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Verstraeten S, Hoeijmakers M, Tonino P, Brüning J, Capelli C, van de Vosse F, Huberts W. Generation of synthetic aortic valve stenosis geometries for in silico trials. Int J Numer Method Biomed Eng 2024; 40:e3778. [PMID: 37961993 DOI: 10.1002/cnm.3778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 11/15/2023]
Abstract
In silico trials are a promising way to increase the efficiency of the development, and the time to market of cardiovascular implantable devices. The development of transcatheter aortic valve implantation (TAVI) devices, could benefit from in silico trials to overcome frequently occurring complications such as paravalvular leakage and conduction problems. To be able to perform in silico TAVI trials virtual cohorts of TAVI patients are required. In a virtual cohort, individual patients are represented by computer models that usually require patient-specific aortic valve geometries. This study aimed to develop a virtual cohort generator that generates anatomically plausible, synthetic aortic valve stenosis geometries for in silico TAVI trials and allows for the selection of specific anatomical features that influence the occurrence of complications. To build the generator, a combination of non-parametrical statistical shape modeling and sampling from a copula distribution was used. The developed virtual cohort generator successfully generated synthetic aortic valve stenosis geometries that are comparable with a real cohort, and therefore, are considered as being anatomically plausible. Furthermore, we were able to select specific anatomical features with a sensitivity of around 90%. The virtual cohort generator has the potential to be used by TAVI manufacturers to test their devices. Future work will involve including calcifications to the synthetic geometries, and applying high-fidelity fluid-structure-interaction models to perform in silico trials.
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Affiliation(s)
- Sabine Verstraeten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Pim Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan Brüning
- Institute of Computer-assisted Cardiovascular Medicine, Charite Universitaetsmedizin, Berlin, Germany
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, UK
| | - Frans van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Fonken J, Maas E, Nievergeld A, van Sambeek M, van de Vosse F, Lopata R. The Impact of a Limited Field-of-View on Computed Hemodynamics in Abdominal Aortic Aneurysms: Evaluating the Feasibility of Completing Ultrasound Segmentations with Parametric Geometries. Ann Biomed Eng 2023; 51:1296-1309. [PMID: 36709232 PMCID: PMC10172266 DOI: 10.1007/s10439-022-03133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/25/2022] [Indexed: 01/30/2023]
Abstract
To improve abdominal aortic aneurysm (AAA) rupture risk assessment, a large, longitudinal study on AAA hemodynamics and biomechanics is necessary, using personalized fluid-structure interaction (FSI) modeling. 3-dimensional, time-resolved ultrasound (3D+t US) is the preferred image modality to obtain the patient-specific AAA geometry for such a study, since it is safe, affordable and provides temporal information. However, the 3D+t US field-of-view (FOV) is limited and therefore often fails to capture the inlet and aorto-iliac bifurcation geometry. In this study, a framework was developed to add parametric inlet and bifurcation geometries to the abdominal aortic aneurysm geometry by employing dataset statistics and parameters of the AAA geometry. The impact of replacing the patient-specific inlet and bifurcation geometries, acquired using computed tomography (CT) scans, by parametric geometries was evaluated by examining the differences in hemodynamics (systolic and time-averaged wall shear stress and oscillatory shear index) in the aneurysm region. The results show that the inlet geometry has a larger effect on the AAA hemodynamics (median differences of 7.5 to 18.8%) than the bifurcation geometry (median differences all below 1%). Therefore, it is not feasible to replace the patient-specific inlet geometry by a generic one. Future studies should investigate the possibilities of extending the proximal FOV of 3D+t US. However, this study did show the feasibility of adding a parametric bifurcation geometry to the aneurysm geometry. After extending the proximal FOV, the obtained framework can be used to extract AAA geometries from 3D+t US for FSI simulations, despite the absence of the bifurcation geometry.
