Effect of microcirculatory dysfunction on coronary hemodynamics: A pilot study based on computational fluid dynamics simulation

Yingyi Geng; Haipeng Liu; Xinhong Wang; Jucheng Zhang; Yinglan Gong; Dingchang Zheng; Jun Jiang; Ling Xia

doi:10.1016/j.compbiomed.2022.105583

Effect of microcirculatory dysfunction on coronary hemodynamics: A pilot study based on computational fluid dynamics simulation

Yingyi Geng, Haipeng Liu, Xinhong Wang, Jucheng Zhang, Yinglan Gong, Dingchang Zheng, Jun Jiang, Ling Xia

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Abstract

Background: Invasively measured fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) are gold standards for the diagnosis of coronary artery disease (CAD) and coronary microcirculatory dysfunction (CMD). However, the interaction between CAD and CMD has not been comprehensively investigated. We aim to non-invasively investigate hemodynamic effect of CMD in nonobstructive CAD cases using computational fluid dynamics (CFD) simulation.
Method: This study employed CFD simulations on six cases with nonobstructive CAD and CMD in left anterior descending artery (LAD) territories. Two microcirculatory situations were simulated: normal microcirculatory resistance (MR) situation; CMD situation where MR at the outlets of LAD branches were multiplied by the ratio of clinically measured IMR to the cutoff value. Blood flow, translesional pressure drop (Δp_tl), and simulated FFR (FFR_CT) of LAD and non-culprit branches were compared between the two microcirculatory situations using Wilcoxon signed rank test.
Results: The results are in accordance with existing studies and clinical measurements. Compared with normal MR, there were significant decreases in outlet flow velocity and increases in FFR_CT (p < 0.01 for both in Wilcoxon signed rank tests) in LAD branches with CMD, with minor decreases (0.63–5.64 mmHg) in Δp_tl.There was no significant influence on outlet flow velocity ( < 2%) and FFR_CT ( < 0.02) in non-culprit branches (p > 0.05 for both).
Conclusion: IMR-based CFD simulation could estimate hemodynamic effects of CMD. CMD in a coronary artery branch can decrease its blood flow and Δp_tl, increase its FFR, with little effect on non-culprit branches.

Original language	English
Article number	105583
Number of pages	11
Journal	Computers in Biology and Medicine
Volume	146
Early online date	4 May 2022
DOIs	https://doi.org/10.1016/j.compbiomed.2022.105583
Publication status	Published - Jul 2022

Bibliographical note

Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.

This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

Funder

This study was supported by the Natural Science Foundation of China (NSFC) under grant number 61527811 and 61701435, the Key Research and Development Program of Zhejiang Province under grant number 2020C03016, the Zhejiang Provincial Natural Science Foundation of China under grant number LY17H180003, and the Major Scientific Project of Zhejiang Lab under grant number 2020ND8AD01.

Funding

This study was supported by the Natural Science Foundation of China (NSFC) under grant number 61527811 and 61701435, the Key Research and Development Program of Zhejiang Province under grant number 2020C03016, the Zhejiang Provincial Natural Science Foundation of China under grant number LY17H180003, and the Major Scientific Project of Zhejiang Lab under grant number 2020ND8AD01.

Funders	Funder number
National Natural Science Foundation of China	61527811, 61701435
Key Research and Development Program of Zhejiang Province	2020C03016
Zhejiang Provincial Natural Science Foundation	LY17H180003
Zhejiang Lab	2020ND8AD01

Keywords

Myocardial ischemia
Fractional flow reserve (FFR)
Index of microcirculatory resistance (IMR)
Coronary microcirculatory dysfunction (CMD)
Computational fluid dynamics (CFD)

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10.1016/j.compbiomed.2022.105583

Liu2022AAMAccepted author manuscript, 1.54 MBLicence: CC BY-NC-ND

Cite this

@article{0dfbb5532e254c50af57180b8af17ccb,

title = "Effect of microcirculatory dysfunction on coronary hemodynamics: A pilot study based on computational fluid dynamics simulation",

abstract = "Background: Invasively measured fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) are gold standards for the diagnosis of coronary artery disease (CAD) and coronary microcirculatory dysfunction (CMD). However, the interaction between CAD and CMD has not been comprehensively investigated. We aim to non-invasively investigate hemodynamic effect of CMD in nonobstructive CAD cases using computational fluid dynamics (CFD) simulation. Method: This study employed CFD simulations on six cases with nonobstructive CAD and CMD in left anterior descending artery (LAD) territories. Two microcirculatory situations were simulated: normal microcirculatory resistance (MR) situation; CMD situation where MR at the outlets of LAD branches were multiplied by the ratio of clinically measured IMR to the cutoff value. Blood flow, translesional pressure drop (Δptl), and simulated FFR (FFRCT) of LAD and non-culprit branches were compared between the two microcirculatory situations using Wilcoxon signed rank test.Results: The results are in accordance with existing studies and clinical measurements. Compared with normal MR, there were significant decreases in outlet flow velocity and increases in FFRCT (p < 0.01 for both in Wilcoxon signed rank tests) in LAD branches with CMD, with minor decreases (0.63–5.64 mmHg) in Δptl. There was no significant influence on outlet flow velocity ( < 2%) and FFRCT ( < 0.02) in non-culprit branches (p > 0.05 for both).Conclusion: IMR-based CFD simulation could estimate hemodynamic effects of CMD. CMD in a coronary artery branch can decrease its blood flow and Δptl, increase its FFR, with little effect on non-culprit branches.",

