The purpose of this study is to use the coronary computed tomography angiography (CCTA) to simulate the coronary blood flow with different theoretical flow models by using not only the computation fluid dynamics (CFD) method, but also additional patient boundary conditions obtained with echocardiography, and evaluate the feasibility of simulated fractional flow reserve (FFR CTS ), compared with the invasive CTA-based FFR. The laminar and three turbulence models (k-ε(kepsilon), k-ω(k-omega), SST (Menter's shear stress transport)) were implemented to predict coronary blood flow. The study investigates an ideal stenosis model and six patients, with invasive FFR measurements. Three-dimensional reconstructions of coronary arteries of six subjects were performed from CCTA images of 320-detector scanner. The measured velocity profile of the left ventricular outflow tract from the echocardiography was employed for the inlet velocity in simulation. The pressure waveform of the patient aortic blood flow was used as the pressure profile at the outlet. With simulations, we found that the maximum velocity in the stenotic coronary artery reached about 395 cm s −1 , which was about 2.4 times faster than the inlet velocity of 165 cm s −1 for the patient with coronary stenosis diagnosed 50%-75% on CTA. The pressure drop across the stenosis was about 28 mmHg. Meanwhile, the value of FFR CTS using the laminar flow pattern was 0.788 closely to its invasive FFR of 0.79. In conclusion, this study demonstrated that the CFD method has moderate more blood flow information to assess the hemodynamic significance of the coronary blood flow and calculate the non-invasive FFR CTS values, which were very close to those measured with invasive FFR. Abbreviations3D three-dimensional CCTA coronary computed tomography angiography CFD computation fluid dynamics CT computed tomography FFR fractional flow reserve FFR CT computational of fractional flow reserve using coronary computed tomography angiography FFR CTS simulated fractional flow reserve using coronary computed tomography angiography and computational fluid dynamics simulation in this studyRECEIVED
The number of PsO patients treated with biologics has steadily increased from 2014 (N=1,133) to 2018 (N=3,167). The increasing trend in biologics users was apparent in 2016 and 2018, which sparked an annual increase of 65% and 83% in total medical costs for biologics users respectively. The 5-year average of PsO medication costs per biologics users amounted to 8,237,266 KRW as opposed to non-biologics users' 225,607 KRW. Total medical costs for treating PsO for biologics users and nonbiologics users on average were 8,372,181 KRW and 377,396 KRW. The gap peaked in 2018 with biologics users' 9,218,123 KRW and non-biologics users' 300,931 KRW. In the next stage of our analysis, the costs per co-morbidities will be stratified. Conclusions: The results demonstrated that high health care costs were associated with PsO patients treated with biologics. Furthermore, among biologics users, the average total medical costs are higher among patients with specified comorbidities indicating additional incremental burden of healthcare spending in management of PsO with associated co-morbid conditions.
The aim of this study was to use the computational fluid dynamics (CFD) method, patient-specific electrocardiogram (ECG) signals, and computed tomography three-dimensional image reconstruction technique to investigate the blood flow in coronary arteries during cardiac arrhythmia. Methods Two patients with premature ventricular contraction-type cardiac arrhythmia and one with atrial fibrillation-type cardiac arrhythmia were investigated. The inlet velocity of the coronary artery in simulation was applied with the measured velocity profile of the left ventricular outflow tract (LVOT) from the Doppler echocardiography. The measured patient central aortic blood pressure waveform was employed for the coronary artery outlet in simulation. The no-slip boundary condition was applied to the arterial wall. Results For the patient with irregular cardiac rhythms (Case I), the coronary blood flow rate under the shortened and lengthened cardiac rhythms were 0.66 and 0.96 mL/s, respectively. In Case II, the maximum velocity at the LVOT under a normal heartbeat was found to be 101 cm/s, whereas the average value was 73 cm/s. In Case III, the patient was also diagnosed with a congenital stenosis problem at the myocardial bridge (MCB) at the LAD. The measured blood flow rate at the MCB of the LAD for the three heartbeats in Case III was found to be 0.68, 1.08, and 1.14 mL/s. Conclusion The integration of patient-specific ECG signals and image-based CFD methods can clearly analyze hemodynamic information for patients during cardiac arrhythmia. The cardiac arrhythmia can reduce the blood flow in the coronary arteries.
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