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Affiliation(s)
- Judith Fonken
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. .,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Esther Maas
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Arjet Nievergeld
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marc van Sambeek
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans van de Vosse
- Cardiovascular Biomechanics, Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Richard Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Liu J, Hao L, van de Vosse F, Xu L. A noninvasive method of estimating patient-specific left ventricular pressure waveform. Comput Methods Programs Biomed 2022; 227:107192. [PMID: 36323176 DOI: 10.1016/j.cmpb.2022.107192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE The left ventricular pressure waveform is indispensable for the construction of the pressure strain loop when investigating coronary artery disease (CAD) patients. In previous studies by others, exclusion of CAD patients has not allowed a reliable estimation of the left ventricular pressure waveform from the pressure strain loop of these patients. To remedy this, we propose a patient-specific noninvasive method for the estimation of left ventricular pressure. METHODS A simplified systemic circulation model consisting primarily of a single fiber model and a 1D simulation of the arterial tree was used. Sensitivity analysis based on the Morris method was performed to select a subset of the important parameters. Following this, the important parameter subset and the set of all the parameters were identified in the model using the pressure waveform of a peripheral artery as input, in a two-step process. In addition, the left ventricular pressure waveform was estimated using the set of all parameters. RESULTS Reducing the size of the parameter subset significantly decreases the computational cost of parameter optimization in the first step and greatly simplifies the identification of the full parameter set in the second step. Comparison with the reference left ventricular pressure waveform from CAD patients, showed that the proposed method provides a good estimate of the reference left ventricular pressure waveform. The correlation coefficients between the estimated and reference were r = 0.907, r = 0.904 and r = 0.780 for systolic blood pressure, pulse pressure and mean blood pressure, respectively. CONCLUSIONS This work may provide a convenient surrogate for the estimation of the left ventricular pressure waveform.
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Affiliation(s)
- Jun Liu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China; Department of Biomedical Engineering, China Medical University, Shenyang 110122, China
| | - Liling Hao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China
| | - Frans van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5600MB, the Netherlands
| | - Lisheng Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China; Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang 110167, China.
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van Hees R, Muller JW, van de Vosse F, Rutten M, van Sambeek M, Wu M, Lopata R. SVD-based filtering to detect intraplaque hemorrhage using single wavelength photoacoustic imaging. J Biomed Opt 2021; 26:JBO-210198RR. [PMID: 34743446 PMCID: PMC8571807 DOI: 10.1117/1.jbo.26.11.116003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE Intraplaque hemorrhage (IPH) is an important indicator of plaque vulnerability. Early detection could aid the prevention of stroke. AIM We aim to detect IPH with single wavelength PA imaging in vivo and to improve image quality. APPROACH We developed a singular value decomposition (SVD)-based filter to detect the nonstationary and stationary components in ultrasound data. A PA mask was created to detect stationary (IPH) sources. The method was tested ex vivo using phantoms and in vivo in patients. RESULTS The flow and IPH channels were successfully separated in the phantom data. We can also detect the PA signals from IPH and reject signals from the carotid lumen in vivo. Generalized contrast-to-noise ratio improved in both ex vivo and in vivo in US imaging. CONCLUSIONS SVD-based filtering can successfully detect IPH using a single laser wavelength, opening up opportunities for more economical and cost-effective laser sources.
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Affiliation(s)
- Roy van Hees
- Eindhoven University of Technology, Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven, The Netherlands
| | - Jan-Willem Muller
- Eindhoven University of Technology, Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven, The Netherlands
| | - Frans van de Vosse
- Eindhoven University of Technology, Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven, The Netherlands
| | - Marcel Rutten
- Eindhoven University of Technology, Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven, The Netherlands
| | - Marc van Sambeek
- Eindhoven University of Technology, Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Min Wu
- Eindhoven University of Technology, Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven, The Netherlands
| | - Richard Lopata
- Eindhoven University of Technology, Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven, The Netherlands
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Petterson N, Sjoerdsma M, van Sambeek M, van de Vosse F, Lopata R. Mechanical characterization of abdominal aortas using multi-perspective ultrasound imaging. J Mech Behav Biomed Mater 2021; 119:104509. [PMID: 33865067 DOI: 10.1016/j.jmbbm.2021.104509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/13/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
Mechanical characterization of abdominal aortic aneurysms using personalized biomechanical models is being widely investigated as an alternative criterion to assess risk of rupture. These methods rely on accurate wall motion detection and appropriate model boundary conditions. In this study, multi-perspective ultrasound is combined with finite element models to perform mechanical characterization of abdominal aortas in volunteers. Multi-perspective biplane radio frequency ultrasound recordings were made under seven angles (-45° to 45°) in one phantom set-up and eight volunteers, which were merged using automatic image registration. 2-D displacement fields were estimated in the seven longitudinal ultrasound views, creating a sparse, high resolution 3-D map of the wall motion at relatively high frame rates (20-27 Hz). The displacements were used to personalize the subject-specific finite element model of which the geometry of the aorta, spine, and surrounding tissue were determined from a single 3-D ultrasound acquisition. Automatic registration of the multi-perspective images was successful in six out of eight cases with an average error of 5.4° compared to the ground truth. Displacements of the aortic wall were measured and cyclic strain of the aortic diameter was found ranging from 4.2% to 8.6%. The subject-specific mesh and inverse FE analysis was performed yielding shear moduli estimates for the wall between 104 and 215 kPa. Comparative results from a single-perspective workflow revealed very low aortic wall motion signal, which resulted in relatively high modulus estimates, between 230 and 754 kPa. Multi-perspective biplane ultrasound imaging was used to personalize finite element models of the abdominal aorta and its surroundings, and performing mechanical characterization of the aortic shear modulus. The method was found to be a more robust method compared to a single-perspective 3-D ultrasound approach. Future research will focus on investigating the use of multiple 3-D ultrasound acquisitions, the feasibility of free-hand scanning, the creation of a full 3-D automatic registration process, and with that, enable a clinical continuation of this study.
