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Hemodynamic influence of mild stenosis morphology in different coronary arteries: a computational fluid dynamic
Xi Chen1, Haoyao Cao1,2, Yiming Li3
1Department of Mechanics and Engineering, College Architecture and Environment, Sichuan University, Chengdu, China.
Insights
Mild coronary stenosis (20-50%) poses risks, with specific locations and degrees influencing progression to acute coronary syndromes. Hemodynamic analysis reveals distinct patterns for different stenosis severities, guiding clinical assessment.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Medical Imaging and Diagnostics
Background:
- Mild coronary stenosis (degree of stenosis < 50%) is often considered nonobstructive.
- The progression of mild stenosis to acute coronary syndromes (ACS) is unpredictable.
- Understanding hemodynamic factors is crucial for assessing the risk of mild lesions.
Purpose of the Study:
- To investigate the hemodynamic influence of various mild stenosis morphologies in coronary arteries.
- To correlate hemodynamic characteristics with the risk of plaque progression and rupture.
- To provide a basis for improved clinical assessment and management of mild coronary stenosis.
Main Methods:
- Computational fluid dynamics (CFD) analysis was employed to model coronary stenoses.
- Hemodynamic parameters including fractional flow reserve (FFR), wall shear stress (WSS), and oscillatory shear index (OSI) were calculated.
- Simulations were based on healthy individual data with varying degrees of stenosis (DS) and morphologies.
Main Results:
- Significant hemodynamic variations were observed across different DS (20-50%) and locations.
- Mild stenosis (20-30% DS) generated low time-average wall shear stress (TAWSS) (<4 dyne/cm²), indicating potential for vortex formation.
- Moderate stenosis (30-50% DS) in the left main artery and LAD resulted in high TAWSS (>40 dyne/cm²) and extensive high OSI (>0.19 cm²) areas, suggesting plaque injury risk.
Conclusions:
- While mild stenosis (FFR > 0.95) may not cause immediate ischemia, its hemodynamic profile warrants attention.
- Stenosis location and DS are critical; proximal LAD lesions (20-30% DS) show rapid progression potential.
- Lesions with 30-50% DS are associated with plaque injury and rupture risk, necessitating closer monitoring and preventive strategies.
Abstract:
Introduction: Mild stenosis [degree of stenosis (DS) < 50%] is commonly labeled as nonobstructive lesion. Some lesions remain stable for several years, while others precipitate acute coronary syndromes (ACS) rapidly. The causes of ACS and the factors leading to diverse clinical outcomes remain unclear. Method: This study aimed to investigate the hemodynamic influence of mild stenosis morphologies in different coronary arteries. The stenoses were modeled with different morphologies based on a healthy individual data. Computational fluid dynamics analysis was used to obtain hemodynamic characteristics, including flow waveforms, fractional flow reserve (FFR), flow streamlines, time-average wall shear stress (TAWSS), and oscillatory shear index (OSI). Results: Numerical simulation indicated significant hemodynamic differences among different DS and locations. In the 20%-30% range, significant large, low-velocity vortexes resulted in low TAWSS (<4 dyne/cm2) around stenoses. In the 30%-50% range, high flow velocity due to lumen area reduction resulted in high TAWSS (>40 dyne/cm2), rapidly expanding the high TAWSS area (averagely increased by 0.46 cm2) in left main artery and left anterior descending artery (LAD), where high OSI areas remained extensive (>0.19 cm2). Discussion: While mild stenosis does not pose any immediate ischemic risk due to a FFR > 0.95, 20%-50% stenosis requires attention and further subdivision based on location is essential. Rapid progression is a danger for lesions with 20%-30% DS near the stenoses and in the proximal LAD, while lesions with 30%-50% DS can cause plaque injury and rupture. These findings support clinical practice in early assessment, monitoring, and preventive treatment.
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