Coronary artery plaque growth: A two‐way coupled shear stress–driven model

Arzani, Amirhossein

doi:10.1002/cnm.3293

Cited by 21 publications

(15 citation statements)

References 70 publications

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“…It is important to note that the coronary stenosis is more likely to form in the locations with disturbed flow conditions which is characterised by low WSS (Zhang et al, 2015). Furthermore, low WSS appears to be the most important hemodynamic parameter promoting atherosclerotic plaque growth that in turn influences the blood flow and WSS distribution (Arzani, 2020). As the highest wall shear stress during a cardiac cycle happens during the maximum velocity phase, as explained before, wall shear stress contour of this phase for the fourth pulsation cycle of the case3 from both top and bottom views is displayed in Figure 13.…”

Section: Transitional Turbulent Behaviour Of Different Phases Of a Pulsation Cyclementioning

confidence: 99%

Transitional turbulent flow in a stenosed coronary artery with a physiological pulsatile flow

Freidoonimehr

Arjomandi

Sedaghatizadeh

et al. 2020

Numer Methods Biomed Eng

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The turbulence in the blood flow, caused by plaque deposition on the arterial wall, increases by the combined effect of the complex plaque geometries and the pulsatile blood flow. The correlation between the plaque geometry, the pulsatile inlet flow and the induced turbulence in a constricted artery is investigated in this study. Pressure drop, flow velocity and wall shear stress are determined for stenosed coronary artery models with three different degrees of asymmetric stenosis and for different heart working conditions. A Computational Fluid Dynamics model, validated against experimental data published in the literature, was developed to simulate the blood pulsatile flow inside a stenosed coronary artery model. The transitional flow behaviour was quantified by investigation of the changes in the turbulence kinetic energy. It was shown that the separation starts from the side of the asymmetric stenosis and spreads to its opposite side further downstream. The results suggest that there is a high risk of the formation of a secondary stenosis at a downstream distance equal to 10-times of the artery diameter at the side and bottom regions of the first stenosis due to the existence of the recirculation zones and low shear stresses. Finally, a stenosed patient specific coronary artery model was employed to illustrate the applicability of the obtained results for real geometry models. The results of this study provide a good prediction of pressure drop and blood flow rate, which can be applied in the investigation of the heart muscle workout and the required heart power.

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Section: Transitional Turbulent Behaviour Of Different Phases Of a Pulsation Cyclementioning

confidence: 99%

Transitional turbulent flow in a stenosed coronary artery with a physiological pulsatile flow

Freidoonimehr

Arjomandi

Sedaghatizadeh

et al. 2020

Numer Methods Biomed Eng

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“…The geometry of a plaque can influence the hemodynamic parameters, such as wall shear stress, which, in turn, influence the evolution of plaque geometry (Yamamoto et al, 2017;Arzani, 2020;Pleouras et al, 2020a). For example, the clinical observation and computational simulation have disclosed that plaques grow faster in the downstream areas than the upstream areas (Arzani, 2020). Considering the haemodynamics-driven plaque growth, in this study, we hypothesize that different coronary plaques may be consistent in geometry.…”

Section: Introductionmentioning

confidence: 77%

“…With a certain degree of stenosis, the plaque geometry has a direct effect on the turbulence flow characteristics in the surrounding areas (Bhaganagar, 2009). As a result, an area with low values of wall shear stress (WSS), which is a hemodynamic parameter directly related to endothelial function and atherosclerosis, will appear in the distal segment of the plaque, accelerating the plaque growth (Liu et al, 2018;Arzani, 2020). In a study on 900 artery segments extracted from 94 patient-specific coronary arteries, Pleouras et al found that the plaque growth and degree of stenosis predicted using the baseline WSS values derived from computational simulation were in accordance with the follow-up clinical observation (Pleouras et al, 2020b).…”

Section: Discussionmentioning

confidence: 99%

“…Using the three-dimensional reconstruction of plaque geometry from CCTA images, many geometric parameters can be accurately estimated, including the burden (i.e., the severity of stenosis), size, diameter, and composition of coronary artery plaques (Liu et al, 2021). The geometry of a plaque can influence the hemodynamic parameters, such as wall shear stress, which, in turn, influence the evolution of plaque geometry (Yamamoto et al, 2017;Arzani, 2020;Pleouras et al, 2020a). For example, the clinical observation and computational simulation have disclosed that plaques grow faster in the downstream areas than the upstream areas (Arzani, 2020).…”

