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Menon K, Khan MO, Sexton ZA, Richter J, Nguyen PK, Malik SB, Boyd J, Nieman K, Marsden AL. Personalized coronary and myocardial blood flow models incorporating CT perfusion imaging and synthetic vascular trees. NPJ IMAGING 2024; 2:9. [PMID: 38706558 PMCID: PMC11062925 DOI: 10.1038/s44303-024-00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/25/2024] [Indexed: 05/07/2024]
Abstract
Computational simulations of coronary artery blood flow, using anatomical models based on clinical imaging, are an emerging non-invasive tool for personalized treatment planning. However, current simulations contend with two related challenges - incomplete anatomies in image-based models due to the exclusion of arteries smaller than the imaging resolution, and the lack of personalized flow distributions informed by patient-specific imaging. We introduce a data-enabled, personalized and multi-scale flow simulation framework spanning large coronary arteries to myocardial microvasculature. It includes image-based coronary anatomies combined with synthetic vasculature for arteries below the imaging resolution, myocardial blood flow simulated using Darcy models, and systemic circulation represented as lumped-parameter networks. We propose an optimization-based method to personalize multiscale coronary flow simulations by assimilating clinical CT myocardial perfusion imaging and cardiac function measurements to yield patient-specific flow distributions and model parameters. Using this proof-of-concept study on a cohort of six patients, we reveal substantial differences in flow distributions and clinical diagnosis metrics between the proposed personalized framework and empirical methods based purely on anatomy; these errors cannot be predicted a priori. This suggests virtual treatment planning tools would benefit from increased personalization informed by emerging imaging methods.
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Affiliation(s)
- Karthik Menon
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA USA
| | - Muhammed Owais Khan
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON Canada
| | | | - Jakob Richter
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA USA
| | - Patricia K. Nguyen
- VA Palo Alto Healthcare System, Palo Alto, CA USA
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA USA
| | | | - Jack Boyd
- Department of Cardiothoracic Surgery, Stanford School of Medicine, Stanford, CA USA
| | - Koen Nieman
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, CA USA
- Department of Radiology, Stanford School of Medicine, Stanford, CA USA
| | - Alison L. Marsden
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA USA
- Department of Bioengineering, Stanford University, Stanford, CA USA
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2
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Menon K, Khan MO, Sexton ZA, Richter J, Nieman K, Marsden AL. Personalized coronary and myocardial blood flow models incorporating CT perfusion imaging and synthetic vascular trees. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.17.23294242. [PMID: 37645850 PMCID: PMC10462196 DOI: 10.1101/2023.08.17.23294242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Computational simulations of coronary artery blood flow, using anatomical models based on clinical imaging, are an emerging non-invasive tool for personalized treatment planning. However, current simulations contend with two related challenges - incomplete anatomies in image-based models due to the exclusion of arteries smaller than the imaging resolution, and the lack of personalized flow distributions informed by patient-specific imaging. We introduce a data-enabled, personalized and multi-scale flow simulation framework spanning large coronary arteries to myocardial microvasculature. It includes image-based coronary models combined with synthetic vasculature for arteries below the imaging resolution, myocardial blood flow simulated using Darcy models, and systemic circulation represented as lumped-parameter networks. Personalized flow distributions and model parameters are informed by clinical CT myocardial perfusion imaging and cardiac function using surrogate-based optimization. We reveal substantial differences in flow distributions and clinical diagnosis metrics between the proposed personalized framework and empirical methods based on anatomy; these errors cannot be predicted a priori. This suggests virtual treatment planning tools would benefit from increased personalization informed by emerging imaging methods.
