Patient-specific flow descriptors and normalised wall index in peripheral artery disease: a preliminary study

Background and Aims MRI-based hemodynamics have been applied to study the relationship between time-averaged wall shear stresses (TAWSS), oscillatory shear index (OSI) and atherosclerotic lesions in the coronary arteries, carotid artery, and human aorta. However, the role of TAWSS and OSI are poorly understood in lower extremity arteries. The aim of this work was to investigate the feasibility of hemodynamic assessment of the superficial femoral artery (SFA) in patients with peripheral artery disease (PAD) and we hypothesized that there is an association between TAWSS and OSI, respectively, and atherosclerotic burden expressed as the normalized wall index (NWI). Methods Six cases of 3D vascular geometries of the SFA and related inlet/outlet flow conditions were extracted from patient-specific MRI data including baseline, 12 and 24 months. Blood flow simulations were performed to compute flow descriptors, including TAWSS and OSI, and NWI. Results NWI was correlated positively with TAWSS (correlation coefficient: r = 0.592; p < 0.05). NWI was correlated negatively with OSI (correlation coefficient: r = -0.310, p < 0.01). Spatially averaged TAWSS and average NWI increased significantly between baseline and 24-months, whereas OSI decreased over 2-years. Conclusions In this pilot study with a limited sample size, TAWSS was positively associated with NWI, a measure of plaque burden, whereas OSI showed an inverse relationship. However, our findings need to be verified in a larger prospective study. MRI-based study of hemodynamics is feasible in the superficial femoral artery.

[1]  Shawn C Shadden,et al.  A longitudinal comparison of hemodynamics and intraluminal thrombus deposition in abdominal aortic aneurysms. , 2014, American journal of physiology. Heart and circulatory physiology.

[2]  E. Edelman,et al.  Prediction of the Localization of High-Risk Coronary Atherosclerotic Plaques on the Basis of Low Endothelial Shear Stress: An Intravascular Ultrasound and Histopathology Natural History Study , 2008, Circulation.

[3]  Mark Woodward,et al.  Cross-sectional, prospective study of MRI reproducibility in the assessment of plaque burden of the carotid arteries and aorta. , 2009, Nature clinical practice. Cardiovascular medicine.

[4]  D. Ku,et al.  Pulsatile Flow and Atherosclerosis in the Human Carotid Bifurcation: Positive Correlation between Plaque Location and Low and Oscillating Shear Stress , 1985, Arteriosclerosis.

[5]  Zahi A Fayad,et al.  Variations in atherosclerosis and remodeling patterns in aorta and carotids , 2010, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[6]  K Perktold,et al.  Numerical simulation of pulsatile flow in a carotid bifurcation model. , 1986, Journal of biomedical engineering.

[7]  C Kleinstreuer,et al.  Hemodynamics simulation and identification of susceptible sites of atherosclerotic lesion formation in a model abdominal aorta. , 2003, Journal of biomechanics.

[8]  J. Schaller,et al.  MRI‐based computational fluid dynamics for diagnosis and treatment prediction: Clinical validation study in patients with coarctation of aorta , 2015, Journal of magnetic resonance imaging : JMRI.

[9]  Claudio Chiastra,et al.  On the necessity of modelling fluid-structure interaction for stented coronary arteries. , 2014, Journal of the mechanical behavior of biomedical materials.

[10]  R. Nerem.  Vascular fluid mechanics, the arterial wall, and atherosclerosis. , 1992, Journal of biomechanical engineering.

[11]  P. Faries,et al.  Shifting Paradigms in the Treatment of Lower Extremity Vascular Disease: A Report of 1000 Percutaneous Interventions , 2007, Annals of surgery.

[12]  A. Lumsden,et al.  Peripheral Arterial Occlusive Disease: Magnetic Resonance Imaging and the Role of Aggressive Medical Management , 2007, World Journal of Surgery.

[13]  D. Ku,et al.  Pulsatile flow in the human left coronary artery bifurcation: average conditions. , 1996, Journal of biomechanical engineering.

[14]  F. Migliavacca,et al.  Computational fluid dynamic simulations of image-based stented coronary bifurcation models , 2013, Journal of The Royal Society Interface.

[15]  L. Antiga,et al.  Correlations among indicators of disturbed flow at the normal carotid bifurcation. , 2009, Journal of biomechanical engineering.

[16]  D. Tang,et al.  Influence of non-Newtonian properties of blood on the wall shear stress in human atherosclerotic right coronary arteries. , 2011, Molecular & cellular biomechanics : MCB.

[17]  C. Walker,et al.  Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease , 2015, Clinical interventions in aging.

[18]  S Glagov,et al.  The role of fluid mechanics in the localization and detection of atherosclerosis. , 1993, Journal of biomechanical engineering.

[19]  R. Kim,et al.  Magnetic resonance evaluation of peripheral arterial disease. , 2007, Cardiology clinics.

[20]  Eric Y. Yang,et al.  The Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial (ELIMIT). , 2013, Atherosclerosis.

[21]  Matts Karlsson,et al.  WALL SHEAR STRESS IN A SUBJECT SPECIFIC HUMAN AORTA - INFLUENCE OF FLUID-STRUCTURE INTERACTION , 2011 .

[22]  Cornelius Weiller,et al.  In vivo assessment of wall shear stress in the atherosclerotic aorta using flow‐sensitive 4D MRI , 2010, Magnetic resonance in medicine.

