Jun-Bean Park1, Gilwoo Choi2, Eun Ju Chun3, Hyun Jin Kim4, Jonghanne Park1, Ji-Hyun Jung1, Min-Ho Lee5, Hiromasa Otake6, Joon-Hyung Doh7, Chang-Wook Nam8, Eun-Seok Shin9, Bernard De Bruyne10, Charles A Taylor11, Bon-Kwon Koo12. 1. Department of Medicine, Seoul National University Hospital, Seoul, South Korea. 2. HeartFlow, Inc., Redwood City, California, USA Department of Surgery, Stanford University Medical Center, Stanford, California, USA. 3. Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea. 4. HeartFlow, Inc., Redwood City, California, USA. 5. Department of Medicine, Soonchunhyang University Hospital, Seoul, South Korea. 6. Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. 7. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea. 8. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea. 9. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. 10. Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. 11. HeartFlow, Inc., Redwood City, California, USA Department of Bioengineering, Stanford University, Stanford, California, USA. 12. Department of Medicine, Seoul National University Hospital, Seoul, South Korea Institute of Aging, Seoul National University, Seoul, South Korea.
Abstract
OBJECTIVE: To assess the distribution of pressure and shear-related forces acting on atherosclerotic plaques and their association with lesion characteristics using coronary CT angiography (cCTA)-based computational fluid dynamics (CFD) model of epicardial coronary arteries. METHODS: Patient-specific models of epicardial coronary arteries were reconstructed from cCTA in 80 patients (12 women, 63.8±9.0 years). The pressure and wall shear stress (WSS) in left anterior descending coronary arteries were assessed using CFD. High-risk plaques were defined as the presence of at least one of the following adverse plaque characteristics: low-density plaque, positive remodelling, napkin-ring sign and spotty calcification. RESULTS: At resting condition, 39.5% of stenotic segments (% diameter stenosis 52.3±14.4%) were exposed to high WSS (>40 dyne/cm(2)). When the stenotic lesion was subdivided into three segments, the distribution of WSS was different from that of pressure change and its magnitude was highest at minimal lumen area (p<0.001). High pressure gradient, proximal location, small lumen and short length were independent determinants of WSS (all p<0.05). The plaques exposed to the highest WSS tertile had a significantly greater proportion of high-risk plaques. The addition of WSS to % diameter stenosis significantly improved the measures of discrimination and reclassification of high-risk plaques (area under the curves from 0.540 to 0.718, p=0.031; net reclassification index 0.827, p<0.001). CONCLUSIONS: The cCTA-based CFD method can improve the identification of high-risk plaques and the risk stratification for coronary artery disease patients by providing non-invasive measurements of WSS affecting coronary plaques. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVE: To assess the distribution of pressure and shear-related forces acting on atherosclerotic plaques and their association with lesion characteristics using coronary CT angiography (cCTA)-based computational fluid dynamics (CFD) model of epicardial coronary arteries. METHODS:Patient-specific models of epicardial coronary arteries were reconstructed from cCTA in 80 patients (12 women, 63.8±9.0 years). The pressure and wall shear stress (WSS) in left anterior descending coronary arteries were assessed using CFD. High-risk plaques were defined as the presence of at least one of the following adverse plaque characteristics: low-density plaque, positive remodelling, napkin-ring sign and spottycalcification. RESULTS: At resting condition, 39.5% of stenotic segments (% diameter stenosis 52.3±14.4%) were exposed to high WSS (>40 dyne/cm(2)). When the stenotic lesion was subdivided into three segments, the distribution of WSS was different from that of pressure change and its magnitude was highest at minimal lumen area (p<0.001). High pressure gradient, proximal location, small lumen and short length were independent determinants of WSS (all p<0.05). The plaques exposed to the highest WSS tertile had a significantly greater proportion of high-risk plaques. The addition of WSS to % diameter stenosis significantly improved the measures of discrimination and reclassification of high-risk plaques (area under the curves from 0.540 to 0.718, p=0.031; net reclassification index 0.827, p<0.001). CONCLUSIONS: The cCTA-based CFD method can improve the identification of high-risk plaques and the risk stratification for coronary artery diseasepatients by providing non-invasive measurements of WSS affecting coronary plaques. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Parham Eshtehardi; Adam J Brown; Ankit Bhargava; Charis Costopoulos; Olivia Y Hung; Michel T Corban; Hossein Hosseini; Bill D Gogas; Don P Giddens; Habib Samady Journal: Int J Cardiovasc Imaging Date: 2017-01-10 Impact factor: 2.357
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Authors: Khaled M Abdelrahman; Marcus Y Chen; Amit K Dey; Renu Virmani; Aloke V Finn; Ramzi Y Khamis; Andrew D Choi; James K Min; Michelle C Williams; Andrew J Buckler; Charles A Taylor; Campbell Rogers; Habib Samady; Charalambos Antoniades; Leslee J Shaw; Matthew J Budoff; Udo Hoffmann; Ron Blankstein; Jagat Narula; Nehal N Mehta Journal: J Am Coll Cardiol Date: 2020-09-08 Impact factor: 24.094