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Affiliation(s)
- Karthik Menon
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Muhammed Owais Khan
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Zachary A Sexton
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jakob Richter
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA, USA
| | - Koen Nieman
- Departments of Radiology and Medicine (Cardiovascular Medicine), Stanford School of Medicine, Stanford, CA, USA
| | - Alison L Marsden
- Department of Pediatrics (Cardiology), Stanford School of Medicine, Stanford, CA, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
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3
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Schwarz EL, Pegolotti L, Pfaller MR, Marsden AL. Beyond CFD: Emerging methodologies for predictive simulation in cardiovascular health and disease. BIOPHYSICS REVIEWS 2023; 4:011301. [PMID: 36686891 PMCID: PMC9846834 DOI: 10.1063/5.0109400] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023]
Abstract
Physics-based computational models of the cardiovascular system are increasingly used to simulate hemodynamics, tissue mechanics, and physiology in evolving healthy and diseased states. While predictive models using computational fluid dynamics (CFD) originated primarily for use in surgical planning, their application now extends well beyond this purpose. In this review, we describe an increasingly wide range of modeling applications aimed at uncovering fundamental mechanisms of disease progression and development, performing model-guided design, and generating testable hypotheses to drive targeted experiments. Increasingly, models are incorporating multiple physical processes spanning a wide range of time and length scales in the heart and vasculature. With these expanded capabilities, clinical adoption of patient-specific modeling in congenital and acquired cardiovascular disease is also increasing, impacting clinical care and treatment decisions in complex congenital heart disease, coronary artery disease, vascular surgery, pulmonary artery disease, and medical device design. In support of these efforts, we discuss recent advances in modeling methodology, which are most impactful when driven by clinical needs. We describe pivotal recent developments in image processing, fluid-structure interaction, modeling under uncertainty, and reduced order modeling to enable simulations in clinically relevant timeframes. In all these areas, we argue that traditional CFD alone is insufficient to tackle increasingly complex clinical and biological problems across scales and systems. Rather, CFD should be coupled with appropriate multiscale biological, physical, and physiological models needed to produce comprehensive, impactful models of mechanobiological systems and complex clinical scenarios. With this perspective, we finally outline open problems and future challenges in the field.
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Affiliation(s)
- Erica L. Schwarz
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
| | - Luca Pegolotti
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
| | - Martin R. Pfaller
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
| | - Alison L. Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California 94305, USA
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4
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Karanasiou GS, Tsompou PI, Tachos N, Karanasiou GE, Sakellarios A, Kyriakidis S, Antonini L, Pennati G, Petrini L, Gijsen F, Vaughan T, Katsouras C, Michalis L, Fotiadis DI. An in silico trials platform for the evaluation of stent design effect in post-implantation outcomes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4970-4973. [PMID: 36086562 DOI: 10.1109/embc48229.2022.9871483] [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
Bioresorbable Vascular Scaffolds (BVS), developed to allow drug deliver and mechanical support, followed by complete resorption, have revolutionized atherosclerosis treatment. InSilc is a Cloud platform for in silico clinical trials (ISCT) used in the design, development and evaluation pipeline of stents. The platform integrates beyond the state-of-the-art multi-disciplinary and multiscale models, which predict the scaffold's performance in the short/acute and medium/long term. In this study, a use case scenario of two Bioabsorbable Vascular Stents (BVSs) implanted in the same arterial anatomy is presented, allowing the whole InSilc in silico pipeline to be applied and predict how the different aspects of this intervention affect the success of stenting process.
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Zainib Z, Ballarin F, Fremes S, Triverio P, Jiménez-Juan L, Rozza G. Reduced order methods for parametric optimal flow control in coronary bypass grafts, toward patient-specific data assimilation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3367. [PMID: 32458572 DOI: 10.1002/cnm.3367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Coronary artery bypass grafts (CABG) surgery is an invasive procedure performed to circumvent partial or complete blood flow blockage in coronary artery disease. In this work, we apply a numerical optimal flow control model to patient-specific geometries of CABG, reconstructed from clinical images of real-life surgical cases, in parameterized settings. The aim of these applications is to match known physiological data with numerical hemodynamics corresponding to different scenarios, arisen by tuning some parameters. Such applications are an initial step toward matching patient-specific physiological data in patient-specific vascular geometries as best as possible. Two critical challenges that reportedly arise in such problems are: (a) lack of robust quantification of meaningful boundary conditions required to match known data as best as possible and (b) high computational cost. In this work, we utilize unknown control variables in the optimal flow control problems to take care of the first challenge. Moreover, to address the second challenge, we propose a time-efficient and reliable computational environment for such parameterized problems by projecting them onto a low-dimensional solution manifold through proper orthogonal decomposition-Galerkin.
