Non-invasive characterization of complex coronary lesions

Area of Science:

• Cardiovascular Imaging and Hemodynamics
• Computational Fluid Dynamics in Medicine
• Interventional Cardiology

Background:

• Complex coronary lesions (Type B and C) pose diagnostic and treatment challenges, often excluded from clinical trials.
• Current invasive techniques lack validated methods to characterize hemodynamics and guide intervention for these complex lesions.
• Personalized treatment for complex lesions is hindered by inadequate assessment of hemodynamic quantities.

Purpose of the Study:

• To introduce and validate a coronary angiography-based computational fluid dynamic (CFD-CA) framework for intracoronary assessment of complex coronary lesions.
• To identify key biomarkers differentiating complex Type B and C lesions from simple Type A lesions.
• To evaluate the hemodynamic differences between complex and simple coronary lesions using the CFD-CA framework.

Main Methods:

• Developed and validated an ultra-high resolution CFD-CA framework using data from 14 patients (7 complex, 7 simple lesions).
• Intracoronary assessment included derivation of local pressure, endothelial shear stress (ESS), and velocity profiles.
• CFD-CA framework accuracy was validated against invasive pressure-based measurements, such as fractional flow reserve (FFR).

Main Results:

• The CFD-CA framework demonstrated excellent agreement with invasive measurements.
• The model enabled physiological assessment and quantification of hemodynamic metrics in vessels down to 1mm in diameter.
• Complex lesions exhibited significantly higher ESS (e.g., [Formula: see text] Pa) compared to simple lesions ([Formula: see text] Pa) under both resting and hyperemic states.

Conclusions:

• The validated CFD-CA framework provides accurate physiological assessment for complex coronary lesions.
• Differential hemodynamic evaluation, particularly ESS, offers insights into adverse outcomes in complex lesion patients.
• This hemodynamic assessment has incremental prognostic value over traditional pressure-based indices like FFR for complex coronary lesions.