Muhammad Owais Khan1,2, Takeshi Nishi3, Shinji Imura3, Jongmin Seo1,2, Hanjay Wang4, Yasuhiro Honda3, Koen Nieman3,5, Ian S Rogers3, Jennifer A Tremmel3, Jack Boyd4, Ingela Schnittger3, Alison Marsden6,7,8. 1. Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA. 2. Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA. 3. Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, USA. 4. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA. 5. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA. 6. Department of Pediatrics, Stanford University School of Medicine, 318 Campus Drive, Clark Center E100b, Stanford, CA, 94305-5428, USA. amarsden@stanford.edu. 7. Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA. amarsden@stanford.edu. 8. Department of Bioengineering, Stanford University, Stanford, CA, USA. amarsden@stanford.edu.
Abstract
PURPOSE: Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque. METHODS: We identified N = 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS. RESULTS: WSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm2, p value < 0.01). Plaque area and plaque burden measured from IVUS peaked at 1-3 cm proximal to the MB entrance, coinciding with the first diagonal branch. Normalized WSS showed a statistically significant moderate correlation with plaque area (r = 0.41, p < 0.01). CONCLUSION: WSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.
PURPOSE: Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque. METHODS: We identified N = 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS. RESULTS: WSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm2, p value < 0.01). Plaque area and plaque burden measured from IVUS peaked at 1-3 cm proximal to the MB entrance, coinciding with the first diagonal branch. Normalized WSS showed a statistically significant moderate correlation with plaque area (r = 0.41, p < 0.01). CONCLUSION: WSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.
Authors: Arnav Kumar; Olivia Y Hung; Marina Piccinelli; Parham Eshtehardi; Michel T Corban; David Sternheim; Boyi Yang; Adrien Lefieux; David S Molony; Elizabeth W Thompson; Wenjie Zeng; Yasir Bouchi; Sonu Gupta; Hossein Hosseini; Mohamad Raad; Yi-An Ko; Chang Liu; Michael C McDaniel; Bill D Gogas; John S Douglas; Arshed A Quyyumi; Don P Giddens; Alessandro Veneziani; Habib Samady Journal: JACC Cardiovasc Interv Date: 2018-09-26 Impact factor: 11.195
Authors: Jack H Boyd; Vedant S Pargaonkar; David H Scoville; Ian S Rogers; Takumi Kimura; Shigemitsu Tanaka; Ryotaro Yamada; Michael P Fischbein; Jennifer A Tremmel; Robert Scott Mitchell; Ingela Schnittger Journal: Ann Thorac Surg Date: 2016-10-13 Impact factor: 4.330
Authors: Signe Helene Forsdahl; Ian S Rogers; Ingela Schnittger; Shigemitsu Tanaka; Takumi Kimura; Vedant S Pargaonkar; Frandics P Chan; Dominik Fleischmann; Jennifer A Tremmel; Hans-Christoph Becker Journal: Circ J Date: 2017-07-07 Impact factor: 2.993
Authors: Kathrin Bäumler; Vijay Vedula; Anna M Sailer; Jongmin Seo; Peter Chiu; Gabriel Mistelbauer; Frandics P Chan; Michael P Fischbein; Alison L Marsden; Dominik Fleischmann Journal: Biomech Model Mechanobiol Date: 2020-01-28
Authors: Michel T Corban; Olivia Y Hung; Parham Eshtehardi; Emad Rasoul-Arzrumly; Michael McDaniel; Girum Mekonnen; Lucas H Timmins; Jerre Lutz; Robert A Guyton; Habib Samady Journal: J Am Coll Cardiol Date: 2014-02-26 Impact factor: 24.094
Authors: Yiannis S Chatzizisis; Ahmet Umit Coskun; Michael Jonas; Elazer R Edelman; Charles L Feldman; Peter H Stone Journal: J Am Coll Cardiol Date: 2007-06-08 Impact factor: 24.094
Authors: Yiannis S Chatzizisis; Michael Jonas; Ahmet U Coskun; Roy Beigel; Benjamin V Stone; Charles Maynard; Ross G Gerrity; William Daley; Campbell Rogers; Elazer R Edelman; Charles L Feldman; Peter H Stone Journal: Circulation Date: 2008-02-04 Impact factor: 29.690