Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation
<i>Background.</i> The treatment of coronary stenosis is decided by performing high risk invasive surgery to generate the fractional flow reserve diagnostics index, a ratio of distal to proximal pressures in respect of coronary atherosclerotic plaques. Non-invasive methods are a need of...
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MDPI AG
2022-04-01
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| Online Access: | https://www.mdpi.com/2076-3417/12/9/4281 |
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| author | Jermiah J. Joseph Clara Sun Ting-Yim Lee Daniel Goldman Sanjay R. Kharche Christopher W. McIntyre |
| author_facet | Jermiah J. Joseph Clara Sun Ting-Yim Lee Daniel Goldman Sanjay R. Kharche Christopher W. McIntyre |
| author_sort | Jermiah J. Joseph |
| collection | DOAJ |
| description | <i>Background.</i> The treatment of coronary stenosis is decided by performing high risk invasive surgery to generate the fractional flow reserve diagnostics index, a ratio of distal to proximal pressures in respect of coronary atherosclerotic plaques. Non-invasive methods are a need of the times that necessitate the use of mathematical models of coronary hemodynamic physiology. This study proposes an extensible mathematical description of the coronary vasculature that provides an estimate of coronary fractional flow reserve. <i>Methods.</i> By adapting an existing computational model of human coronary blood flow, the effects of large vessel stenosis and microvascular disease on fractional flow reserve were quantified. Several simulations generated flow and pressure information, which was used to compute fractional flow reserve under several conditions including focal stenosis, diffuse stenosis, and microvascular disease. Sensitivity analysis was used to uncover the influence of model parameters on fractional flow reserve. The model was simulated as coupled non-linear ordinary differential equations and numerically solved using our implicit higher order method. <i>Results.</i> Large vessel stenosis affected fractional flow reserve. The model predicts that the presence, rather than severity, of microvascular disease affects coronary flow deleteriously. <i>Conclusions.</i> The model provides a computationally inexpensive instrument for future in silico coronary blood flow investigations as well as clinical-imaging decision making. A combination of focal and diffuse stenosis appears to be essential to limit coronary flow. In addition to pressure measurements in the large epicardial vessels, diagnosis of microvascular disease is essential. The independence of the index with respect to heart rate suggests that computationally inexpensive steady state simulations may provide sufficient information to reliably compute the index. |
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| language | English |
| last_indexed | 2024-03-10T04:23:03Z |
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| spelling | doaj.art-987f3b76647e4a54b419a40a266e4c152023-11-23T07:46:52ZengMDPI AGApplied Sciences2076-34172022-04-01129428110.3390/app12094281Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve EstimationJermiah J. Joseph0Clara Sun1Ting-Yim Lee2Daniel Goldman3Sanjay R. Kharche4Christopher W. McIntyre5Lawson Health Research Institute, Western University, 750 Baseline Road East, London, ON N6C 2R5, CanadaLawson Health Research Institute, Western University, 750 Baseline Road East, London, ON N6C 2R5, CanadaDepartment of Medical Biophysics, Western University, 1151 Richmond Street North, London, ON N6A 5C1, CanadaDepartment of Medical Biophysics, Western University, 1151 Richmond Street North, London, ON N6A 5C1, CanadaLawson Health Research Institute, Western University, 750 Baseline Road East, London, ON N6C 2R5, CanadaLawson Health Research Institute, Western University, 750 Baseline Road East, London, ON N6C 2R5, Canada<i>Background.</i> The treatment of coronary stenosis is decided by performing high risk invasive surgery to generate the fractional flow reserve diagnostics index, a ratio of distal to proximal pressures in respect of coronary atherosclerotic plaques. Non-invasive methods are a need of the times that necessitate the use of mathematical models of coronary hemodynamic physiology. This study proposes an extensible mathematical description of the coronary vasculature that provides an estimate of coronary fractional flow reserve. <i>Methods.</i> By adapting an existing computational model of human coronary blood flow, the effects of large vessel stenosis and microvascular disease on fractional flow reserve were quantified. Several simulations generated flow and pressure information, which was used to compute fractional flow reserve under several conditions including focal stenosis, diffuse stenosis, and microvascular disease. Sensitivity analysis was used to uncover the influence of model parameters on fractional flow reserve. The model was simulated as coupled non-linear ordinary differential equations and numerically solved using our implicit higher order method. <i>Results.</i> Large vessel stenosis affected fractional flow reserve. The model predicts that the presence, rather than severity, of microvascular disease affects coronary flow deleteriously. <i>Conclusions.</i> The model provides a computationally inexpensive instrument for future in silico coronary blood flow investigations as well as clinical-imaging decision making. A combination of focal and diffuse stenosis appears to be essential to limit coronary flow. In addition to pressure measurements in the large epicardial vessels, diagnosis of microvascular disease is essential. The independence of the index with respect to heart rate suggests that computationally inexpensive steady state simulations may provide sufficient information to reliably compute the index.https://www.mdpi.com/2076-3417/12/9/4281coronary vasculaturelumped parameter modelfractional flow reservecomputational cardiology |
| spellingShingle | Jermiah J. Joseph Clara Sun Ting-Yim Lee Daniel Goldman Sanjay R. Kharche Christopher W. McIntyre Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation Applied Sciences coronary vasculature lumped parameter model fractional flow reserve computational cardiology |
| title | Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation |
| title_full | Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation |
| title_fullStr | Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation |
| title_full_unstemmed | Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation |
| title_short | Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation |
| title_sort | structure epicardial stenosis and function microvascular dysfunction that influence coronary fractional flow reserve estimation |
| topic | coronary vasculature lumped parameter model fractional flow reserve computational cardiology |
| url | https://www.mdpi.com/2076-3417/12/9/4281 |
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