An automated software for real-time quantification of wall shear stress distribution in quantitative coronary angiography data

Tufaro, Vincenzo; Torii, Ryo; Erdoğan, Emrah; Kitslaar, Pieter H.; Koo, Bon‐Kwon; Rakhit, Roby; Karamasis, Grigoris V.; Costa, Christos; Serruys, Patrick W.; Jones, Daniel A.; Mathur, Anthony; Baumbach, Andreas; Aben, Jean‐Paul; Bourantas, Christos V.

doi:10.1016/j.ijcard.2022.03.022

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…In this study WSS computation time was less than 4 minutes for non-bifurcated and less than 5 minutes for bifurcated models including 3D-QCA reconstruction. These ndings are in line with previous reports 5 supporting the potential of this software for clinical use. However, before advocating the use of CAAS Workstation WSS software in the clinical practice further research is needed to explore in retrospective but mainly in prospective studies its value of in detecting high-risk lesions and patients.…”

Section: Discussionsupporting

confidence: 93%

“…The curved-based approach and small number of near-wall layers enable fast analysis without compromising WSS computations. 5 A pulsatile ow pro le was applied at the inlet of the reconstructed segment based on generic timevarying Doppler velocity curves of the studied vessel (e.i, left anterior descending artery, left circum ex or right coronary artery). 9 The blood ow velocity at the in ow of the model was patient-speci c and estimated from the model length, the frame rate of the analysed angiogram and the number of frames required for the contrast to ll the reconstructed segment.…”

Section: D-qca Reconstruction and Wss Computationmentioning

confidence: 99%

“…5 Previous studies have demonstrated that 3D-QCA derived WSS using processing of the 3D reconstructed coronary geometries with CFD techniques enables accurate quanti cation of ow patterns and WSS distribution 6 and potentially detection of lesions causing major adverse cardiovascular events (MACE); [7][8][9] in addition, a recent study has shown a high agreement between the estimations of the CAAS Workstation WSS software and the WSS computed using conventional CFD analysis in 3D-QCA reconstructions. 5 Since WSS calculation involves multiple steps of analysis, it is important to evaluate the reproducibility of WSS computation using the CAAS Workstation WSS software between two imaging core laboratories. 10 The aim of this study is therefore to present inter-corelab reproducibility of WSS using this novel software.…”

Section: Introductionmentioning

confidence: 99%

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Agreement of wall shear stress distribution between two core laboratories using three-dimensional quantitative coronary angiography

Kageyama

Tufaro

Torii

et al. 2023

Preprint

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Purpose: Wall shear stress (WSS) estimated in models reconstructed from intravascular imaging and 3-dimensional-quantitative coronary angiography (3D-QCA) data provides important prognostic information and enables identification of high-risk lesions. However, these analyses are time-consuming and require expertise, limiting WSS adoption in clinical practice. Recently, a novel software has been developed for real-time computation of time-averaged WSS (TAWSS) and multidirectional WSS distribution. This study aims to examine its inter-corelab reproducibility. Methods: Sixty lesions (20 coronary bifurcations) with a borderline negative fractional flow reserve were processed using the CAAS Workstation WSS prototype to estimate WSS and multi-directional WSS values. Analysis was performed by two corelabs and their estimations for the WSS in 3mm segments across each reconstructed vessel were extracted and compared. Results: In total 700 segments (256 located in bifurcated vessels) were included in the analysis. A high intra-class correlation was noted for all the 3D-QCA and TAWSS metrics between the estimations of the two corelabs irrespective of the presence (range: 0.90-0.92) or absence (range: 0.89-0.90) of a coronary bifurcation, while the ICC was good-moderate for the multidirectional WSS (range: 0.72-0.86). Lesion level analysis demonstrated a high agreement of the two corelabls for detecting lesions exposed to an unfavourable haemodynamic environment (WSS >8.24Pa, κ=0.77) that had a high-risk morphology (area stenosis >61.3%, κ=0.71) and were prone to progress and cause events. Conclusion: The CAAS Workstation WSS enables reproducible 3D-QCA reconstruction and computation of WSS metrics. Further research is needed to explore its value in detecting high-risk lesions.

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Section: Discussionsupporting

confidence: 93%

Section: D-qca Reconstruction and Wss Computationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Agreement of wall shear stress distribution between two core laboratories using three-dimensional quantitative coronary angiography

Kageyama

Tufaro

Torii

et al. 2023

Preprint

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“…These parameters (pressure, velocity, ESS, and vorticity) provide numerous degrees of freedom, as compared to currently available reduced order CFD methods, and may be able to resolve nuanced disruptions in coronary arterial blood flow. Several works have previously explored the role of ESS, a proatherogenic risk factor, to understand intracoronary hemodynamic patterns that can play role in the plaque formation (Rikhtegar et al, 2012;Szabó et al, 2021;Tufaro et al, 2022). Low fluid velocity and the resulting low ESS on the vessel wall have been reported to be directly related to vessel wall thickening and plaque development (Rikhtegar et al, 2012;Szabó et al, 2021;Tufaro et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

“…Several works have previously explored the role of ESS, a proatherogenic risk factor, to understand intracoronary hemodynamic patterns that can play role in the plaque formation (Rikhtegar et al, 2012;Szabó et al, 2021;Tufaro et al, 2022). Low fluid velocity and the resulting low ESS on the vessel wall have been reported to be directly related to vessel wall thickening and plaque development (Rikhtegar et al, 2012;Szabó et al, 2021;Tufaro et al, 2022). Such hemodynamic risk factors can provide valuable information for physiologic lesion assessment in patients diagnosed with coronary disease.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of intracoronary hemodynamics identifies perturbations in vorticity

Vardhan

Gounley²,

Chen³

et al. 2022

Front. Syst. Biol.