Section: Introductionmentioning

confidence: 99%

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Consistency in Geometry Among Coronary Atherosclerotic Plaques Extracted From Computed Tomography Angiography

et al. 2021

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Background: The three-dimensional (3D) geometry of coronary atherosclerotic plaques is associated with plaque growth and the occurrence of coronary artery disease. However, there is a lack of studies on the 3D geometric properties of coronary plaques. We aim to investigate if coronary plaques of different sizes are consistent in geometric properties.Methods: Nineteen cases with symptomatic stenosis caused by atherosclerotic plaques in the left coronary artery were included. Based on attenuation values on computed tomography angiography images, coronary atherosclerotic plaques and calcifications were identified, 3D reconstructed, and manually revised. Multidimensional geometric parameters were measured on the 3D models of plaques and calcifications. Linear and non-linear (i.e., power function) fittings were used to investigate the relationship between multidimensional geometric parameters (length, surface area, volume, etc.). Pearson correlation coefficient (r), R-squared, and p-values were used to evaluate the significance of the relationship. The analysis was performed based on cases and plaques, respectively. Significant linear relationship was defined as R-squared > 0.25 and p < 0.05.Results: In total, 49 atherosclerotic plaques and 56 calcifications were extracted. In the case-based analysis, significant linear relationships were found between number of plaques and number of calcifications (r = 0.650, p = 0.003) as well as total volume of plaques (r = 0.538, p = 0.018), between number of calcifications and total volume of plaques (r = 0.703, p = 0.001) as well as total volume of calcification (r = 0.646, p = 0.003), and between the total volumes of plaques and calcifications (r = 0.872, p < 0.001). In plaque-based analysis, the power function showed higher R-squared values than the linear function in fitting the relationships of multidimensional geometric parameters. Two presumptions of plaque geometry in different growth stages were proposed with simplified geometric models developed. In the proposed models, the exponents in the power functions of geometric parameters were in accordance with the fitted values.Conclusion: In patients with coronary artery disease, coronary plaques and calcifications are positively related in number and volume. Different coronary plaques are consistent in the relationship between geometry parameters in different dimensions.

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“…However, there is no comprehensive computational simulation for calculation of FFR, iFR, and CFR, simultaneously, to show which one is more conservative based on the biomechanical factors. In addition, many simulations have been performed on the study of hemodynamic parameters, such as TAWSS, OSI, and RRT in healthy or diseased arteries 37‐40 . Nevertheless, there is no computational model to predict the atherosuseptible regions in a patient who has no significant coronary stenosis (in terms of FFR, iFR, and CFR).…”

Section: Introductionmentioning

confidence: 99%

High precision invasive FFR, low‐cost invasive iFR, or non‐invasive CFR?: optimum assessment of coronary artery stenosis based on the patient‐specific computational models

Tajeddini

Nikmaneshi

Firoozabadi

et al. 2020

Numer Methods Biomed Eng

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The objective of this paper is to apply computational fluid dynamic (CFD) as a complementary tool for clinical tests to not only predict the present and future status of left coronary artery stenosis but also to evaluate some clinical hypotheses. In order to assess the present status of the coronary artery stenosis severity, and thereby selecting the most appropriate type of treatment for each patient, fractional flow reserve (FFR), instantaneous wave free-ratio (iFR), and coronary flow reserve (CFR) are calculated. To examine FFR, iFR, and CFR results, the effect of geometric features of stenoses, including diameter reduction (%), lesion length (LL), and minimum lumen diameter (MLD), is studied on them. It is observed that FFR is a more conservative index than iFR and CFR to assess the severity of coronary stenosis. In addition, it is seen that FFR, iFR, and CFR decrease by increasing LL and decreasing MLD. Therefore, the morphological indices, LL/MLD and LL/MLD^4, with the calculated conservative cutoff values equal to 5.5 and 3.6, are considered. Next, some controversial clinical hypotheses about the assessment of the severity of coronary stenosis are evaluated numerically. These include the examination of FFR, iFR, and CFR accuracies, investigating the effect of coronary hyperemia on iFR, as well as the reliability of the hybrid iFR-FFR decision-making strategy. The presented numerical model can also be used as a predictive tool to identify the atherosuseptible sites of arteries by calculating the time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT).

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Coronary artery plaque growth: A two‐way coupled shear stress–driven model

Cited by 21 publications

References 70 publications

Transitional turbulent flow in a stenosed coronary artery with a physiological pulsatile flow

Transitional turbulent flow in a stenosed coronary artery with a physiological pulsatile flow

Consistency in Geometry Among Coronary Atherosclerotic Plaques Extracted From Computed Tomography Angiography

High precision invasive FFR, low‐cost invasive iFR, or non‐invasive CFR?: optimum assessment of coronary artery stenosis based on the patient‐specific computational models

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