatzizisis YS, Albiero R, Louvard Y, Stankovic G. Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 14:112-120. [PMID: 29786539 DOI: 10.4244/eij-d-18-00357] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The 2017 European Bifurcation Club (EBC) meeting was held in Porto (Portugal) and allowed a multidisciplinary international faculty to review and discuss the latest data collected in the field of coronary bifurcation interventions. In particular, the topic of percutaneous coronary intervention (PCI) on left main coronary artery (LM) disease was highlighted as a contemporary priority. Herein, we summarise the key LM anatomy features, the diagnostic modalities and available data that are relevant for a patient's procedural management. Since the clinical outcomes of patients undergoing PCI on LM disease may depend on both PCI team organisation and PCI performance, the optimal catheterisation laboratory set-up and the rationales for device and technique selection are critically reviewed. The best lesion preparation modalities, the different DES implantation technique choices and the strategies to be considered during PCI on unprotected LM for optimal PCI results are reviewed step by step.
Collapse
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Biomechanical Impact of Wrong Positioning of a Dedicated Stent for Coronary Bifurcations: A Virtual Bench Testing Study. Cardiovasc Eng Technol 2018; 9:415-426. [DOI: 10.1007/s13239-018-0359-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022]
|
24
|
Skowronski J, Pregowski J, Mintz GS, Kruk M, Kepka C, Tyczynski P, Michalowska I, Kalinczuk L, Opolski MP, Ciszewski M, Wolny R, Chmielak Z, Witkowski A. Measurements of Lumen Areas and Diameters of Proximal and Middle Coronary Artery Segments in Subjects Without Coronary Atherosclerosis. Am J Cardiol 2018; 121:917-923. [PMID: 29452689 DOI: 10.1016/j.amjcard.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/18/2017] [Accepted: 01/05/2018] [Indexed: 12/30/2022]
Abstract
There are plenty of data on morphology and lumen dimensions of diseased coronary arteries. However, information on normal coronary vessel anatomy is scarce. We provided computed tomography angiography-derived reference values of lumen dimensions in proximal and middle coronary segments in a healthy population with respect to gender and vessel dominance. Consecutive 2,849 computed tomography angiography examinations were reviewed to identify 201 subjects (77 men, patient age 50 ± 13 years) whose coronary arteries were free from any sign of atherosclerosis (calcium score 0, no detectable plaque). For all proximal and middle coronary segments, lumen areas (LAs) and lumen diameters were measured. Coronary vessel segmentation and dominance pattern were defined using the Syntax Score. Normal values of LAs and lumen diameters were significantly smaller for women compared with men except for the proximal right coronary artery and the left main coronary artery (LMCA) (20.2 ± 6.6 mm2 vs 23.0 ± 6.1 mm2, p = 0.0003, and 5.0 ± 0.8 mm vs 5.4 ± 0.7 mm, p = 0.0001). The lower limit of normal for the LMCA (defined as mean LA - 2 standard deviations) equaled 7.0 and 10.8 mm2 for women and men, respectively. Subjects with left (vs right) coronary dominance had significantly larger areas and diameters of the LMCA (26.2 ± 9.2 mm2 vs 20.7 ± 6.0 mm2, p = 0.0017, and 5.7 ± 1.0 mm vs 5.1 ± 0.7 mm, p = 0.0017, respectively) and proximal left circumflex (13.8 ± 2.7 mm2 vs 10.4 ± 3.8 mm2, p = 0.0001, and 4.2 ± 0.4 mm vs 3.6 ± 0.7 mm, p = 0.0001, respectively) and smaller areas and diameters of the proximal right coronary artery (7.1 ± 2.0 mm2 vs 13.3 ± 3.6 mm2, p <0.0001, and 3.0 ± 0.4 mm vs 4.1 ± 0.6 mm, p <0.0001, respectively). In conclusion, gender and coronary artery dominance pattern significantly impact normal LAs and dimensions in subjects without coronary atherosclerosis.
Collapse
|
25
|
Grundeken MJ, Chiastra C, Wu W, Wykrzykowska JJ, De Winter RJ, Dubini G, Migliavacca F. Differences in rotational positioning and subsequent distal main branch rewiring of the Tryton stent: An optical coherence tomography and computational study. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maik J. Grundeken
- Department of Cardiology; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,”; Politecnico di Milano; Milan Italy
| | - Wei Wu
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,”; Politecnico di Milano; Milan Italy
- Department of Mechanical Engineering; University of Texas at San Antonio; San Antonio TX
| | - Joanna J. Wykrzykowska
- Department of Cardiology; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Robbert J. De Winter
- Department of Cardiology; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,”; Politecnico di Milano; Milan Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,”; Politecnico di Milano; Milan Italy
| |
Collapse
|
26
|
Zivelonghi C, van Kuijk JP, Nijenhuis V, Poletti E, Suttorp MJ, van der Heyden JAS, Eefting FD, Rensing BJ, ten Berg JM, Azzalini L, van den Brink FS, Ribichini F, Colombo A, Henriques JPS, Agostoni P. First report of the use of long-tapered sirolimus-eluting coronary stent for the treatment of chronic total occlusions with the hybrid algorithm. Catheter Cardiovasc Interv 2018; 92:E299-E307. [DOI: 10.1002/ccd.27539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Carlo Zivelonghi
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
- Department of Cardiology; University of Verona; Verona Italy
| | - Jan P. van Kuijk
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Vincent Nijenhuis
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Enrico Poletti
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department; San Raffaele Scientific Institute; Milano Italy
| | - Maarten J. Suttorp
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | | | - Frank D. Eefting
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Benno J. Rensing
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Jurrien M. ten Berg
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department; San Raffaele Scientific Institute; Milano Italy
| | | | | | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department; San Raffaele Scientific Institute; Milano Italy
| | - José P. S. Henriques
- Department of Cardiology; Academic Medical Center, University of Amsterdam; Amsterdam the Netherlands
| | | |
Collapse
|
27
|
Ormiston JA, Kassab G, Finet G, Chatzizisis YS, Foin N, Mickley TJ, Chiastra C, Murasato Y, Hikichi Y, Wentzel JJ, Darremont O, Iwasaki K, Lefèvre T, Louvard Y, Beier S, Hojeibane H, Netravali A, Wooton J, Cowan B, Webster MW, Medrano-Gracia P, Stankovic G. Bench testing and coronary artery bifurcations: a consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:e1794-e1803. [PMID: 29131803 DOI: 10.4244/eij-d-17-00270] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is a consensus document from the European Bifurcation Club concerning bench testing in coronary artery bifurcations. It is intended to provide guidelines for bench assessment of stents and other strategies in coronary bifurcation treatment where the United States Food and Drug Administration (FDA) or International Organization for Standardization (ISO) guidelines are limited or absent. These recommendations provide guidelines rather than a step-by-step manual. We provide data on the anatomy of bifurcations and elastic response of coronary arteries to aid model construction. We discuss testing apparatus, bench testing endpoints and bifurcation nomenclature.