keywords = "Myocardial ischemia, Fractional flow reserve (FFR), Index of microcirculatory resistance (IMR), Coronary microcirculatory dysfunction (CMD), Computational fluid dynamics (CFD)",

author = "Yingyi Geng and Haipeng Liu and Xinhong Wang and Jucheng Zhang and Yinglan Gong and Dingchang Zheng and Jun Jiang and Ling Xia",

note = "Copyright {\textcopyright} and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author{\textquoteright}s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it. ",

year = "2022",

month = jul,

doi = "10.1016/j.compbiomed.2022.105583",

language = "English",

volume = "146",

journal = "Computers in Biology and Medicine",

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T1 - Effect of microcirculatory dysfunction on coronary hemodynamics

T2 - A pilot study based on computational fluid dynamics simulation

AU - Geng, Yingyi

AU - Liu, Haipeng

AU - Wang, Xinhong

AU - Zhang, Jucheng

AU - Gong, Yinglan

AU - Zheng, Dingchang

AU - Jiang, Jun

AU - Xia, Ling

N1 - Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

PY - 2022/7

Y1 - 2022/7

N2 - Background: Invasively measured fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) are gold standards for the diagnosis of coronary artery disease (CAD) and coronary microcirculatory dysfunction (CMD). However, the interaction between CAD and CMD has not been comprehensively investigated. We aim to non-invasively investigate hemodynamic effect of CMD in nonobstructive CAD cases using computational fluid dynamics (CFD) simulation. Method: This study employed CFD simulations on six cases with nonobstructive CAD and CMD in left anterior descending artery (LAD) territories. Two microcirculatory situations were simulated: normal microcirculatory resistance (MR) situation; CMD situation where MR at the outlets of LAD branches were multiplied by the ratio of clinically measured IMR to the cutoff value. Blood flow, translesional pressure drop (Δptl), and simulated FFR (FFRCT) of LAD and non-culprit branches were compared between the two microcirculatory situations using Wilcoxon signed rank test.Results: The results are in accordance with existing studies and clinical measurements. Compared with normal MR, there were significant decreases in outlet flow velocity and increases in FFRCT (p < 0.01 for both in Wilcoxon signed rank tests) in LAD branches with CMD, with minor decreases (0.63–5.64 mmHg) in Δptl. There was no significant influence on outlet flow velocity ( < 2%) and FFRCT ( < 0.02) in non-culprit branches (p > 0.05 for both).Conclusion: IMR-based CFD simulation could estimate hemodynamic effects of CMD. CMD in a coronary artery branch can decrease its blood flow and Δptl, increase its FFR, with little effect on non-culprit branches.

AB - Background: Invasively measured fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) are gold standards for the diagnosis of coronary artery disease (CAD) and coronary microcirculatory dysfunction (CMD). However, the interaction between CAD and CMD has not been comprehensively investigated. We aim to non-invasively investigate hemodynamic effect of CMD in nonobstructive CAD cases using computational fluid dynamics (CFD) simulation. Method: This study employed CFD simulations on six cases with nonobstructive CAD and CMD in left anterior descending artery (LAD) territories. Two microcirculatory situations were simulated: normal microcirculatory resistance (MR) situation; CMD situation where MR at the outlets of LAD branches were multiplied by the ratio of clinically measured IMR to the cutoff value. Blood flow, translesional pressure drop (Δptl), and simulated FFR (FFRCT) of LAD and non-culprit branches were compared between the two microcirculatory situations using Wilcoxon signed rank test.Results: The results are in accordance with existing studies and clinical measurements. Compared with normal MR, there were significant decreases in outlet flow velocity and increases in FFRCT (p < 0.01 for both in Wilcoxon signed rank tests) in LAD branches with CMD, with minor decreases (0.63–5.64 mmHg) in Δptl. There was no significant influence on outlet flow velocity ( < 2%) and FFRCT ( < 0.02) in non-culprit branches (p > 0.05 for both).Conclusion: IMR-based CFD simulation could estimate hemodynamic effects of CMD. CMD in a coronary artery branch can decrease its blood flow and Δptl, increase its FFR, with little effect on non-culprit branches.

KW - Myocardial ischemia

KW - Fractional flow reserve (FFR)

KW - Index of microcirculatory resistance (IMR)

KW - Coronary microcirculatory dysfunction (CMD)

KW - Computational fluid dynamics (CFD)

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DO - 10.1016/j.compbiomed.2022.105583

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JF - Computers in Biology and Medicine

M1 - 105583

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Effect of microcirculatory dysfunction on coronary hemodynamics: A pilot study based on computational fluid dynamics simulation

Abstract

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