Influence of microcalcifications on vulnerable plaque mechanics using FSI modeling

Bluestein, Danny; Alemu, Yared; Avrahami, Idit; Gharib, Morteza; Dumont, Kris; Ricotta, John J.; Einav, Shmuel

doi:10.1016/j.jbiomech.2007.11.029

Cited by 146 publications

(92 citation statements)

References 24 publications

(34 reference statements)

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“…In fact, mathematical modeling predicts that plaques with the embedded calcified spots display higher wall stress concentration in the fibrous cap a bit upstream to the calcified spot, even in the presence of mild stenosis (38). We emphasize that when patients with a degree of stenosis #30% are considered, the presence of echogenic plaques is still significantly associated with future MACE, even after adjusting for mean IMT.…”

Section: Discussionmentioning

confidence: 81%

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Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

et al. 2015

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OBJECTIVEThe presence of carotid plaques is associated with future cardiovascular events, with local plaque composition being an independent outcome predictor. We examined the association between ultrasonographically determined carotid plaque calcification and incident major adverse cardiovascular events (MACE) and death in type 2 diabetes (T2D). RESEARCH DESIGN AND METHODSWe enrolled 581 patients with T2D who underwent routine carotid ultrasonography. Plaques were classified as echolucent (lipid rich), heterogenous, and echogenic (calcific). We collected demographic, anthropometric, and clinical data at baseline and followed the patients for up to 9 years. RESULTSPlaques were detected in 81.8% of the patients (echolucent in 16.4%, heterogenous in 43.2%, and echogenic in 22.2%). During follow-up (4.3 6 0.1 years), 58 deaths (27 cardiovascular) and 236 fatal and nonfatal MACE occurred. In univariate analyses, presence versus absence of any carotid plaque was associated with incident MACE, and the hazard ratio (95% CI) progressively increased from echolucent (1.97 [0.93-3.44]), to heterogeneous (3.10 [2.09-4.23]), to echogenic (3.71 [2.09-5.59]) plaques. Compared with echolucent plaques, echogenic plaques were associated with incident MACE independently from confounders. This association was attenuated after adjusting for the degree of stenosis, but in patients with stenosis £30%, echogenic plaque type still predicted total and atherosclerotic MACE, even after further adjusting for mean intima-media thickness. CONCLUSIONSIn T2D, carotid plaque calcification predicts MACE, especially in patients with a low degree of stenosis. The biology of atherosclerotic calcification in diabetes needs to be further elucidated to understand the basis of this association.Atherosclerosis is a common complication of diabetes, driving severe morbidity and mortality. Atherosclerotic plaques are complex structures with multiple tissues and cell types that differentially contribute to lesion vulnerability (1). In populationbased longitudinal studies, atherosclerotic plaque characteristics have been shown to predict atherosclerosis progression at a systemic level, being associated with incident cardio-and cerebrovascular events (2-7). Based on ultrasonographic plaque characterization, echolucent (lipid-rich) plaques seem to be a better predictor of stroke and cardiovascular events than echogenic or echorich plaques containing

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Section: Discussionmentioning

confidence: 81%

“…Obesity 223 (38) 127 (37) 96 ( (18) 45 (13) 61 (26) ,0.0001 14 ( (14) 35 (10) 44 ( (Fig. 1A) plaques.…”

Section: Follow-up and Incident Adverse Eventsmentioning

confidence: 99%

Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

et al. 2015

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“…Small-Ca contributed to increase in stresses within the aortic wall (comparison of FSI simulations with and without Ca), while larger plaque-like Ca appeared to locally reduce these stresses. 4 At the interface between the rigid embedded Ca and the much softer wall material there was a strong stress gradient that propagated around the calcification. This stress gradient may offer a significant contribution to the rupture potential.…”

Section: Discussionmentioning

confidence: 99%

Patient-Based Abdominal Aortic Aneurysm Rupture Risk Prediction with Fluid Structure Interaction Modeling

et al. 2010

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Abstract-Elective repair of abdominal aortic aneurysm (AAA) is warranted when the risk of rupture exceeds that of surgery, and is mostly based on the AAA size as a crude rupture predictor. A methodology based on biomechanical considerations for a reliable patient-specific prediction of AAA risk of rupture is presented. Fluid-structure interaction (FSI) simulations conducted in models reconstructed from CT scans of patients who had contained ruptured AAA (rAAA) predicted the rupture location based on mapping of the stresses developing within the aneurysmal wall, additionally showing that a smaller rAAA presented a higher rupture risk. By providing refined means to estimate the risk of rupture, the methodology may have a major impact on diagnostics and treatment of AAA patients.

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“…Experimental data showed that wall motion of non-stenosed coronary arteries was approximately less than 8.4% of the vessel diameter (5.4±2% [19] and 2% [20] in terms of strain, 8.4% in diameter [21]). However, studies on stenosis and plaque structure [22][23][24][25] have demonstrated the importance of FSI in stenosed arteries. FSI analyses of coronary arteries are still sparse, largely due to lack of in vivo information such as subject-specific material properties, flow and pressure waveforms.…”

Section: Introductionmentioning

confidence: 99%

Fluid–structure interaction analysis of a patient‐specific right coronary artery with physiological velocity and pressure waveforms

Torii

Wood

Hadjiloizou

et al. 2009

Commun. Numer. Meth. Engng.

130

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SUMMARYCoupled fluid-structure interaction (FSI) analysis of the human right coronary artery (RCA) has been carried out to investigate the effects of wall compliance on coronary hemodynamics. A 3-D model of a stenosed RCA was reconstructed based on multislice computerized tomography images. A velocity waveform in the proximal RCA and a pressure waveform in the distal RCA of a patient with a severe stenosis were acquired with a catheter delivered wire probe and applied as boundary conditions. The arterial wall was modeled as a Mooney-Rivlin hyperelastic material. The predicted maximum wall displacement (3.85 mm) was comparable with the vessel diameter (∼ 4mm), but the diameter variation was much smaller, 0.134 mm at the stenosis and 0.486 mm in the distal region. Comparison of the computational results between the FSI and rigid-wall models showed that the instantaneous wall shear stress (WSS) distributions were affected by diameter variation in the arterial wall; increasing systolic blood pressure dilated the vessel and consequently lowered WSS, whereas the opposite occurred when pressure started to decrease. However, the effects of wall compliance on time-averaged WSS (TAWSS) and oscillatory shear index (OSI) were insignificant (4.5 and 2.7% difference in maximum TAWSS and OSI, respectively).

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Influence of microcalcifications on vulnerable plaque mechanics using FSI modeling

Cited by 146 publications

References 24 publications

Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

Patient-Based Abdominal Aortic Aneurysm Rupture Risk Prediction with Fluid Structure Interaction Modeling

Fluid–structure interaction analysis of a patient‐specific right coronary artery with physiological velocity and pressure waveforms

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