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Affiliation(s)
- Zakia Zainib
- mathLab, Mathematics Area, SISSA-International School for Advance Studies, Trieste, Italy
| | - Francesco Ballarin
- mathLab, Mathematics Area, SISSA-International School for Advance Studies, Trieste, Italy
| | - Stephen Fremes
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Piero Triverio
- Department of Electrical and Computer Engineering, Institute of Biomaterials & Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Gianluigi Rozza
- mathLab, Mathematics Area, SISSA-International School for Advance Studies, Trieste, Italy
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6
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Hsieh YF, Lee CK, Wang W, Huang YC, Lee WJ, Wang TD, Chou CY. Coronary CT angiography-based estimation of myocardial perfusion territories for coronary artery FFR and wall shear stress simulation. Sci Rep 2021; 11:13855. [PMID: 34226598 PMCID: PMC8257574 DOI: 10.1038/s41598-021-93237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
This study aims to apply a CCTA-derived territory-based patient-specific estimation of boundary conditions for coronary artery fractional flow reserve (FFR) and wall shear stress (WSS) simulation. The non-invasive simulation can help diagnose the significance of coronary stenosis and the likelihood of myocardial ischemia. FFR is often regarded as the gold standard to evaluate the functional significance of stenosis in coronary arteries. In another aspect, proximal wall shear stress (\documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{{WSS}_{prox}}$$\end{document}WSSprox) can also be an indicator of plaque vulnerability. During the simulation process, the mass flow rate of the blood in coronary arteries is one of the most important boundary conditions. This study utilized the myocardium territory to estimate and allocate the mass flow rate. 20 patients are included in this study. From the knowledge of anatomical information of coronary arteries and the myocardium, the territory-based FFR and the \documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{{WSS}_{prox}}$$\end{document}WSSprox can both be derived from fluid dynamics simulations. Applying the threshold of distinguishing between significant and non-significant stenosis, the territory-based method can reach the accuracy, sensitivity, and specificity of 0.88, 0.90, and 0.80, respectively. For significantly stenotic cases (\documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{FFR}_{m}$$\end{document}FFRm\documentclass[12pt]{minimal}
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\begin{document}$$\le$$\end{document}≤ 0.80), the vessels usually have higher wall shear stress in the proximal region of the lesion.
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Affiliation(s)
- Yu-Fang Hsieh
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, 106, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, 106, Taiwan
| | - Yu-Cheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Wen-Jeng Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Cheng-Ying Chou
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, 106, Taiwan.
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7
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Liu J, Yu Y, Zhu C, Zhang Y. Comparison of LBM and FVM in the estimation of LAD stenosis. Proc Inst Mech Eng H 2021; 235:1058-1068. [PMID: 33985369 DOI: 10.1177/09544119211016912] [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: 11/17/2022]
Abstract
The finite volume method (FVM)-based computational fluid dynamics (CFD) technology has been applied in the non-invasive diagnosis of coronary artery stenosis. Nonetheless, FVM is a time-consuming process. In addition to FVM, the lattice Boltzmann method (LBM) is used in fluid flow simulation. Unlike FVM solving the Navier-Stokes equations, LBM directly solves the simplified Boltzmann equation, thus saving computational time. In this study, 12 patients with left anterior descending (LAD) stenosis, diagnosed by CTA, are analysed using FVM and LBM. The velocities, pressures, and wall shear stress (WSS) predicted using FVM and LBM for each patient is compared. In particular, the ratio of the average and maximum speed at the stenotic part characterising the degree of stenosis is compared. Finally, the golden standard of LAD stenosis, invasive fractional flow reserve (FFR), is applied to justify the simulation results. Our results show that LBM and FVM are consistent in blood flow simulation. In the region with a high degree of stenosis, the local flow patterns in those two solvers are slightly different, resulting in minor differences in local WSS estimation and blood speed ratio estimation. Notably, these differences do not result in an inconsistent estimation. Comparison with invasive FFR shows that, in most cases, the non-invasive diagnosis is consistent with FFR measurements. However, in some cases, the non-invasive diagnosis either underestimates or overestimates the degree of stenosis. This deviation is caused by the difference between physiological and simulation conditions that remains the biggest challenge faced by all CFD-based non-invasive diagnostic methods.