Collapse
|
28
|
Chiastra C, Gallo D, Tasso P, Iannaccone F, Migliavacca F, Wentzel JJ, Morbiducci U. Healthy and diseased coronary bifurcation geometries influence near-wall and intravascular flow: A computational exploration of the hemodynamic risk. J Biomech 2017; 58:79-88. [PMID: 28457603 DOI: 10.1016/j.jbiomech.2017.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 01/09/2023]
Abstract
Local hemodynamics has been identified as one main determinant in the onset and progression of atherosclerotic lesions at coronary bifurcations. Starting from the observation that atherosensitive hemodynamic conditions in arterial bifurcation are majorly determined by the underlying anatomy, the aim of the present study is to investigate how peculiar coronary bifurcation anatomical features influence near-wall and intravascular flow patterns. Different bifurcation angles and cardiac curvatures were varied in population-based, idealized models of both stenosed and unstenosed bifurcations, representing the left anterior descending (LAD) coronary artery with its diagonal branch. Local hemodynamics was analyzed in terms of helical flow and exposure to low/oscillatory shear stress by performing computational fluid dynamics simulations. Results show that bifurcation angle impacts lowly hemodynamics in both stenosed and unstenosed cases. Instead, curvature radius influences the generation and transport of helical flow structures, with smaller cardiac curvature radius associated to higher helicity intensity. Stenosed bifurcation models exhibit helicity intensity values one order of magnitude higher than the corresponding unstenosed cases. Cardiac curvature radius moderately affects near-wall hemodynamics of the stenosed cases, with smaller curvature radius leading to higher exposure to low shear stress and lower exposure to oscillatory shear stress. In conclusion, the proposed controlled benchmark allows investigating the effect of various geometrical features on local hemodynamics at the LAD/diagonal bifurcation, highlighting that cardiac curvature influences near wall and intravascular hemodynamics, while bifurcation angle has a minor effect.
Collapse
Affiliation(s)
- Claudio Chiastra
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Paola Tasso
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
| |
Collapse
|
29
|
Medrano-Gracia P, Ormiston J, Webster M, Beier S, Ellis C, Wang C, Smedby Ö, Young A, Cowan B. A Study of Coronary Bifurcation Shape in a Normal Population. J Cardiovasc Transl Res 2016; 10:82-90. [PMID: 28028693 PMCID: PMC5323506 DOI: 10.1007/s12265-016-9720-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022]
Abstract
During percutaneous coronary intervention, stents are placed in narrowings of the arteries to restore normal blood flow. Despite improvements in stent design, deployment techniques and drug-eluting coatings, restenosis and stent thrombosis remain a significant problem. Population stent design based on statistical shape analysis may improve clinical outcomes. Computed tomographic (CT) coronary angiography scans from 211 patients with a zero calcium score, no stenoses and no intermediate artery, were used to create statistical shape models of 446 major coronary artery bifurcations (left main, first diagonal and obtuse marginal and right coronary crux). Coherent point drift was used for registration. Principal component analysis shape scores were tested against clinical risk factors, quantifying the importance of recognised shape features in intervention including size, angles and curvature. Significant differences were found in (1) vessel size and bifurcation angle between the left main and other bifurcations; (2) inlet and curvature angle between the right coronary crux and other bifurcations; and (3) size and bifurcation angle by sex. Hypertension, smoking history and diabetes did not appear to have an association with shape. Physiological diameter laws were compared, with the Huo-Kassab model having the best fit. Bifurcation coronary anatomy can be partitioned into clinically meaningful modes of variation showing significant shape differences. A computational atlas of normal coronary bifurcation shape, where disease is common, may aid in the design of new stents and deployment techniques, by providing data for bench-top testing and computational modelling of blood flow and vessel wall mechanics.
Collapse
Affiliation(s)
- Pau Medrano-Gracia
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
| | | | | | - Susann Beier
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - Chunliang Wang
- School of Technology and Health, KTH Royal Institute of Technology, Brinellvägen 8, Stockholm, Sweden
| | - Örjan Smedby
- School of Technology and Health, KTH Royal Institute of Technology, Brinellvägen 8, Stockholm, Sweden
| | - Alistair Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Brett Cowan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| |
Collapse
|