Impact of spatial characteristics in the left stenotic coronary artery on the hemodynamics and visualization of 3D replica models

Yang, Yang; Liu, Xin; Xia, Yufa; Wu, Wanqing; Xiong, Hongyan; Xu, Lin; Wong, Kelvin K. L.; Ouyang, Hui; Huang, Wenhua

doi:10.1038/s41598-017-15620-1

Cited by 30 publications

(17 citation statements)

References 44 publications

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“…[ 39 ] The recovery of myocardial motor function could be used to evaluate the impact of PPIs on cardiovascular events. [ 40 ] Hemodynamics analysis of narrowed coronary arteries [ 41 ] and visualization based on 3D printed models [ 42 ] provide noninvasive assessments of coronary conditions that can aid in the medical decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Influence of proton pump inhibitors on clinical outcomes in coronary heart disease patients receiving aspirin and clopidogrel

Jin²,

Kuang³

et al. 2018

Medicine

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Background:Proton pump inhibitors (PPIs) are usually prescribed to protect against gastrointestinal bleeding in patients on dual antiplatelet therapy. This meta-analysis reviewed clinical outcomes in patients taking aspirin and clopidogrel, with and without concomitant PPIs to address concerns of adverse reactions.Methods:We searched PubMed, Embase, and the Cochrane Library for articles published between January 1, 2010 and April 11, 2017. The primary end points were major adverse cardiovascular events and gastrointestinal bleeding. Secondary end points were myocardial infarction, stent thrombosis, revascularization, cardiogenic death, and all-cause mortality.Results:The meta-analysis included 33,492 patients in 4 randomized controlled trials and 8 controlled observational studies. Overall, patients taking PPIs had statistical differences in major adverse cardiovascular events [odds ratio (OR) 1.17 (95% confidence interval [CI] 1.07–1.28); P = .001; I2 = 28.3%], gastrointestinal bleeding [OR 0.58 (95% CI 0.36–0.92); P = .022; I2 = 80.6%], stent thrombosis [OR 1.30 (95% CI 1.01–1.68); P = .041; I2 = 0%], and revascularization [OR 1.20 (95% CI 1.04–1.38); P = .011; I2 = 5.1%], compared those not taking PPIs. There were no significant differences in myocardial infarction [OR 1.03 (95% CI 0.87–1.22); P = .742; I2 = 0%], cardiogenic death [OR 1.09 (95% CI 0.83–1.43); P = .526; I2 = 0%], or all-cause mortality [OR 1.08 (95% CI 0.93–1.25); P = .329; I2 = 0%).Conclusions:Among the patients taking aspirin and clopidogrel, the results indicated that the combined use of PPIs increased the rates of major adverse cardiovascular events, stent thrombosis, and revascularization.

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Section: Discussionmentioning

confidence: 99%

Influence of proton pump inhibitors on clinical outcomes in coronary heart disease patients receiving aspirin and clopidogrel

Jin²,

Kuang³

et al. 2018

Medicine

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“…In principle, the FFR value could be also determined by conducting experiments on models fabricated with 3D printing [ 46 , 47 ]. Increasing the size of the model does not reduce the error coming from image segmentation, but does decrease that associated with a poor representation of the artery surface.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the use of big models allows one to increase the number N of triangles of the faceted geometry while keeping the ratio constant, which results in higher values of SRI. In this sense, high-resolution printers have proved to be capable of forming precise replicas of big models of coronary arteries [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Numerical analysis of the pressure drop across highly-eccentric coronary stenoses: application to the calculation of the fractional flow reserve

et al. 2018

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BackgroundFractional flow reverse (FFR) is the gold standard assessment of the hemodynamic significance of coronary stenoses. However, it requires the catheterization of the coronary artery to determine the pressure waveforms proximal and distal to the stenosis. On the contrary, computational fluid dynamics enables the calculation of the FFR value from relatively non-invasive computed tomography angiography (CTA).MethodsWe analyze the flow across idealized highly-eccentric coronary stenoses by solving the Navier–Stokes equations. We examine the influence of several aspects (approximations) of the simulation method on the calculation of the FFR value. We study the effects on the FFR value of errors made in the segmentation of clinical images. For this purpose, we compare the FFR value for the nominal geometry with that calculated for other shapes that slightly deviate from that geometry. This analysis is conducted for a range of stenosis severities and different inlet velocity and pressure waveforms.Results and conclusionsThe errors made in assuming a uniform velocity profile in front of the stenosis, as well as those due to the Newtonian and laminar approximations, are negligible for stenosis severities leading to FFR values around the threshold 0.8. The limited resolution of the stenosis geometry reconstruction is the major source of error when predicting the FFR value. Both systematic errors in the contour detection of just 1-pixel size in the CTA images and a low-quality representation of the stenosis surface (coarse faceted geometry) may yield wrong outcomes of the FFR assessment for an important set of eccentric stenoses. On the contrary, the spatial resolution of images acquired with optical coherence tomography may be sufficient to ensure accurate predictions for the FFR value.

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“…Although cCTA alone can accurately detect anatomically obstructive coronary stenosis, it cannot define the hemodynamic significance of a stenosis due to the complex relationship between stenosis and flow [ 1 ]. The spatial characteristics of stenosis have great impact on flow [ 41 – 43 ]. Even for stenosis with similar AS%, the pressure-flow behaviors still can be different due to the different shapes of stenosis (as shown in Figs.…”

Section: Discussionmentioning

confidence: 99%

A new CFD based non-invasive method for functional diagnosis of coronary stenosis

et al. 2018

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BackgroundAccurate functional diagnosis of coronary stenosis is vital for decision making in coronary revascularization. With recent advances in computational fluid dynamics (CFD), fractional flow reserve (FFR) can be derived non-invasively from coronary computed tomography angiography images (FFRCT) for functional measurement of stenosis. However, the accuracy of FFRCT is limited due to the approximate modeling approach of maximal hyperemia conditions. To overcome this problem, a new CFD based non-invasive method is proposed.MethodsInstead of modeling maximal hyperemia condition, a series of boundary conditions are specified and those simulated results are combined to provide a pressure-flow curve for a stenosis. Then, functional diagnosis of stenosis is assessed based on parameters derived from the obtained pressure-flow curve.ResultsThe proposed method is applied to both idealized and patient-specific models, and validated with invasive FFR in six patients. Results show that additional hemodynamic information about the flow resistances of a stenosis is provided, which cannot be directly obtained from anatomy information. Parameters derived from the simulated pressure-flow curve show a linear and significant correlations with invasive FFR (r > 0.95, P < 0.05).ConclusionThe proposed method can assess flow resistances by the pressure-flow curve derived parameters without modeling of maximal hyperemia condition, which is a new promising approach for non-invasive functional assessment of coronary stenosis.

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Impact of spatial characteristics in the left stenotic coronary artery on the hemodynamics and visualization of 3D replica models

Cited by 30 publications

References 44 publications

Influence of proton pump inhibitors on clinical outcomes in coronary heart disease patients receiving aspirin and clopidogrel

Influence of proton pump inhibitors on clinical outcomes in coronary heart disease patients receiving aspirin and clopidogrel

Numerical analysis of the pressure drop across highly-eccentric coronary stenoses: application to the calculation of the fractional flow reserve

A new CFD based non-invasive method for functional diagnosis of coronary stenosis

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