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Affiliation(s)
- Niels Petterson
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - Marloes Sjoerdsma
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands.
| | - Marc van Sambeek
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - Frans van de Vosse
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - Richard Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
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Keramati H, van Houts L, Chen CK, van de Vosse F, Nakao M, Kim S, Leo HL. Multiscale modeling of a modified Blalock-Taussig surgery in a patient-specific tetralogy of Fallot. Int J Numer Method Biomed Eng 2021; 37:e3436. [PMID: 33438839 DOI: 10.1002/cnm.3436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
Tetralogy of Fallot (TOF) is a congenital heart anomaly that causes a drastic reduction in the oxygen level. In this study, we coupled a lumped-parameter model with a patient-specific three-dimensional (3D) model which included a modified Blalock-Taussig (MBT) shunt. By forming a closed loop, we investigated the effects of certain parameters on the flow rates and the pressures at different locations of the developed network. A local sensitivity analysis on an initial zero-dimensional (0D) closed-loop model was conducted. The 0D lumped parameter (LP) model was then refined based on the results of the multiscale 0D-3D model and the local sensitivity analysis was repeated for the refined 0D model. It was shown that the maximum pressure of the pulmonary bed had the highest sensitivity of 94% to the diameter of MBT shunt. We observed that the existence of the flow in the shunt during the diastole caused an elevated wall shear stress (WSS) in the pulmonary artery. In this work, we calculated the flow velocity and pressure field in a 3D patient-specific aorta with an MBT shunt, and then we used the results to increase the accuracy of our LP model to simulate numerous 0D simulations in a significantly shorter time, which is potentially applicable for medical decision-making.
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Affiliation(s)
- Hamed Keramati
- NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Lex van Houts
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, North Brabant, Netherlands
| | - Ching Kit Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospita, Singapore, Singapore
| | - Frans van de Vosse
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, North Brabant, Netherlands
| | - Masakazu Nakao
- Department of Paediatric Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sangho Kim
- NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Hwa Liang Leo
- NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
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Zhang Y, Qi L, van de Vosse F, Du C, Yao Y, Du J, Wu G, Xu L. Recovery Responses of Central Hemodynamics in Basketball Athletes and Controls After the Bruce Test. Front Physiol 2020; 11:593277. [PMID: 33281624 PMCID: PMC7688748 DOI: 10.3389/fphys.2020.593277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose It is commonly believed that central hemodynamics is closely associated with the presence of cardiovascular events. However, controversial data exist on the acute response of competitive sports on central hemodynamics. Moreover, the central hemodynamic response to exercise is too transient to be investigated. Therefore, this study aimed to investigate the central hemodynamic response in young basketball athletes and controls after 1 h recovery after exercise. Methods Fifteen young basketball athletes and fifteen aged-matched controls were recruited to perform the Bruce test. Central hemodynamics were measured and calculated, including heart rate (HR), aortic systolic, diastolic, and pulse pressure (ASP, ADP, and APP), ejection duration (ED), sub-endocardial viability ratio (SEVR), central augmentation index (AIx), and AIx@HR75. Intra-group and inter-group differences were analyzed by two-way repeated measures ANOVA. Results ASP significantly decreased at 10 min after exercise in athletes, while it markedly declined at 15 min after exercise in controls (p < 0.01). Additionally, only in the athlete group, ADP significantly decreased at 50 min and at 1 h after exercise. AIx was also significantly reduced at 1-2, 20, 30, and 40 min after exercise (all p < 0.05). Moreover, there were significant differences in the changes of these parameters between the two groups at these measurement points (p < 0.05). SEVR significantly recovered to the baseline level after 30 min, while ED and HR returned to baseline levels at 40 min after exercise in both groups. Conclusion Sustained decrease of aortic BPs was sooner after the cessation of exercise in athletes than in controls, and changes of aortic stiffness were more evident in athletes than those in controls during the 1 h recovery period. Additionally, SEVR returned to the baseline sooner than ED and HR in athletes.