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Affiliation(s)
- Jian Liu
- People's Hospital, Peking University, Beijing, P. R. China
| | - Yong Yu
- School of Aerospace Engineering, Beijing Institute of Technology, Beijing, P. R. China
| | - Chenqi Zhu
- School of Medicine, Tsinghua University-RocketHeart Co., Ltd., Joint Research Center, Beijing, P. R. China
| | - Yu Zhang
- School of Medicine, Tsinghua University, Beijing, P. R. China
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8
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Gijsen F, Katagiri Y, Barlis P, Bourantas C, Collet C, Coskun U, Daemen J, Dijkstra J, Edelman E, Evans P, van der Heiden K, Hose R, Koo BK, Krams R, Marsden A, Migliavacca F, Onuma Y, Ooi A, Poon E, Samady H, Stone P, Takahashi K, Tang D, Thondapu V, Tenekecioglu E, Timmins L, Torii R, Wentzel J, Serruys P. Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications. Eur Heart J 2020; 40:3421-3433. [PMID: 31566246 PMCID: PMC6823616 DOI: 10.1093/eurheartj/ehz551] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/09/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Frank Gijsen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Yuki Katagiri
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter Barlis
- Department of Medicine and Radiology, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Cardiology, Northern Hospital, 185 Cooper Street, Epping, Australia.,St Vincent's Heart Centre, Building C, 41 Victoria Parade, Fitzroy, Australia
| | - Christos Bourantas
- Institute of Cardiovascular Sciences, University College of London, London, UK.,Department of Cardiology, Barts Heart Centre, London, UK.,School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Carlos Collet
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Umit Coskun
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jouke Dijkstra
- LKEB-Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Elazer Edelman
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.,Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA
| | - Paul Evans
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | - Kim van der Heiden
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rod Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK.,Department of Circulation and Imaging, NTNU, Trondheim, Norway
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.,Institute of Aging, Seoul National University, Seoul, Korea
| | - Rob Krams
- School of Engineering and Materials Science Queen Mary University of London, London, UK
| | - Alison Marsden
- Departments of Bioengineering and Pediatrics, Institute of Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Yoshinobu Onuma
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andrew Ooi
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric Poon
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Habib Samady
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter Stone
- Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kuniaki Takahashi
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Dalin Tang
- Department of Mathematics, Southeast University, Nanjing, China; Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Vikas Thondapu
- Department of Medicine and Radiology, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, Australia.,Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erhan Tenekecioglu
- Department of Interventional Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Lucas Timmins
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, UK
| | - Jolanda Wentzel
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patrick Serruys
- Erasmus University Medical Center, Rotterdam, the Netherlands.,Imperial College London, London, UK.,Melbourne School of Engineering, University of Melbourne, Melbourne, Australia
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9
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Xu L, Chen X, Cui M, Ren C, Yu H, Gao W, Li D, Zhao W. The improvement of the shear stress and oscillatory shear index of coronary arteries during Enhanced External Counterpulsation in patients with coronary heart disease. PLoS One 2020; 15:e0230144. [PMID: 32191730 PMCID: PMC7082042 DOI: 10.1371/journal.pone.0230144] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/23/2020] [Indexed: 12/25/2022] Open
Abstract
