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Effect of microcirculatory dysfunction on coronary hemodynamics: A pilot study based on computational fluid dynamics

Yingyi Geng1, Haipeng Liu2, Xinhong Wang3

  • 1Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou, China.

Computers in Biology and Medicine
|May 9, 2022
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Summary

Computational fluid dynamics (CFD) simulations reveal that coronary microcirculatory dysfunction (CMD) in nonobstructive coronary artery disease (CAD) reduces blood flow and pressure drop while increasing simulated FFR in the affected artery, with minimal impact on other branches.

Keywords:
Computational fluid dynamics (CFD)Coronary microcirculatory dysfunction (CMD)Fractional flow reserve (FFR)Index of microcirculatory resistance (IMR)Myocardial ischemia

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Computational Science

Background:

  • Invasive Fractional Flow Reserve (FFR) and Index of Microcirculatory Resistance (IMR) are gold standards for diagnosing Coronary Artery Disease (CAD) and Coronary Microcirculatory Dysfunction (CMD).
  • The interplay between CAD and CMD remains incompletely understood.
  • Non-invasive computational fluid dynamics (CFD) can elucidate the hemodynamic impact of CMD in nonobstructive CAD.

Purpose of the Study:

  • To non-invasively investigate the hemodynamic effects of CMD in patients with nonobstructive CAD using CFD simulations.
  • To compare hemodynamic parameters between normal microcirculatory resistance and simulated CMD conditions.

Main Methods:

  • CFD simulations were performed on six cases with nonobstructive CAD and CMD in the Left Anterior Descending (LAD) artery territory.
  • Two microcirculatory states were simulated: normal microcirculatory resistance (MR) and CMD (MR multiplied by the clinical IMR/cutoff ratio).
  • Blood flow, translesional pressure drop (Δptl), and simulated FFR (FFRCT) were compared between states using Wilcoxon signed rank tests.

Main Results:

  • CMD significantly decreased outlet flow velocity and increased FFRCT in LAD branches (p < 0.01).
  • Minor decreases in Δptl (0.63–5.64 mmHg) were observed in LAD branches with CMD.
  • Non-culprit branches showed no significant changes in outlet flow velocity (< 2%) or FFRCT (< 0.02).

Conclusions:

  • IMR-based CFD simulations can effectively estimate the hemodynamic consequences of CMD.
  • CMD in a coronary artery segment reduces its blood flow and pressure drop while increasing its FFR.
  • The hemodynamic effects of CMD are localized, with minimal impact on non-culprit coronary branches.