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Updated: Aug 5, 2025
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Validation of a novel numerical model to predict regionalized blood flow in the coronary arteries
Daniel J Taylor1, Jeroen Feher2, Krzysztof Czechowicz1
1Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK.
Insights
A new computational fluid dynamics (CFD) method regionalizes coronary blood flow along the artery length. This approach differentiates inlet, outlet, and side branch flows, aiding in assessing ischaemic heart disease during angiography.
Area of Science:
- Cardiovascular Science
- Medical Imaging
- Computational Fluid Dynamics
Background:
- Ischaemic heart disease stems from reduced coronary blood flow, a critical parameter not routinely measured in catheterization labs.
- Interventional cardiologists currently use surrogate markers due to the lack of direct absolute flow measurements (mL/min).
- Previous work introduced a CFD method to predict flow dynamics, differentiating inlet, side branch, and outlet flows.
Purpose of the Study:
- To evaluate a novel computational fluid dynamics (CFD) method for regionalizing coronary blood flow along the arterial length.
- To assess the accuracy of this regionalized flow model against invasive measurements.
- To determine the clinical applicability of CFD-based flow regionalization in diagnosing coronary artery disease.
Main Methods:
- Three-dimensional coronary anatomy was reconstructed from patient angiograms.
- Computational fluid dynamics (CFD) was employed to compute blood flow, modeling side branches as porous walls.
- Two CFD models were tested: a homogeneous model and a regionalized model based on local arterial taper. Flow results were validated against invasive thermodilution measurements.
Main Results:
- Both homogeneous and regionalized CFD models showed good correlation with invasive flow measurements (r=0.47 and r=0.43, respectively).
- Both models exhibited zero bias, indicating no systematic over- or underestimation of flow.
- The regionalized model, considering local taper, provided flow quantification relative to invasive measures.
Conclusions:
- Coronary flow can be regionalized and differentiated at various arterial points (inlet, outlet, side branches) using CFD during angiography.
- The CFD model's accuracy in assessing flow agreement is influenced by epicardial disease.
- This regionalized CFD approach may be particularly beneficial for cases involving stenosis near arterial side branches.
Aims:
Ischaemic heart disease results from insufficient coronary blood flow. Direct measurement of absolute flow (mL/min) is feasible, but has not entered routine clinical practice in most catheterization laboratories. Interventional cardiologists, therefore, rely on surrogate markers of flow. Recently, we described a computational fluid dynamics (CFD) method for predicting flow that differentiates inlet, side branch, and outlet flows during angiography. In the current study, we evaluate a new method that regionalizes flow along the length of the artery.
Methods And Results:
Three-dimensional coronary anatomy was reconstructed from angiograms from 20 patients with chronic coronary syndrome. All flows were computed using CFD by applying the pressure gradient to the reconstructed geometry. Side branch flow was modelled as a porous wall boundary. Side branch flow magnitude was based on morphometric scaling laws with two models: a homogeneous model with flow loss along the entire arterial length; and a regionalized model with flow proportional to local taper. Flow results were validated against invasive measurements of flow by continuous infusion thermodilution (Coroventis™, Abbott). Both methods quantified flow relative to the invasive measures: homogeneous (r 0.47, P 0.006; zero bias; 95% CI -168 to +168 mL/min); regionalized method (r 0.43, P 0.013; zero bias; 95% CI -175 to +175 mL/min).
Conclusion:
During angiography and pressure wire assessment, coronary flow can now be regionalized and differentiated at the inlet, outlet, and side branches. The effect of epicardial disease on agreement suggests the model may be best targeted at cases with a stenosis close to side branches.
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