Background Enhanced External Counterpulsation (EECP) can chronically relieve ischemic chest pain and improve the prognosis of coronary heart disease (CHD). Despite its role in mitigating heart complications, EECP and the mechanisms behind its therapeutic nature, such as its effects on blood flow hemodynamics, are still not fully understood. This study aims to elucidate the effect of EECP on significant hemodynamic parameters in the coronary arterial tree. Methods A finite volume method was used in conjunction with the inlet pressure wave (surrogated by the measured aortic pressure) before and during EECP and outlet flow resistance, assuming the blood as newtonian fluid. The time-average wall shear stress (TAWSS) and oscillatory shear index (OSI) were determined from the flow field. Results Regardless of the degree of vascular stenosis, hemodynamic conditions and flow patterns could be improved during EECP. In comparison with the original tree, the tree with a severe stenosis (75% area stenosis) demonstrated more significant improvement in hemodynamic conditions and flow patterns during EECP, with surface area ratio of TAWSS risk area (SAR-TAWSS) reduced from 12.3% to 6.7% (vs. SAR-TAWSS reduced from 7.2% to 5.6% in the original tree) and surface area ratio of OSI risk area (SAR-OSI) reduced from 6.8% to 2.5% (vs. SAR-OSI of both 0% before and during EECP in the original tree because of mild stenosis). Moreover, it was also shown that small ratio of diastolic pressure (D) and systolic pressure (S) (D/S) could only improve the hemodynamic condition mildly. The SAR-TAWSS reduction ratio significantly increased as D/S became larger. Conclusions A key finding of the study was that the improvement of hemodynamic conditions along the LMCA trees during EECP became more significant with the increase of D/S and the severity degree of stenoses at the bifurcation site. These findings have important implications on EECP as adjuvant therapy before or after percutaneous coronary intervention (PCI) in patients with diffuse atherosclerosis.
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Affiliation(s)
- Ling Xu
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xi Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Ming Cui
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Chuan Ren
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Haiyi Yu
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Wei Gao
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Dongguo Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- * E-mail: (DGL); (WZ)
| | - Wei Zhao
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
- * E-mail: (DGL); (WZ)
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10
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Kobayashi K, Wakasa S, Sato K, Kanai S, Date H, Kimura S, Oyama-Manabe N, Matsui Y. Quantitative analysis of regional endocardial geometry dynamics from 4D cardiac CT images: endocardial tracking based on the iterative closest point with an integrated scale estimation. ACTA ACUST UNITED AC 2019; 64:055009. [DOI: 10.1088/1361-6560/ab009a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Assessment of boundary conditions for CFD simulation in human carotid artery. Biomech Model Mechanobiol 2018; 17:1581-1597. [PMID: 29982960 DOI: 10.1007/s10237-018-1045-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 06/19/2018] [Indexed: 01/19/2023]
Abstract
Computational fluid dynamics (CFD) is an increasingly used method for investigation of hemodynamic parameters and their alterations under pathological conditions, which are important indicators for diagnosis of cardiovascular disease. In hemodynamic simulation models, the employment of appropriate boundary conditions (BCs) determines the computational accuracy of the CFD simulation in comparison with pressure and velocity measurements. In this study, we have first assessed the influence of inlet boundary conditions on hemodynamic CFD simulations. We selected two typical patients suspected of carotid artery disease, with mild stenosis and severe stenosis. Both patients underwent digital subtraction angiography (DSA), magnetic resonance angiography, and the invasive pressure guide wire measured pressure profile. We have performed computational experiments to (1) study the hemodynamic simulation outcomes of distributions of wall shear stress, pressure, pressure gradient and (2) determine the differences in hemodynamic performances caused by inlet BCs derived from DSA and Womersley analytical solution. Our study has found that the difference is related to the severity of the stenosis; the greater the stenosis, the more the difference ensues. Further, in our study, the two typical subjects with invasively measured pressure profile and thirty subjects with ultrasound Doppler velocimeter (UDV) measurement served as the criteria to evaluate the hemodynamic outcomes of wall shear stress, pressure, pressure gradient and velocity due to different outlet BCs based on the Windkessel model, structured-tree model, and fully developed flow model. According to the pressure profiles, the fully developed model appeared to have more fluctuations compared with the other two models. The Windkessel model had more singularities before convergence. The three outlet BCs models also showed good correlation with the UDV measurement, while the Windkessel model appeared to be slightly better ([Formula: see text]). The structured-tree model was seen to have the best performance in terms of available computational cost and accuracy. The results of our numerical simulation and the good correlation with the computed pressure and velocity with their measurements have highlighted the effectiveness of CFD simulation in patient-specific human carotid artery with suspected stenosis.