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Affiliation(s)
- Yahui Zhang
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, China.,Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Lin Qi
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, China
| | - Frans van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Chenglin Du
- Department of Physical Education, Northeastern University, Shenyang, China
| | - Yudong Yao
- Department of Electrical and Computer Engineering, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Jianhang Du
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Guifu Wu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Lisheng Xu
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, China
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de Ruijter J, van Sambeek M, van de Vosse F, Lopata R. Automated 3D geometry segmentation of the healthy and diseased carotid artery in free-hand, probe tracked ultrasound images. Med Phys 2020; 47:1034-1047. [PMID: 31837022 PMCID: PMC7079173 DOI: 10.1002/mp.13960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/25/2019] [Accepted: 12/05/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Rupture of an arterosclerotic plaque in the carotid artery is a major cause of stroke. Biomechanical analysis of plaques is under development aiming to aid the clinician in the assessment of plaque vulnerability. Patient-specific three-dimensional (3D) geometry assessment of the carotid artery, including the bifurcation, is required as input for these biomechanical models. This requires a high-resolution, 3D, noninvasive imaging modality such as ultrasound (US). In this study, a high-resolution two-dimensional (2D) linear array in combination with a magnetic probe tracking device and automatic segmentation method was used to assess the geometry of the carotid artery. The advantages of using this system over a 3D ultrasound probe are its higher resolution (spatial and temporal) and its larger field of view. METHODS A slow sweep (v = ± 5 mm/s) was made over the subject's neck so that the full geometry of the bifurcated geometry of the carotid artery is captured. An automated segmentation pipeline was developed. First, the Star-Kalman method was used to approximate the center and size of the vessels for every frame. Images were filtered with a Gaussian high-pass filter before conversion into the 2D monogenic signals, and multiscale asymmetry features were extracted from these data, enhancing low lateral wall-lumen contrast. These images, in combination with the initial ellipse contours, were used for an active deformable contour model to segment the vessel lumen. To segment the lumen-plaque boundary, Otsu's automatic thresholding method was used. Distension of the wall due to the change in blood pressure was removed using a filter approach. Finally, the contours were converted into a 3D hexahedral mesh for a patient-specific solid mechanics model of the complete arterial wall. RESULTS The method was tested on 19 healthy volunteers and on 3 patients. The results were compared to manual segmentation performed by three experienced observers. Results showed an average Hausdorff distance of 0.86 mm and an average similarity index of 0.91 for the common carotid artery (CCA) and 0.88 for the internal and external carotid artery. For the total algorithm, the success rate was 89%, in 4 out of 38 datasets the ICA and ECA were not sufficient visible in the US images. Accurate 3D hexahedral meshes were successfully generated from the segmented images . CONCLUSIONS With this method, a subject-specific biomechanical model can be constructed directly from a hand-held 2D US measurement, within 10 min, with a minimal user input. The performance of the proposed segmentation algorithm is comparable to or better than algorithms previously described in literature. Moreover, the algorithm is able to segment the CCA, ICA, and ECA including the carotid bifurcation in transverse B-mode images in both healthy and diseased arteries.