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Background and objective: Coronary artery disease (CAD) is highly prevalent and associated with adverse events. Challenges have emerged in the treatment of intermediate coronary artery stenoses. These lesions are often interrogated with fractional flow reserve (FFR) testing to determine if a stenosis is likely to be causative for ischemia in a cardiac territory. This invasive test requires insertion of a pressure wire into a coronary vessel. Recently computational fluid dynamics (CFD) has been used to noninvasively assess fractional flow reserve in vessels reconstructed from medical imaging data. However, many of these simulations are unable to provide additional information about intravascular hemodynamics, including velocity, endothelial shear stress (ESS), and vorticity. We hypothesized that vorticity, which has demonstrated utility in the assessment of ventricular and aortic diseases, would also be an important hemodynamic factor in CAD.Methods: Three-dimensional (3D), patient-specific coronary artery geometries that included all vessels >1 mm in diameter were created from angiography data obtained from 10 patients who underwent diagnostic angiography and FFR testing (n = 9). A massively parallel CFD solver (HARVEY) was used to calculate coronary hemodynamic parameters including pressure, velocity, ESS, and vorticity. These simulations were validated by comparing velocity flow fields from simulation to both velocities derived from in vitro particle image velocimetry and to invasively acquired pressure wire-based data from clinical testing.Results: There was strong agreement between findings from CFD simulations and particle image velocimetry experimental testing (p < 0.01). CFD-FFR was also highly correlated with invasively measured FFR (ρ = 0.77, p = 0.01) with an average error of 5.9 ± 0.1%. CFD-FFR also had a strong inverse correlation with the vorticity (ρ = -0.86, p = 0.001). Simulations to determine the effect of the coronary stenosis on intravascular hemodynamics demonstrated significant differences in velocity and vorticity (both p < 0.05). Further evaluation of an angiographically normal appearing non-FFR coronary vessel in patients with CAD also demonstrated differences in vorticity when compared with FFR vessels (p < 0.05).Conclusion: The use of highly accurate 3D CFD-derived intravascular hemodynamics provides additional information beyond pressure measurements that can be used to calculate FFR. Vorticity is one parameter that is modified by a coronary stenosis and appears to be abnormal in angiographically normal vessels in patients with CAD, highlighting a possible use-case in preventative screening for early coronary disease.

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Agreement of wall shear stress distribution between two core laboratories using three-dimensional quantitative coronary angiography

Kageyama

Tufaro

Torii

et al. 2023

Int J Cardiovasc Imaging

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Wall shear stress (WSS) estimated in models reconstructed from intravascular imaging and 3-dimensional-quantitative coronary angiography (3D-QCA) data provides important prognostic information and enables identification of high-risk lesions. However, these analyses are time-consuming and require expertise, limiting WSS adoption in clinical practice. Recently, a novel software has been developed for real-time computation of time-averaged WSS (TAWSS) and multidirectional WSS distribution. This study aims to examine its inter-corelab reproducibility. Sixty lesions (20 coronary bifurcations) with a borderline negative fractional flow reserve were processed using the CAAS Workstation WSS prototype to estimate WSS and multi-directional WSS values. Analysis was performed by two corelabs and their estimations for the WSS in 3 mm segments across each reconstructed vessel was extracted and compared. In total 700 segments (256 located in bifurcated vessels) were included in the analysis. A high intra-class correlation was noted for all the 3D-QCA and TAWSS metrics between the estimations of the two corelabs irrespective of the presence (range: 0.90–0.92) or absence (range: 0.89–0.90) of a coronary bifurcation, while the ICC was good-moderate for the multidirectional WSS (range: 0.72–0.86). Lesion level analysis demonstrated a high agreement of the two corelabls for detecting lesions exposed to an unfavourable haemodynamic environment (WSS > 8.24 Pa, κ = 0.77) that had a high-risk morphology (area stenosis > 61.3%, κ = 0.71) and were prone to progress and cause events. The CAAS Workstation WSS enables reproducible 3D-QCA reconstruction and computation of WSS metrics. Further research is needed to explore its value in detecting high-risk lesions.

show abstract

An automated software for real-time quantification of wall shear stress distribution in quantitative coronary angiography data

Cited by 7 publications

References 24 publications

Agreement of wall shear stress distribution between two core laboratories using three-dimensional quantitative coronary angiography

Agreement of wall shear stress distribution between two core laboratories using three-dimensional quantitative coronary angiography

Evaluation of intracoronary hemodynamics identifies perturbations in vorticity

Agreement of wall shear stress distribution between two core laboratories using three-dimensional quantitative coronary angiography

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