Numerical modeling of the flow in stenosed coronary artery. The relationship between main hemodynamic parameters

The severity of coronary arterial stenosis is usually measured by either simple geometrical parameters, such as percent diameter stenosis, or hemodynamically based parameters, such as the fractional flow reserve (FFR) or coronary flow reserve (CFR). The present study aimed to establish a relationship between actual hemodynamic conditions and the parameters that define stenosis severity in the clinical setting. We used a computational model of the blood flow in a vessel with a blunt stenosis and an autoregulated vascular bed to simulate a stenosed blood vessel. A key point in creating realistic simulations is to properly model arterial autoregulation. A constant flow regulation mechanism resulted in CFR and FFR values that were within the physiological range, while a constant wall-shear stress model yielded unrealistic values. The simulation tools developed in the present study may be useful in the clinical assessment of single and multiple stenoses by means of minimally invasive methods.

[1]  D. F. Young,et al.  Flow characteristics in models of arterial stenoses. II. Unsteady flow. , 1973, Journal of biomechanics.

[2]  D. Atar,et al.  Assessment of coronary artery stenosis pressure gradient by quantitative coronary arteriography in patients with coronary artery disease. , 1994, Clinical physiology.

[3]  D. F. Young,et al.  Flow characteristics in models of arterial stenoses. I. Steady flow. , 1973, Journal of biomechanics.

[4]  Don P. Giddens,et al.  Response of Arteries to Near-Wall Fluid Dynamic Behavior , 1990 .

[5]  A. Pries,et al.  Design principles of vascular beds. , 1995, Circulation research.

[6]  C D Murray,et al.  The Physiological Principle of Minimum Work: I. The Vascular System and the Cost of Blood Volume. , 1926, Proceedings of the National Academy of Sciences of the United States of America.

[7]  S. Orszag,et al.  Renormalization group analysis of turbulence. I. Basic theory , 1986 .

[8]  P. Serruys,et al.  Principles of interpretation of coronary velocity and pressure tracings. , 1995, European heart journal.

[9]  J D Laird,et al.  Diastolic‐Systolic Coronary Flow Differences are Caused by Intramyocardial Pump Action in the Anesthetized Dog , 1981, Circulation research.

[10]  C. D. Murray THE PHYSIOLOGICAL PRINCIPLE OF MINIMUM WORK , 1931, The Journal of general physiology.

[11]  S. Orszag,et al.  Renormalization group analysis of turbulence. I. Basic theory , 1986, Physical review letters.

[12]  S. Kaul,et al.  Role of capillaries in determining CBF reserve: new insights using myocardial contrast echocardiography. , 1999, The American journal of physiology.

[13]  Harold D. Green,et al.  REGISTRATION AND INTERPRETATION OF NORMAL PHASIC INFLOW INTO A LEFT CORONARY ARTERY BY AN IMPROVED DIFFERENTIAL MANOMETRIC METHOD , 1940 .

[14]  E L Bolson,et al.  Experimental Validation of Quantitative Coronary Arteriography for Determining Pressure-Flow Characteristics of Coronary Stenosis , 1982, Circulation.

[15]  R. Erbel,et al.  Improved assessment of coronary stenosis severity using the relative flow velocity reserve. , 1998, Circulation.

[16]  B. Bruyne,et al.  Coronary Pressure , 1997, Developments in Cardiovascular Medicine.

[17]  Yasuo Ogasawara,et al.  Intramyocardial Influences on Blood Flow Distributions in the Myocardial Wall , 2000, Annals of Biomedical Engineering.

[18]  M. Kern,et al.  From research to clinical practice: current role of intracoronary physiologically based decision making in the cardiac catheterization laboratory. , 1997, Journal of the American College of Cardiology.

[19]  S. Nakatani,et al.  Intravascular ultrasonic evidence for importance of plaque distribution (eccentric vs circumferential) in determining distensibility of the left anterior descending artery. , 1997, The American journal of cardiology.

[20]  N Westerhof,et al.  Effect of ventricular contraction, pressure, and wall stretch on vessels at different locations in the wall. , 1997, The American journal of physiology.

[21]  G W Hamilton,et al.  Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. , 1974, The American journal of cardiology.

[22]  E S Kirk,et al.  Inhibition of Coronary Blood Flow by a Vascular Waterfall Mechanism , 1975, Circulation research.

[23]  P. Serruys,et al.  Utilization of translesional hemodynamics: comparison of pressure and flow methods in stenosis assessment in patients with coronary artery disease. , 1996, Catheterization and cardiovascular diagnosis.

[24]  R. Vogel Assessing the Hemodynamics of Coronary Artery Stenosis , 1988 .

[25]  E Fleck,et al.  Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: the DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe). , 1997, Circulation.

[26]  T. Togawa,et al.  Adaptive regulation of wall shear stress optimizing vascular tree function. , 1984, Bulletin of mathematical biology.