1
|
Rodero C, Baptiste TMG, Barrows RK, Keramati H, Sillett CP, Strocchi M, Lamata P, Niederer SA. A systematic review of cardiac in-silico clinical trials. PROGRESS IN BIOMEDICAL ENGINEERING (BRISTOL, ENGLAND) 2023; 5:032004. [PMID: 37360227 PMCID: PMC10286106 DOI: 10.1088/2516-1091/acdc71] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Computational models of the heart are now being used to assess the effectiveness and feasibility of interventions through in-silico clinical trials (ISCTs). As the adoption and acceptance of ISCTs increases, best practices for reporting the methodology and analysing the results will emerge. Focusing in the area of cardiology, we aim to evaluate the types of ISCTs, their analysis methods and their reporting standards. To this end, we conducted a systematic review of cardiac ISCTs over the period of 1 January 2012-1 January 2022, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). We considered cardiac ISCTs of human patient cohorts, and excluded studies of single individuals and those in which models were used to guide a procedure without comparing against a control group. We identified 36 publications that described cardiac ISCTs, with most of the studies coming from the US and the UK. In 75% of the studies, a validation step was performed, although the specific type of validation varied between the studies. ANSYS FLUENT was the most commonly used software in 19% of ISCTs. The specific software used was not reported in 14% of the studies. Unlike clinical trials, we found a lack of consistent reporting of patient demographics, with 28% of the studies not reporting them. Uncertainty quantification was limited, with sensitivity analysis performed in only 19% of the studies. In 97% of the ISCTs, no link was provided to provide easy access to the data or models used in the study. There was no consistent naming of study types with a wide range of studies that could potentially be considered ISCTs. There is a clear need for community agreement on minimal reporting standards on patient demographics, accepted standards for ISCT cohort quality control, uncertainty quantification, and increased model and data sharing.
Collapse
Affiliation(s)
- Cristobal Rodero
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiac Modelling and Imaging Biomarkers (CMIB), Department of Biomedical Engineering and Imaging Sciences Department, King’s College London, London, United Kingdom
| | - Tiffany M G Baptiste
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Rosie K Barrows
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Hamed Keramati
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiac Modelling and Imaging Biomarkers (CMIB), Department of Biomedical Engineering and Imaging Sciences Department, King’s College London, London, United Kingdom
| | - Charles P Sillett
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Marina Strocchi
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Pablo Lamata
- Cardiac Modelling and Imaging Biomarkers (CMIB), Department of Biomedical Engineering and Imaging Sciences Department, King’s College London, London, United Kingdom
| | - Steven A Niederer
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
| |
Collapse
|
2
|
Wu M, Xun M, Chen Y. Adaptation of Vascular Smooth Muscle Cell to Degradable Metal Stent Implantation. ACS Biomater Sci Eng 2023. [PMID: 37364226 DOI: 10.1021/acsbiomaterials.3c00637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Iron-, magnesium-, or zinc-based metal vessel stents support vessel expansion at the period early after implantation and degrade away after vascular reconstruction, eliminating the side effects due to the long stay of stent implants in the body and the risks of restenosis and neoatherosclerosis. However, emerging evidence has indicated that their degradation alters the vascular microenvironment and induces adaptive responses of surrounding vessel cells, especially vascular smooth muscle cells (VSMCs). VSMCs are highly flexible cells that actively alter their phenotype in response to the stenting, similarly to what they do during all stages of atherosclerosis pathology, which significantly influences stent performance. This Review discusses how biodegradable metal stents modify vascular conditions and how VSMCs respond to various chemical, biological, and physical signals attributable to stent implantation. The focus is placed on the phenotypic adaptation of VSMCs and the clinical complications, which highlight the importance of VSMC transformation in future stent design.
Collapse
Affiliation(s)
- Meichun Wu
- Hengyang Medical School, University of South China, Hengyang, Hunan 410001, China
- School of Nursing, University of South China, Hengyang, Hunan 410001, China
| | - Min Xun
- Institute of Pharmacy and Pharmacology, School of Pharmaceutical Science, University of South China, Hengyang, Hunan 410001, China
| | - Yuping Chen
- Hengyang Medical School, University of South China, Hengyang, Hunan 410001, China
- Institute of Pharmacy and Pharmacology, School of Pharmaceutical Science, University of South China, Hengyang, Hunan 410001, China
| |
Collapse
|
3
|
Karanasiou GE, Loukas VS, Tsompou PI, Karanasiou GS, Kyriakidis S, Antonini L, Poletti G, Pennati G, Papafaklis M, Gergidis LN, Fotiadis DI, Sakellarios AI. A proof-of-concept study for the simulation of blood flow in a post arterial segment for different blood rheology models. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3985-3988. [PMID: 36086124 DOI: 10.1109/embc48229.2022.9871397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cardiovascular disease (CVD) and especially atherosclerosis are chronic inflammatory diseases which cause the atherosclerotic plaque growth in the arterial vessels and the blood flow reduction. Stents have revolutionized the treatment of this disease to a great extent by restoring the blood flow in the vessel. The present study investigates the performance of the blood flow after stent implantation in patient-specific coronary artery and demonstrates the effect of using Newtonian vs. non-Newtonian blood fluid models in the distribution of endothelial shear stress. In particular, the Navier-Stokes and continuity equations were employed, and three non-Newtonian fluid models were investigated (Carreau, Carreau-Yasuda and the Casson model). Computational finite elements models were used for the simulation of blood flow. The comparison of the results demonstrates that the Newtonian fluid model underestimates the calculation of Endothelial Shear Stress, while the three non-Newtonian fluids present similar distribution of shear stress. Keywords: Blood flow dynamics, stented artery, non-Newtonian fluid. Clinical Relevance- This work demonstrates that when blood flow modeling is performed at stented arteries and predictive models are developed, the non-Newtonian nature of blood must be considered.
Collapse
|
5
|
Blanco PJ. Absorbable Stents and the Ever-Evolving Coronary Hemodynamic Landscape. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:16-17. [PMID: 34148812 DOI: 10.1016/j.carrev.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Pablo J Blanco
- Department of Mathematical and Computational Methods, National Laboratory for Scientific Computing, Av. Getúlio Vargas 333, 25651-075 Petrópolis, RJ, Brazil.
| |
Collapse
|