Sengupta Dibyendu, Kahn Andrew M, Kung Ethan, Esmaily Moghadam Mahdi, Shirinsky Olga, Lyskina Galina A, Burns Jane C, Marsden Alison L
Department of Mechanical and Aerospace Engineering, University of California San Diego, 9500 Gilman Dr., La Jolla, CA , 92037, USA.
Biomech Model Mechanobiol. 2014 Nov;13(6):1261-76. doi: 10.1007/s10237-014-0570-z. Epub 2014 Apr 11.
Kawasaki disease (KD) is the leading cause of acquired heart disease in children and can result in life-threatening coronary artery aneurysms in up to 25 % of patients. These aneurysms put patients at risk of thrombus formation, myocardial infarction, and sudden death. Clinicians must therefore decide which patients should be treated with anticoagulant medication, and/or surgical or percutaneous intervention. Current recommendations regarding initiation of anticoagulant therapy are based on anatomy alone with historical data suggesting that patients with aneurysms [Formula: see text]8 mm are at greatest risk of thrombosis. Given the multitude of variables that influence thrombus formation, we postulated that hemodynamic data derived from patient-specific simulations would more accurately predict risk of thrombosis than maximum diameter alone. Patient-specific blood flow simulations were performed on five KD patients with aneurysms and one KD patient with normal coronary arteries. Key hemodynamic and geometric parameters, including wall shear stress, particle residence time, and shape indices, were extracted from the models and simulations and compared with clinical outcomes. Preliminary fluid structure interaction simulations with radial expansion were performed, revealing modest differences in wall shear stress compared to the rigid wall case. Simulations provide compelling evidence that hemodynamic parameters may be a more accurate predictor of thrombotic risk than aneurysm diameter alone and motivate the need for follow-up studies with a larger cohort. These results suggest that a clinical index incorporating hemodynamic information be used in the future to select patients for anticoagulant therapy.
川崎病（KD）是儿童后天性心脏病的主要病因，高达25%的患者可能会出现危及生命的冠状动脉瘤。这些动脉瘤使患者面临血栓形成、心肌梗死和猝死的风险。因此，临床医生必须决定哪些患者应接受抗凝药物治疗，和/或手术或经皮介入治疗。目前关于启动抗凝治疗的建议仅基于解剖学，历史数据表明，动脉瘤直径≥8毫米的患者血栓形成风险最高。鉴于影响血栓形成的变量众多，我们推测，从患者特异性模拟中得出的血流动力学数据比单独的最大直径更能准确预测血栓形成风险。对5例患有动脉瘤的KD患者和1例冠状动脉正常的KD患者进行了患者特异性血流模拟。从模型和模拟中提取关键的血流动力学和几何参数，包括壁面剪应力、颗粒停留时间和形状指数，并与临床结果进行比较。进行了初步的伴有径向扩张的流固耦合模拟，结果显示与刚性壁情况相比，壁面剪应力存在适度差异。模拟提供了令人信服的证据，表明血流动力学参数可能比单独的动脉瘤直径更能准确预测血栓形成风险，并促使有必要对更大的队列进行后续研究。这些结果表明，未来应使用纳入血流动力学信息的临床指标来选择接受抗凝治疗的患者。