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Affiliation(s)
- Joerik de Ruijter
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhoven5600MBThe Netherlands
- Department of Vascular SurgeryCatharina HospitalEindhoven5602ZAThe Netherlands
| | - Marc van Sambeek
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhoven5600MBThe Netherlands
- Department of Vascular SurgeryCatharina HospitalEindhoven5602ZAThe Netherlands
| | - Frans van de Vosse
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhoven5600MBThe Netherlands
| | - Richard Lopata
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhoven5600MBThe Netherlands
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van den Boom T, Stevens R, Delhaas T, van de Vosse F, Huberts W. Zero-dimensional lumped approach to incorporate the dynamic part of the pressure at vessel junctions in a 1D wave propagation model. Int J Numer Method Biomed Eng 2018; 34:e3116. [PMID: 29927092 DOI: 10.1002/cnm.3116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
A benchmark study by Boileau et al tested 6 commonly used numerical schemes for 1D wave propagation, for their ability to capture the main features of pressure, flow, and area waveforms in large arteries. While all numerical schemes showed good agreement in pressure and flow waveforms for smaller arterial networks, the simplified trapezium rule method proposed by Kroon et al showed an overestimation for the systolic pressure of 1% in proximal regions and an underestimation of 3% in distal regions in comparison with the 5 other schemes when using a larger arterial network, published as the ADAN56 model. The authors attributed this difference to the neglection of the dynamic part of the pressure at vessel junctions. Carson et al resolved these differences by proposing 2 methods to implement the dynamic part of the pressure in the simplified trapezium rule method scheme. In the present study, an alternative method is introduced extending the work by Kroon et al. This alternative method consists of a new 0D element, which is placed at vessel junctions. The strength of this new element is the ease of implementation and its flexible coupling with other elements, without introducing additional degrees of freedom or the need of a penalty function. This new approach is compared with 5 other numerical schemes, which already have the dynamic part of the pressure incorporated. The new method shows excellent agreement with these schemes for the ADAN56 model.
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Affiliation(s)
- Tim van den Boom
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Raoul Stevens
- Department of Biomedical Engineering, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, School of Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, School of Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frans van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, School of Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, School of Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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10
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Zhang Y, Qi L, Xu L, Sun X, Liu W, Zhou S, van de Vosse F, Greenwald SE. Effects of exercise modalities on central hemodynamics, arterial stiffness and cardiac function in cardiovascular disease: Systematic review and meta-analysis of randomized controlled trials. PLoS One 2018; 13:e0200829. [PMID: 30036390 PMCID: PMC6056055 DOI: 10.1371/journal.pone.0200829] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/29/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Exercise is accepted as an important contribution to the rehabilitation of patients with cardiovascular disease (CVD). This study aims to better understand the possible causes for lack of consensus and reviews the effects of three exercise modalities (aerobic, resistance and combined exercise) on central hemodynamics, arterial stiffness and cardiac function for better rehabilitation strategies in CVD. METHODS The electronic data sources, Cochrane Library, MEDLINE, Web of Science, EBSCO (CINAHL), and ScienceDirect from inception to July 2017 were searched for randomized controlled trials (RCTs) investigating the effect of exercise modalities in adult patients with CVD. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis and meta-regression were used to study potential moderating factors. RESULTS Thirty-eight articles describing RCTs with a total of 2089 patients with CVD were included. The pooling revealed that aerobic exercise [MD(95%CI) = -5.87 (-8.85, -2.88), P = 0.0001] and resistance exercise [MD(95%CI) = -7.62 (-10.69, -4.54), P<0.00001] significantly decreased aortic systolic pressure (ASP). Resistance exercise significantly decreased aortic diastolic pressure [MD(95%CI) = -4(-5.63, -2.37), P<0.00001]. Aerobic exercise significantly decreased augmentation index (AIx) based on 24-week exercise duration and patients aged 50-60 years. Meanwhile, aerobic exercise significantly improved carotid-femoral pulse wave velocity (cf-PWV) [MD(95%CI) = -0.42 (-0.83, -0.01), P = 0.04], cardiac output (CO) [MD(95% CI) = 0.36(0.08, 0.64), P = 0.01] and left ventricular ejection fraction (LVEF) [MD(95%CI) = 3.02 (2.11, 3.93), P<0.00001]. Combined exercise significantly improved cf-PWV [MD(95%CI) = -1.15 (-1.95, -0.36), P = 0.004] and CO [MD(95% CI) = 0.9 (0.39, 1.41), P = 0.0006]. CONCLUSIONS Aerobic and resistance exercise significantly decreased ASP, and long-term aerobic exercise reduced AIx. Meanwhile, aerobic and combined exercise significantly improved central arterial stiffness and cardiac function in patients with CVD. These findings suggest that a well-planned regime could optimize the beneficial effects of exercise and can provide some evidence-based guidance for those involved in cardiovascular rehabilitation of patients with CVD.
