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Patient-Specific Fluid-Structure Interaction Simulations Suggest Wall-Shear-Stress-Related Biomarkers in Type B
Yufan Wu1, Krashn Kr Dwivedi1, Hadi Wiputra2
1Department of Mechanical Engineering and Materials Science, Washington University, One Brookings Dr., MSC 1185-208-125, Saint Louis, MO, 63130, USA.
Insights
New biomarkers measuring wall shear stress show promise for monitoring chronic type B dissection in Marfan syndrome (MFS) patients. These metrics correlate with aortic size and dissection progression, potentially improving clinical management.
Area of Science:
- Cardiovascular research
- Biomedical engineering
- Medical imaging analysis
Background:
- Chronic type B dissection, a tear in the descending aorta (DSC) lasting over three months, can lead to aortic dilation and organ damage.
- Connective tissue disorders like Marfan syndrome (MFS) increase the risk of chronic type B dissection.
- Current surveillance relies on aortic diameter and growth rate, which are geometric and do not capture hemodynamic changes.
Purpose of the Study:
- To assess changes in aortic geometry and hemodynamics in chronic type B dissection.
- To investigate wall-shear-stress-related biomarkers for improved clinical treatment and prognostic assessment.
- To evaluate the utility of these biomarkers in Marfan syndrome patients.
Main Methods:
- Fluid-structure interaction simulations were performed on MFS patient images before and after type B dissection.
- Shear-stress-related metrics, including endothelial cell activation potential and relative residence time, were quantified.
- Variations in these metrics over the DSC length were correlated with geometrical parameters like maximum DSC diameter and false lumen volume index.
Main Results:
- Endothelial cell activation potential and relative residence time variations correlated with maximum DSC diameter.
- Oscillatory shear index variation correlated with the false lumen volume index.
- These findings suggest a link between hemodynamic changes and disease progression metrics.
Conclusions:
- Shear-stress-related metrics show potential as noninvasive biomarkers for chronic type B dissection.
- These biomarkers may enhance surveillance and management strategies for MFS patients.
- Further research could integrate hemodynamic data into clinical decision-making for aortic dissection.
Purpose:
Chronic type B dissection is a cardiovascular complication that occurs in the descending aorta (DSC), involving a tear at the inner wall that is present for more than three months. It can cause progressive aortic dilation, organ malperfusion, and further tearing of the aortic wall. Connective tissue disorders, such as Marfan syndrome (MFS), are associated with chronic type B dissection. Aortic diameter and growth rate are the current surveillance metrics and surgical/interventional criteria for chronic type B dissection. However, they are geometric metrics and fail to capture the hemodynamic changes that may contribute to an increased risk of adverse cardiovascular events. This study aimed to assess changes in aortic geometry and hemodynamics and investigate potential wall-shear-stress-related biomarkers to improve clinical treatment and prognostic assessment of chronic type B dissection.
Methods:
Fluid-structure interaction simulations on MFS patient images before and after type B dissection were performed. Shear-stress-related metrics were quantified, and their variation over the DSC length was correlated with geometrical parameters that have been used as measures of disease progression.
Results:
Patterns of variation over the DSC length for endothelial cell activation potential and relative residence time, two metrics that combine oscillatory shear index and time-averaged wall shear stress, correlated with maximum DSC diameter before and after dissection. Oscillatory shear index variation over the DSC length correlated with the false lumen volume index after dissection.
Conclusion:
Shear-stress-related metrics hold promise as noninvasive biomarkers for chronic type B dissection surveillance and management in MFS.
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