[23]  D. Steinman,et al.  On the relative importance of rheology for image-based CFD models of the carotid bifurcation. , 2007, Journal of biomechanical engineering.

[24]  Fernando Calamante,et al.  Estimation of bolus dispersion effects in perfusion MRI using image-based computational fluid dynamics , 2003, NeuroImage.

[25]  Michael Markl,et al.  Time‐resolved three‐dimensional phase‐contrast MRI , 2003, Journal of magnetic resonance imaging : JMRI.

[26]  L. Kuller,et al.  Lower extremity arterial disease in elderly subjects with systolic hypertension. , 1991, Journal of clinical epidemiology.

[27]  S. Deutsch,et al.  Comparative Study of Continuous and Pulsatile Left Ventricular Assist Devices on Hemodynamics of a Pediatric End-to-Side Anastomotic Graft , 2010, Cardiovascular engineering and technology.

[28]  Shaolie S. Hossain,et al.  Magnetic resonance imaging-based computational modelling of blood flow and nanomedicine deposition in patients with peripheral arterial disease , 2015, Journal of The Royal Society Interface.

[29]  Mark Woodward,et al.  Journal of Cardiovascular Magnetic Resonance Open Access Cardiovascular Magnetic Resonance Parameters of Atherosclerotic Plaque Burden Improve Discrimination of Prior Major Adverse Cardiovascular Events Background , 2022 .

[30]  J. Armitage,et al.  Haemodynamical stress in mouse aortic arch with atherosclerotic plaques: Preliminary study of plaque progression , 2014, Computational and structural biotechnology journal.

[31]  D. de Beer,et al.  Longitudinal Telomere Erosion in Lymphocyte Subsets of Patients with Atherosclerotic Peripheral Arterial Disease (PAD). , 2015, Journal of clinical and diagnostic research : JCDR.

[32]  G. Hutchins,et al.  Correlation between wall shear and intimal thickness at a coronary artery branch. , 1987, Atherosclerosis.

[33]  Gregory B. Lim.  Vascular disease: Peripheral artery disease pandemic , 2013, Nature Reviews Cardiology.

[34]  Shaohua Chen,et al.  Prediction of the initial thickness of shear band localization based on a reduced strain gradient theory , 2011 .

[35]  J. S. Lee,et al.  A linear relation between the compressibility and density of blood. , 2001, The Journal of the Acoustical Society of America.

[36]  Chun Yuan,et al.  MRI of carotid atherosclerosis , 2008, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[37]  S. Alper,et al.  Hemodynamic shear stress and its role in atherosclerosis. , 1999, JAMA.

[38]  Jürgen Hennig,et al.  Three‐dimensional analysis of segmental wall shear stress in the aorta by flow‐sensitive four‐dimensional‐MRI , 2009, Journal of magnetic resonance imaging : JMRI.

[39]  B. Rutt,et al.  Reconstruction of carotid bifurcation hemodynamics and wall thickness using computational fluid dynamics and MRI , 2002, Magnetic resonance in medicine.

[40]  R. Virmani,et al.  Mechanisms of Plaque Formation and Rupture , 2014 .

[41]  Igor Rudan,et al.  Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis , 2013, The Lancet.

[42]  Barbara M. Johnston,et al.  Non-Newtonian blood flow in human right coronary arteries: transient simulations. , 2006, Journal of biomechanics.

[43]  A. Gardner,et al.  Management of lower extremity peripheral arterial disease. , 2008, Journal of cardiopulmonary rehabilitation and prevention.

[44]  A. Nicolaides,et al.  Medical management of patients with peripheral arterial disease. , 2015, International angiology : a journal of the International Union of Angiology.

[45]  Chun Yuan,et al.  Predictors of carotid atherosclerotic plaque progression as measured by noninvasive magnetic resonance imaging. , 2007, Atherosclerosis.

[46]  David A. Steinman,et al.  Image-Based Modeling of Blood Flow and Vessel Wall Dynamics: Applications, Methods and Future Directions , 2010, Annals of Biomedical Engineering.

[47]  Ahmed Tawakol,et al.  Safety and efficacy of dalcetrapib on atherosclerotic disease using novel non-invasive multimodality imaging (dal-PLAQUE): a randomised clinical trial , 2011, The Lancet.

[48]  D. Bilecen,et al.  Integration of the computational fluid dynamics technique with MRI in aortic dissections , 2013, Magnetic resonance in medicine.

[49]  Cornelius Weiller,et al.  In Vivo Wall Shear Stress Distribution in the Carotid Artery: Effect of Bifurcation Geometry, Internal Carotid Artery Stenosis, and Recanalization Therapy , 2010, Circulation. Cardiovascular imaging.

[50]  David A Steinman,et al.  Image-based computational fluid dynamics: a new paradigm for monitoring hemodynamics and atherosclerosis. , 2004, Current drug targets. Cardiovascular & haematological disorders.

[51]  C. Caro.  Discovery of the Role of Wall Shear in Atherosclerosis , 2009, Arteriosclerosis, thrombosis, and vascular biology.

[52]  T. Rassaf,et al.  Local Association Between Endothelial Dysfunction and Intimal Hyperplasia: Relevance in Peripheral Artery Disease , 2015, Journal of the American Heart Association.