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Affiliation(s)
- Yahui Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Lin Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Lisheng Xu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
- Key Laboratory of Medical Image Computing, Ministry of Education, Northeastern University, Shenyang, Liaoning, China
| | - Xingguo Sun
- Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Beijing, China
| | - Wenyan Liu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Shuran Zhou
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Frans van de Vosse
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stephen E. Greenwald
- Blizard Institute, Barts & The London School of Medicine &Dentistry, Queen Mary University of London, London, United Kingdom
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11
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Abdelghani M, Miyazaki Y, de Boer E, Aben JP, van Sloun M, Suchecki T, van 't Veer M, Soliman O, Onuma Y, de Winter R, Tonino P, van de Vosse F, Rutten M, Serruys P. Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation. EUROINTERVENTION 2018; 13:1527-1535. [DOI: 10.4244/eij-d-17-00595] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Vismara R, Leopaldi AM, Piola M, Asselta C, Lemma M, Antona C, Redaelli A, van de Vosse F, Rutten M, Fiore GB. In vitro assessment of mitral valve function in cyclically pressurized porcine hearts. Med Eng Phys 2016; 38:346-53. [PMID: 26908180 DOI: 10.1016/j.medengphy.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 12/22/2015] [Accepted: 01/31/2016] [Indexed: 11/25/2022]
Abstract
Recent approaches to the in vitro experimental study of cardiac fluid mechanics involve the use of whole biological structures to investigate in the lab novel therapeutic approaches for the treatment of heart pathologies. To enhance reliability and repeatability, the influence of the actuation strategy of the experimental apparatuses on the biomechanics of biological structures needs to be assessed. Using echography and intracardiac high-speed imaging, we compared the mitral valve (MV) anatomo-functional features (coaptation areas/lengths, papillary muscles-valvular plane distances) in two passive-beating-heart mock loops with internal (IPML) or external (EPML) pressurization of the ventricular chamber. Both apparatuses showed fluid dynamic conditions that closely resembled the physiology. The MVs analyzed in the EPML presented coaptation areas and lengths that were systematically higher, and exhibited greater variability from early-to peak-systole, as compared to those in the IPML. Moreover, in the EPML, the MV leaflets exhibited a convexity with high curvature toward the atrium. With the IPML, MV coaptation lengths ranged similar to available clinical data and the papillary muscles-valve plane distances were more stable throughout systole. In conclusion, both the apparatuses allow for reproducing in vitro the left heart hemodynamics, in terms of flow rates and pressures, with proper mitral valve continence. Results suggest that the IPML is more suitable for replicating the physiological MV functioning, while the EPML may have more potential as a model for the study of MV pathologies.
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Affiliation(s)
- Riccardo Vismara
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy ; Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy .