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12
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Computational Fluid Dynamics as an Engineering Tool for the Reconstruction of Hemodynamics after Carotid Artery Stenosis Operation: A Case Study. ACTA ACUST UNITED AC 2018; 54:medicina54030042. [PMID: 30344273 PMCID: PMC6122108 DOI: 10.3390/medicina54030042] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/14/2022]
Abstract
Background and objectives: Brain ischemic stroke is caused by impaired or absolutely blocked blood flow into the brain regions. Despite the large number of possible origins, there is no general strategy for preventive treatment. In this paper, we aimed to predict the hemodynamics in a patient who experienced a critical stenosis operation in the carotid artery. This is a unique study where we used medical data together with the computational fluid (CFD) technique not to plan the surgery, but to predict its outcome. Materials and Methods: AngioCT data and blood perfusion of brain tissue (CT-perfusion) together with CFD technique were applied for stroke formation reconstruction in different clinical conditions. With the use of self-made semiautomatic algorithm for image processing and 3DDoctror software, 3D-vascular geometries before and after surgical intervention were reconstructed. As the paper is focused on the analysis of stroke appearance, apparent stroke was simulated as higher and lower pressure values in the cranial part due to different outcomes of the surgical intervention. This allowed to investigate the influence of spatial configuration and pressure values on blood perfusion in the analyzed circulatory system. Results: Application of CFD simulations for blood flow reconstruction for clinical conditions in the circulatory system accomplished on average 98.5% and 98.7% accuracy for CFD results compared to US-Doppler before and after surgical intervention, respectively. Meanwhile, CFD results compared to CT-perfusion indicated an average 89.7% and 92.8% accuracy before and after surgical intervention, respectively. Thus, the CFD is a reliable approach for predicting the patient hemodynamics, as it was confirmed by postoperative data. Conclusions: Our study indicated that the application of CFD simulations for blood flow reconstruction for clinical conditions in circulatory system reached 98% and 90% accuracy for US-Doppler and CT-perfusion, respectively. Therefore, the proposed method might be used as a tool for reconstruction of specific patients' hemodynamics after operation of critical stenosis in the carotid artery. However, further studies are necessary to confirm its usefulness in clinical practice.
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Chiastra C, Migliori S, Burzotta F, Dubini G, Migliavacca F. Patient-Specific Modeling of Stented Coronary Arteries Reconstructed from Optical Coherence Tomography: Towards a Widespread Clinical Use of Fluid Dynamics Analyses. J Cardiovasc Transl Res 2017; 11:156-172. [PMID: 29282628 PMCID: PMC5908818 DOI: 10.1007/s12265-017-9777-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Abstract
The recent widespread application of optical coherence tomography (OCT) in interventional cardiology has improved patient-specific modeling of stented coronary arteries for the investigation of local hemodynamics. In this review, the workflow for the creation of fluid dynamics models of stented coronary arteries from OCT images is presented. The algorithms for lumen contours and stent strut detection from OCT as well as the reconstruction methods of stented geometries are discussed. Furthermore, the state of the art of studies that investigate the hemodynamics of OCT-based stented coronary artery geometries is reported. Although those studies analyzed few patient-specific cases, the application of the current reconstruction methods of stented geometries to large populations is possible. However, the improvement of these methods and the reduction of the time needed for the entire modeling process are crucial for a widespread clinical use of the OCT-based models and future in silico clinical trials.
