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Published on: August 28, 2018
The Comparative Method Based on Coronary Computed Tomography Angiography for Assessing the Hemodynamic Significance
Zbigniew Małota1, Wojciech Sadowski2, Konrad Pieszko3
1Institute of Heart Prostheses, Professor Zbigniew Religa Foundation of Cardiac Surgery Development, Zabrze, Poland. zmalota@frk.pl.
Insights
This study validates a non-invasive computational fluid dynamic method for assessing coronary artery stenosis significance. The novel Energy Flow Reference (EFR) index shows high correlation with existing methods, aiding coronary artery disease prevention.
Area of Science:
- Cardiovascular Imaging and Interventions
- Biomedical Engineering
- Computational Fluid Dynamics
Background:
- Functional evaluation of coronary artery stenosis is crucial for preventing and treating coronary artery disease.
- Medical image-based Computational Fluid Dynamics (CFD) is increasingly utilized for cardiovascular flow studies.
- Non-invasive methods are sought to assess the hemodynamic significance of coronary stenosis.
Purpose of the Study:
- To confirm the feasibility and functionality of a non-invasive computational method for evaluating coronary stenosis.
- To provide hemodynamic insights into narrowed coronary arteries.
- To assess the significance of atherosclerotic lesions.
Main Methods:
- A comparative CFD approach simulating flow energy losses in stenotic and reference (non-stenotic) coronary artery models.
- Utilizing 3D segmentation of cardiac CT images from 25 patients.
- Defining and calculating Fractional Flow Reserve in stenotic (FFRsten) and reconstructed (FFRrec) arteries, alongside a new Energy Flow Reference (EFR) index.
Main Results:
- A direct relationship exists between the degree of vessel narrowing and flow energy loss.
- The EFR index uniquely correlates stenosis geometry and localization with hemodynamic significance.
- Both FFRsten and EFR demonstrated highly significant positive correlations (P < 0.0001) with coronary CT angiography-derived FFR (r=0.8805 and r=0.9011, respectively).
Conclusions:
- The non-invasive comparative CFD test shows promising results for coronary artery disease prevention.
- The method offers valuable functional evaluation of stenosed coronary vessels.
- The EFR index provides a novel, localized assessment of hemodynamic significance.
Purpose:
An important aspect in the prevention and treatment of coronary artery disease is the functional evaluation of narrowed blood vessels. Medical image-based Computational Fluid Dynamic methods are currently increasingly being used in the clinical setting for flow studies of cardio vascular system. The aim of our study was to confirm the feasibility and functionality of a non-invasive computational method providing information about hemodynamic significance of coronary stenosis.
Methods:
A comparative method was used to simulate the flow energy losses in real (stenotic) and reconstructed models without (reference) stenosis of the coronary arteries under stress test conditions, i.e. for maximum blood flow and minimal, constant vascular resistance. In addition to the absolute pressure drop in the stenotic arteries (FFRsten) and in the reconstructed arteries (FFRrec), a new energy flow reference index (EFR) was also defined, which expresses the total pressure changes caused by stenosis in relation to the pressure changes in normal coronary arteries, which also allows a separate assessment of the haemodynamic significance of the atherosclerotic lesion itself. The article presents the results obtained from flow simulations in coronary arteries, reconstructed on the basis of 3D segmentation of cardiac CT images of 25 patients from retrospective data collection, with different degrees of stenoses and different areas of their occurrence.
Results:
The greater the degree of narrowing of the vessel, the greater drop of flow energy. Each parameter introduces an additional diagnostic value. In contrast to FFRsten, the EFR indices that are calculated on the basis of a comparison of stenosed and reconstructed models, are associated directly with localization, shape and geometry of stenosis only. Both FFRsten and EFR showed very significant positive correlation (P < 0.0001) with coronary CT angiography-derived FFR, with a correlation coefficient of 0.8805 and 0.9011 respectively.
Conclusion:
The study presented promising results of non-invasive, comparative test to support of prevention of coronary disease and functional evaluation of stenosed vessels.
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