Personalized computational estimation of relative change in coronary blood flow after percutaneous coronary intervention in short-term and long-term perspectives

Abstract

Coronary artery disease is the leading cause of mortality worldwide, accounting for 12.8% of all deaths. Although the clinical benefits of treating stenosis with percutaneous coronary intervention (PCI) have been extensively demonstrated, residual myocardial ischemia remains in about 30–50% of patients even after a formally successful PCI. We apply previously developed and validated 1D model of haemodynamics, which distributes terminal hydraulic resistance based on the diameters of the parent vessels and Murray’s law by a recursive algorithm. In our new model the terminal resistance is decreased according to a transmural perfusion ratio increase. In contrast to our previous work we calculate the transmural perfusion ratio for personally defined zones. Thus, peripheral hydraulic resistance of myocardial perfusion is personalized based on patient data, whichwere extracted from computed tomography perfusion images. The model serves as a computational tool for simulating pre- to post-PCI changes in coronary haemodynamics of four patients. We simulate fractional flow reserve (FFR), coronary flow reserve (CFR), instantaneous wave-free ratio (iFR), average flow in selected arteries in hyperemic and rest conditions before PCI and after PCI immediately after the surgery (in a short-term) and in a long-term (several months) perspectives. We conclude that high FFR and iFR values in short-term and long-term perspectives are not necessary correlate with CFR improvement and long-term blood flow recovery in coronary arteries.