| | | | - Marco Piola
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Chiara Asselta
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Massimo Lemma
- Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy ; Cardiovascular Surgery Department, 'Luigi Sacco' University general Hospital, Milan, Italy
| | - Carlo Antona
- Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy ; Cardiovascular Surgery Department, 'Luigi Sacco' University general Hospital, Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Alberto Redaelli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy ; Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Frans van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gianfranco B Fiore
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy ; Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy
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13
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Huberts W, de Jonge C, van der Linden W, Inda M, Tordoir J, van de Vosse F, Bosboom M. IMPROVING PERSONALIZATION OF A 1D WAVE PROPAGATION MODEL APPLIED FOR AVF SURGERY. J Biomech 2012. [DOI: 10.1016/s0021-9290(12)70147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Huberts W, van Canneyt K, Verdonck P, Segers P, Tordoir J, van de Vosse F, Bosboom M. EXPERIMENTAL VALIDATION OF A 1D WAVE PROPAGATION MODEL FOR HEMODYNAMICS AFTER AVF SURGERY. J Biomech 2012. [DOI: 10.1016/s0021-9290(12)70028-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Tuzun E, Rutten M, Dat M, van de Vosse F, Kadipasaoglu C, de Mol B. Continuous-Flow Cardiac Assistance: Effects on Aortic Valve Function in a Mock Loop. J Surg Res 2011; 171:443-7. [DOI: 10.1016/j.jss.2010.05.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 04/15/2010] [Accepted: 05/17/2010] [Indexed: 11/16/2022]
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16
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van der Giessen A, Wentzel J, Meijboom W, Mollet N, van der Steen A, van de Vosse F, de Feyter P, Gijsen F. Plaque and shear stress distribution in human coronary bifurcations: a multislice computed tomography study. EUROINTERVENTION 2009; 4:654-61. [DOI: 10.4244/eijv4i5a109] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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van ‘t Veer M, Buth J, Merkx M, Tonino P, van den Bosch H, Pijls N, van de Vosse F. Biomechanical properties of abdominal aortic aneurysms assessed by simultaneously measured pressure and volume changes in humans. J Vasc Surg 2008; 48:1401-7. [DOI: 10.1016/j.jvs.2008.06.060] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/24/2008] [Accepted: 06/26/2008] [Indexed: 11/15/2022]
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18
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Leguy C, Bosboom M, Hoeks A, van de Vosse F. A MODEL BASED EVALUATION OF BLOOD VOLUME FLOW IN SLIGHTLY CURVED ARTERIES USING ULTRASOUND. J Biomech 2008. [DOI: 10.1016/s0021-9290(08)70390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Huberts W, Bosboom M, Tordoir J, van de Vosse F. PREDICTING THE INITIAL POSTOPERATIVE FLOW AFTER AVF CREATION FOR HEMODIALYSIS: TWO MODELING APPROACHES. J Biomech 2008. [DOI: 10.1016/s0021-9290(08)70213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Aarnoudse W, Van't Veer M, Pijls NHJ, Ter Woorst J, Vercauteren S, Tonino P, Geven M, Rutten M, van Hagen E, de Bruyne B, van de Vosse F. Direct volumetric blood flow measurement in coronary arteries by thermodilution. J Am Coll Cardiol 2007; 50:2294-304. [PMID: 18068038 DOI: 10.1016/j.jacc.2007.08.047] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 08/21/2007] [Accepted: 08/28/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to validate a new method for direct volumetric blood flow measurement in coronary arteries in animals and in conscious humans during cardiac catheterization. BACKGROUND Direct volumetric measurement of blood flow in selective coronary arteries would be useful for studying the coronary circulation. METHODS Based on the principle of thermodilution with continuous low-rate infusion of saline at room temperature, we designed an instrumental setup for direct flow measurement during cardiac catheterization. A 2.8-F infusion catheter and a standard 0.014-inch sensor-tipped pressure/temperature guidewire were used to calculate absolute flow (Q(thermo)) in a coronary artery from the infusion rate of saline, temperature of the saline at the tip of the infusion catheter, and distal blood temperature during infusion. The method was tested over a wide range of flow rates in 5 chronically instrumented dogs and in 35 patients referred for physiological assessment of a coronary stenosis or for percutaneous coronary intervention. RESULTS Thermodilution-derived flow corresponded well with true flow (Q) in all dogs (Q(thermo) = 0.73 Q + 42 ml/min; R(2) = 0.72). Reproducibility was excellent (Q(thermo,)(1) = 0.96 x Q(thermo,)(2) + 3 ml/min; R(2) = 0.89). The measurements were independent of infusion rate and sensor position as predicted by theory. In the humans, a good agreement was found between increase of thermodilution-derived volumetric blood flow after percutaneous coronary intervention and increase of fractional flow reserve (R(2) = 0.84); reproducibility of the measurements was excellent (Q(thermo,)(1) = 1.0 Q(thermo,)(2) + 0.9 ml/min, R(2) = 0.97), and the measurements were independent of infusion rate and sensor position. CONCLUSIONS Using a suitable infusion catheter and a 0.014-inch sensor-tipped guidewire for measurement of coronary pressure and temperature, volumetric blood flow can be directly measured in selective coronary arteries during cardiac catheterization.
