Angiography-Based 4-Dimensional Superficial Wall Strain and Stress: A New Diagnostic Tool in the Catheterization Laboratory

Frontiers in Cardiovascular Medicine

Clemens von Birgelen¹  Johan H.C. Reiber²  Christos V. Bourantas⁴  Shengxian Tu⁵  Patrick W. Serruys⁶  Hideyuki Kawashima⁷  Masafumi Ono⁷  Yoshinobu Onuma⁸  Rutao Wang⁹  Chao Gao⁹  Ryo Torii^1,10  Eric K.W. Poon^1,11  Peter Barlis^1,12  William Wijns^1,14  Xinlei Wu^1,14  Atif Shahzad^1,14 

[1] 0Department of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands;1Department of Radiology, Leiden University Medical Center, Leiden, Netherlands;2Institute of Cardiovascular Science, University College London, London, United Kingdom;3Department of Cardiology, Barts Heart Centre, London, United Kingdom;4School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China;5Imperial College London, National Heart and Lung Institute, London, United Kingdom;Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands;Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland;Department of Cardiology, Xijing Hospital, Xi'an, China;Department of Mechanical Engineering, University College London, London, United Kingdom;Department of Medicine, Melbourne Medical School, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia;Faculty of Medicine, Dentistry Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia;Institute of Cardiovascular Development and Translational Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China;Smart Sensors Lab, National University of Ireland Galway (NUIG), Galway, Ireland;Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands;

关键词: invasive coronary angiography;    coronary artery dynamics;    superficial wall strain;    quantitative assessment method;    computational coronary pathophysiology;   

DOI  :  10.3389/fcvm.2021.667310

来源: DOAJ

【 摘 要 】

A novel method for four-dimensional superficial wall strain and stress (4D-SWS) is derived from the arterial motion as pictured by invasive coronary angiography. Compared with the conventional finite element analysis of cardiovascular biomechanics using the estimated pulsatile pressure, the 4D-SWS approach can calculate the dynamic mechanical state of the superficial wall in vivo, which could be directly linked with plaque rupture or stent fracture. The validation of this approach using in silico models showed that the distribution and maximum values of superficial wall stress were similar to those calculated by conventional finite element analysis. The in vivo deformation was validated on 16 coronary arteries, from the comparison of centerlines predicted by the 4D-SWS approach against the actual centerlines reconstructed from angiograms at a randomly selected time-point, which demonstrated a good agreement of the centerline morphology between both approaches (scaling: 0.995 ± 0.018 and dissimilarity: 0.007 ± 0.014). The in silico vessel models with softer plaque and larger plaque burden presented more variation in mean lumen diameter and resulted in higher superficial wall stress. In more than half of the patients (n = 16), the maximum superficial wall stress was found at the proximal lesion shoulder. Additionally, in three patients who later suffered from acute coronary syndrome, the culprit plaque rupture sites co-localized with the site of highest superficial wall stress on their baseline angiography. These representative cases suggest that angiography-based superficial wall dynamics have the potential to identify coronary segments at high-risk of plaque rupture and fracture sites of implanted stents. Ongoing studies are focusing on identifying weak spots in coronary bypass grafts, and on exploring the biomechanical mechanisms of coronary arterial remodeling and aneurysm formation. Future developments involve integration of fast computational techniques to allow online availability of superficial wall strain and stress in the catheterization laboratory.

【 授权许可】

Unknown