Differences in coronary vasodilatory capacity and atherosclerosis in endurance athletes using coronary CTA and computational fluid dynamics (CFD): Comparison with a sedentary lifestyle

Extreme endurance training and coronary artery disease: A systematic review and a meta-analysis

BACKGROUND

Physical activity is advocated for cardiovascular health; however, excessive endurance exercise may pose risks. This systematic review and meta-analysis explore the relationship between endurance training and coronary artery disease (CAD) diagnosed at coronary CT angiography (CCTA).

METHODS

Following PRISMA guidelines, we searched MEDLINE, Embase, and Scopus up to January 4th, 2024. Inclusion criteria encompassed studies on adults with sample size >10, various study designs, and assessment of endurance training and CAD via CCTA.

RESULTS

Endurance athletes exhibited a higher prevalence of coronary atherosclerosis compared to controls. However, they did not demonstrate a greater prevalence of high-risk or obstructive plaques. Continuous coronary artery calcium (CAC) scores did not significantly differ between athletes and controls. Athletes showed a slight increase in the odds of having CAC > 400.

CONCLUSION

Endurance athletes are more likely to have coronary atherosclerosis but not more likely to have high-risk plaques compared to sedentary individuals. Further research is needed to establish threshold values for physical exercise beyond which sports can become harmful and identify which types of sports carry the greatest risk.

Prediction of Hemodynamic-Related Hemolysis in Carotid Stenosis and Aiding in Treatment Planning and Risk Stratification Using Computational Fluid Dynamics

Atherosclerosis affects human health in many ways, leading to disability or premature death due to ischemic heart disease, stroke, or limb ischemia. Poststenotic blood flow disruption may also play an essential role in artery wall impairment linked with hemolysis related to shear stress. The maximum shear stress in the atherosclerotic plaque area is the main parameter determining hemolysis risk. In our work, a 3D internal carotid artery model was built from CT scans performed on patients qualified for percutaneous angioplasty due to its symptomatic stenosis. The obtained stenosis geometries were used to conduct a series of computer simulations to identify critical parameters corresponding to the increase in shear stress in the arteries. Stenosis shape parameters responsible for the increase in shear stress were determined. The effect of changes in the carotid artery size, length, and degree of narrowing on the change in maximum shear stress was demonstrated. Then, a correlation for the quick initial diagnosis of atherosclerotic stenoses regarding the risk of hemolysis was developed. The developed relationship for rapid hemolysis risk assessment uses information from typical non-invasive tests for treated patients. Practical guidelines have been developed regarding which stenosis shape parameters pose a risk of hemolysis, which may be adapted in medical practice.

Mathematical modeling of plaque progression and associated microenvironment: How far from predicting the fate of atherosclerosis?

Mathematical modeling contributes to pathophysiological research of atherosclerosis by helping to elucidate mechanisms and by providing quantitative predictions that can be validated. In turn, the complexity of atherosclerosis is well suited to quantitative approaches as it provides challenges and opportunities for new developments of modeling. In this review, we summarize the current 'state of the art' on the mathematical modeling of the effects of biomechanical factors and microenvironmental factors on the plaque progression, and its potential help in prediction of plaque development. We begin with models that describe the biomechanical environment inside and outside the plaque and its influence on its growth and rupture. We then discuss mathematical models that describe the dynamic evolution of plaque microenvironmental factors, such as lipid deposition, inflammation, smooth muscle cells migration and intraplaque hemorrhage, followed by studies on plaque growth and progression using these modelling approaches. Moreover, we present several key questions for future research. Mathematical models can complement experimental and clinical studies, but also challenge current paradigms, redefine our understanding of mechanisms driving plaque vulnerability and propose future potential direction in therapy for cardiovascular disease.