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Affiliation(s)
- Wilbert Aarnoudse
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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21
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de Putter S, Breeuwer M, Kose U, Laffargue F, Rouet JM, Hoogeveen R, van den Bosch H, Buth J, van de Vosse F, Gerritsen F. Automatic determination of the dynamic geometry of abdominal aortic aneurysm from MR with application to wall stress simulations. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.03.256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Aarnoudse W, Fearon WF, Manoharan G, Geven M, van de Vosse F, Rutten M, De Bruyne B, Pijls NHJ. Epicardial Stenosis Severity Does Not Affect Minimal Microcirculatory Resistance. Circulation 2004; 110:2137-42. [PMID: 15466646 DOI: 10.1161/01.cir.0000143893.18451.0e] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Whether minimal microvascular resistance of the myocardium is affected by the presence of an epicardial stenosis is controversial. Recently, an index of microcirculatory resistance (IMR) was developed that is based on combined measurements of distal coronary pressure and thermodilution-derived mean transit time. In normal coronary arteries, IMR correlates well with true microvascular resistance. However, to be applicable in the case of an epicardial stenosis, IMR should account for collateral flow. We investigated the feasibility of determining IMR in humans and tested the hypothesis that microvascular resistance is independent of epicardial stenosis.
Methods and Results—
Thirty patients scheduled for percutaneous coronary intervention were studied. The stenosis was stented with a pressure guidewire, and coronary wedge pressure (P
w
) was measured during balloon occlusion. After successful stenting, a short compliant balloon with a diameter 1.0 mm smaller than the stent was placed in the stented segment and inflated with increasing pressures, creating a 10%, 50%, and 75% area stenosis. At each of the 3 degrees of stenosis, fractional flow reserve (FFR) and IMR were measured at steady-state maximum hyperemia induced by intravenous adenosine. A total of 90 measurements were performed in 30 patients. When uncorrected for P
w
, an apparent increase in microvascular resistance was observed with increasing stenosis severity (IMR=24, 27, and 37 U for the 3 different degrees of stenosis;
P
<0.001). In contrast, when P
w
is appropriately accounted for, microvascular resistance did not change with stenosis severity (IMR=22, 23, and 23 U, respectively;
P
=0.28).
Conclusions—
Minimal microvascular resistance does not change with epicardial stenosis severity, and IMR is a specific index of microvascular resistance when collateral flow is properly taken into account.
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Affiliation(s)
- Wilbert Aarnoudse
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Aarnoudse W, De Bruyne B, Fearon W, MacCarthy P, van de Vosse F, Koolen J, Geven M, Pijls N. 1120-45 Epicardial stenosis severity does not affect minimal microcirculatory resistance. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aarnoudse W, van den Berg P, van de Vosse F, Geven M, Rutten M, Van Turnhout M, Fearon W, de Bruyne B, Pijls N. Myocardial resistance assessed by guidewire-based pressure-temperature measurement: In vitro validation. Catheter Cardiovasc Interv 2004; 62:56-63. [PMID: 15103605 DOI: 10.1002/ccd.10793] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
By injecting a few cubic centimeters of saline into the coronary artery and using thermodilution principles, mean transit time (T(mn)) of the injectate can be calculated and is inversely proportional to coronary blood flow. Because microvascular resistance equals distal coronary pressure (P(d)) divided by myocardial flow, the product P(d). T(mn) provides an index of myocardial resistance (IMR). In this in vitro study in a physiologic model of the coronary circulation, we compared IMR to true myocardial resistance (TMR) at different degrees of myocardial resistance and at different degrees of epicardial stenosis. Absolute blood flow was varied from 42 to 203 ml/min and TMR varied from 0.39 to 1.63 dynes. sec/cm(5). Inverse mean transit time correlated well to absolute blood flow (R(2) = 0.93). Furthermore, an excellent correlation was found between IMR and TMR (R(2) = 0.94). IMR was independent on the severity of epicardial stenosis and thus specific for myocardial resistance. Thus, using one single guidewire, both fractional flow reserve and IMR can be measured simultaneously as indexes of epicardial and microvascular disease, respectively, enabling separate assessment of both coronary arterial and microvascular disease.
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Affiliation(s)
- Wilbert Aarnoudse
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Reneman RS, Hoeks AP, van de Vosse F, Ku D. Three-Dimensional Blood Flow in Bifurcations: Computational and Experimental Analyses and Clinical Applications. Cerebrovasc Dis 1993. [DOI: 10.1159/000108700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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