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Affiliation(s)
- Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
| | - Susanna Migliori
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
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Zahnd G, Schrauwen J, Karanasos A, Regar E, Niessen W, van Walsum T, Gijsen F. Fusion of fibrous cap thickness and wall shear stress to assess plaque vulnerability in coronary arteries: a pilot study. Int J Comput Assist Radiol Surg 2016; 11:1779-90. [PMID: 27236652 PMCID: PMC5034011 DOI: 10.1007/s11548-016-1422-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/11/2016] [Indexed: 12/16/2022]
Abstract
Purpose Identification of rupture-prone plaques in coronary arteries is a major clinical challenge. Fibrous cap thickness and wall shear stress are two relevant image-based risk factors, but these two parameters are generally computed and analyzed separately. Accordingly, combining these two parameters can potentially improve the identification of at-risk regions. Therefore, the purpose of this study is to investigate the feasibility of the fusion of wall shear stress and fibrous cap thickness of coronary arteries in patient data. Methods Fourteen patients were included in this pilot study. Imaging of the coronary arteries was performed with optical coherence tomography and with angiography. Fibrous cap thickness was automatically quantified from optical coherence tomography pullbacks using a contour segmentation approach based on fast marching. Wall shear stress was computed by applying computational fluid dynamics on the 3D volume reconstructed from two angiograms. The two parameters then were co-registered using anatomical landmarks such as side branches. Results The two image modalities were successfully co-registered, with a mean (±SD) error corresponding to \documentclass[12pt]{minimal}
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\begin{document}$$8.6\,\pm \,6.7\,\%$$\end{document}8.6±6.7% of the length of the analyzed region. For all the analyzed participants, the average thinnest portion of each fibrous cap was \documentclass[12pt]{minimal}
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\begin{document}$$129\,\pm \,69\,\upmu \text {m}$$\end{document}129±69μm, and the average WSS value at the location of the fibrous cap was \documentclass[12pt]{minimal}
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\begin{document}$$1.46\,\pm \,1.16\,\text {Pa}$$\end{document}1.46±1.16Pa. A unique index was finally generated for each patient via the fusion of fibrous cap thickness and wall shear stress measurements, to translate all the measured parameters into a single risk map. Conclusion The introduced risk map integrates two complementary parameters and has potential to provide valuable information about plaque vulnerability.
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Affiliation(s)
- Guillaume Zahnd
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.
| | - Jelle Schrauwen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Antonios Karanasos
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Wiro Niessen
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine and Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Frank Gijsen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
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Schrauwen JTC, Karanasos A, van Ditzhuijzen NS, Aben JP, van der Steen AFW, Wentzel JJ, Gijsen FJH. Influence of the Accuracy of Angiography-Based Reconstructions on Velocity and Wall Shear Stress Computations in Coronary Bifurcations: A Phantom Study. PLoS One 2015; 10:e0145114. [PMID: 26690897 PMCID: PMC4686962 DOI: 10.1371/journal.pone.0145114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 11/28/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Wall shear stress (WSS) plays a key role in the onset and progression of atherosclerosis in human coronary arteries. Especially sites with low and oscillating WSS near bifurcations have a higher propensity to develop atherosclerosis. WSS computations in coronary bifurcations can be performed in angiography-based 3D reconstructions. It is essential to evaluate how reconstruction errors influence WSS computations in mildly-diseased coronary bifurcations. In mildly-diseased lesions WSS could potentially provide more insight in plaque progression. MATERIALS METHODS Four Plexiglas phantom models of coronary bifurcations were imaged with bi-plane angiography. The lumens were segmented by two clinically experienced readers. Based on the segmentations 3D models were generated. This resulted in three models per phantom: one gold-standard from the phantom model itself, and one from each reader. Steady-state and transient simulations were performed with computational fluid dynamics to compute the WSS. A similarity index and a noninferiority test were used to compare the WSS in the phantoms and their reconstructions. The margin for this test was based on the resolution constraints of angiography. RESULTS The reconstruction errors were similar to previously reported data; in seven out of eight reconstructions less than 0.10 mm. WSS in the regions proximal and far distal of the stenosis showed a good agreement. However, the low WSS areas directly distal of the stenosis showed some disagreement between the phantoms and the readers. This was due to small deviations in the reconstruction of the stenosis that caused differences in the resulting jet, and consequently the size and location of the low WSS area. DISCUSSION This study showed that WSS can accurately be computed within angiography-based 3D reconstructions of coronary arteries with early stage atherosclerosis. Qualitatively, there was a good agreement between the phantoms and the readers. Quantitatively, the low WSS regions directly distal to the stenosis were sensitive to small reconstruction errors.
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Affiliation(s)
- Jelle T C Schrauwen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonios Karanasos
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Antonius F W van der Steen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands
| | - Jolanda J Wentzel
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frank J H Gijsen
- Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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