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在冠状动脉粥样硬化中壁切应力拓扑与多向性的非线性关系。

On the nonlinear relationship between wall shear stress topology and multi-directionality in coronary atherosclerosis.

机构信息

School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia.

School of Mechanical Engineering, University of Adelaide, Adelaide, South Australia 5005, Australia.

出版信息

Comput Methods Programs Biomed. 2023 Apr;231:107418. doi: 10.1016/j.cmpb.2023.107418. Epub 2023 Feb 20.

Abstract

BACKGROUND AND OBJECTIVE

In this paper we investigate twelve multi-directional/topological wall shear stress (WSS) derived metrics and their relationships with the formation of coronary plaques in both computational fluid dynamics (CFD) and dynamic fluid-structure interaction (FSI) frameworks. While low WSS is one of the most established biomechanical markers associated with coronary atherosclerosis progression, alone it is limited. Multi-directional and topological WSS derived metrics have been shown to be important in atherosclerosis related mechanotransduction and near-wall transport processes. However, the relationships between these twelve WSS metrics and the influence of both FSI simulations and coronary dynamics is understudied.

METHODS

We first investigate the relationships between these twelve WSS derived metrics, stenosis percentage and lesion length through a parametric, transient CFD study. Secondly, we extend the parametric study to FSI, both with and without the addition of coronary dynamics, and assess their correlations. Finally, we present the case of a patient who underwent invasive coronary angiography and optical coherence tomography imaging at two time points 18 months apart. Associations between each of the twelve WSS derived metrics in CFD, static FSI and dynamic FSI simulations were assessed against areas of positive/negative vessel remodelling, and changes in plaque morphology.

RESULTS

22-32% stenosis was the threshold beyond which adverse multi-directional/topological WSS results. Each metric produced a different relationship with changing stenoses and lesion length. Transient haemodynamics was impacted by coronary dynamics, with the topological shear variation index suppressed by up to 94%. These changes appear more critical at smaller stenosis levels, suggesting coronary dynamics could play a role in the earlier stages of atherosclerosis development. In the patient case, both dynamics and FSI vs CFD changes altered associations with measured changes in plaque morphology. An appendix of the linear fits between the various FSI- and CFD-based simulations is provided to assist in scaling CFD-based results to resemble the compliant walled characteristics of FSI more accurately.

CONCLUSIONS

These results highlight the potential for coronary dynamics to alter multi-directional/topological WSS metrics which could impact associations with changes in coronary atherosclerosis over time. These results warrant further investigation in a wider range of morphological settings and longitudinal cohort studies in the future.

摘要

背景与目的

本文研究了十二种多向/拓扑壁面剪切应力(WSS)衍生指标及其在计算流体动力学(CFD)和动态流固相互作用(FSI)框架下与冠状动脉斑块形成的关系。虽然低壁面剪切应力是与冠状动脉粥样硬化进展最相关的生物力学标志物之一,但它本身是有限的。多向和拓扑壁面剪切应力衍生指标已被证明在与动脉粥样硬化相关的力学转导和近壁面输运过程中很重要。然而,这些十二种壁面剪切应力指标之间的关系以及FSI 模拟和冠状动脉动力学的影响尚未得到充分研究。

方法

我们首先通过参数瞬态 CFD 研究调查了这十二种壁面剪切应力衍生指标、狭窄百分比和病变长度之间的关系。其次,我们将参数研究扩展到 FSI,包括有无冠状动脉动力学,并评估它们的相关性。最后,我们介绍了一位患者的病例,该患者在 18 个月的时间间隔内进行了两次侵入性冠状动脉造影和光学相干断层扫描成像。评估了 CFD、静态 FSI 和动态 FSI 模拟中这十二种壁面剪切应力衍生指标中的每一种与正/负血管重塑区域以及斑块形态变化之间的相关性。

结果

22%-32%的狭窄是导致不良多向/拓扑壁面剪切应力结果的阈值。每个指标与变化的狭窄和病变长度都产生了不同的关系。冠状动脉动力学影响瞬态血流动力学,拓扑剪切变化指数最高可降低 94%。这些变化在较小的狭窄水平下似乎更为关键,这表明冠状动脉动力学可能在动脉粥样硬化发展的早期阶段发挥作用。在患者病例中,动力学和 FSI 与 CFD 的变化改变了与测量的斑块形态变化之间的相关性。提供了一个附录,其中包含了各种 FSI 和 CFD 模拟之间的线性拟合,以帮助将 CFD 结果缩放为更准确地类似于 FSI 的顺应性壁特征。

结论

这些结果强调了冠状动脉动力学改变多向/拓扑壁面剪切应力指标的潜力,这可能会影响随着时间的推移冠状动脉粥样硬化的变化之间的相关性。这些结果需要在更广泛的形态设置和未来的纵向队列研究中进一步研究。

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