Department of Engineering, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
Department of Mechanical Design, College of Mechanical Engineering, Taiyuan University of Technology, Taiyuan, P.R. China.
Proc Inst Mech Eng H. 2020 Nov;234(11):1187-1196. doi: 10.1177/0954411920947972. Epub 2020 Aug 4.
Coronary arterial disease, as the most devastated cardiovascular disease, is caused by the atherosclerosis in the coronary arteries, which blocks the blood flow to the heart, resulting in the deficient supply of oxygen and nutrition to the heart, and eventually leading to heart failure. To date, haemodynamic mechanisms for atherosclerosis development are not fully understood although it is believed that the haemodynamic disturbance at the region of the arterial bifurcation, particular, bifurcation angle, plays an important role in the atherosclerosis development. In this study, two types of computational fluid dynamics models, lesion-specific and idealized models, combined with the computer tomography imaging techniques, are used to explore the mechanism of formation and distribution of the atherosclerosis around the bifurcation of left coronary artery and its association with the bifurcation angle. The lesion-specific model is used to characterize the effect of personalized features on the haemodynamic performance, while the idealized model is focusing on the effect of single factor, bifurcation angle, on the haemodynamic performance. The simulated results from both types of the models, combined with the clinical observation, revealed that the three key areas around the bifurcations are prone to formation of the atherosclerosis. Unlike the idealized models, lesion-specific modelling results did not show the significant correlation between the wall shear stress and bifurcation angle, although the mean value of the wall shear stress in smaller bifurcation angles (less than 90°) is higher than that with larger bifurcation angles (greater than 90°). In conclusion, lesion-specific computational fluid dynamics modelling is an efficient and convenient way to predict the haemodynamic performance around the bifurcation region, allowing the comprehensive information for the clinicians to predict the atherosclerosis development. The idealized models, which only focus on single parameter, may not provide the sufficient and reliable information for the clinical application. A novel multi-parameters modelling technique, therefore, is suggested to be developed in future, allowing the effects of many parameters on the haemodynamic performance to be evaluated.
冠状动脉疾病是最具破坏性的心血管疾病之一，它是由冠状动脉中的动脉粥样硬化引起的，这种硬化会阻塞血液流向心脏，导致心脏供氧和营养不足，最终导致心力衰竭。尽管人们认为动脉分叉处的血液动力学紊乱，特别是分叉角度，在动脉粥样硬化的发展中起着重要作用，但目前对于动脉粥样硬化发展的血液动力学机制还不完全了解。在这项研究中，使用了两种类型的计算流体动力学模型，即病变特异性和理想化模型，并结合计算机断层扫描成像技术，来探索左冠状动脉分叉处周围动脉粥样硬化形成和分布的机制及其与分叉角度的关系。病变特异性模型用于描述个性化特征对血液动力学性能的影响，而理想化模型则专注于单一因素（分叉角度）对血液动力学性能的影响。这两种类型的模型的模拟结果，结合临床观察，揭示了分叉处周围的三个关键区域容易形成动脉粥样硬化。与理想化模型不同，病变特异性建模结果并未显示壁面切应力与分叉角度之间存在显著相关性，尽管较小分叉角度（小于 90°）的壁面切应力平均值高于较大分叉角度（大于 90°）。总之，病变特异性计算流体动力学建模是一种预测分叉区域血液动力学性能的有效且方便的方法，可以为临床医生提供全面的信息，以便预测动脉粥样硬化的发展。仅关注单一参数的理想化模型可能无法为临床应用提供足够可靠的信息。因此，建议开发一种新的多参数建模技术，以评估许多参数对血液动力学性能的影响。
