Non-invasive characterization of complex coronary lesions

Madhurima Vardhan, John Gounley, S. James Chen, Eric C. Chi, Andrew M. Kahn, Jane A. Leopold, Amanda Randles

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Conventional invasive diagnostic imaging techniques do not adequately resolve complex Type B and C coronary lesions, which present unique challenges, require personalized treatment and result in worsened patient outcomes. These lesions are often excluded from large-scale non-invasive clinical trials and there does not exist a validated approach to characterize hemodynamic quantities and guide percutaneous intervention for such lesions. This work identifies key biomarkers that differentiate complex Type B and C lesions from simple Type A lesions by introducing and validating a coronary angiography-based computational fluid dynamic (CFD-CA) framework for intracoronary assessment in complex lesions at ultrahigh resolution. Among 14 patients selected in this study, 7 patients with Type B and C lesions were included in the complex lesion group including ostial, bifurcation, serial lesions and lesion where flow was supplied by collateral bed. Simple lesion group included 7 patients with lesions that were discrete, < 10 mm long and readily accessible. Intracoronary assessment was performed using CFD-CA framework and validated by comparing to clinically measured pressure-based index, such as FFR. Local pressure, endothelial shear stress (ESS) and velocity profiles were derived for all patients. We validates the accuracy of our CFD-CA framework and report excellent agreement with invasive measurements (n= 14 , R2= 0.6 , p= 0.0013). Ultra-high resolution achieved by the model enable physiological assessment in complex lesions and quantify hemodynamic metrics in all vessels up to 1mm in diameter. Importantly, we demonstrate that in contrast to traditional pressure-based metrics, there is a significant difference in the intracoronary hemodynamic forces, such as ESS, in complex lesions compared to simple lesions at both resting and hyperemic physiological states [n = 14, p= 0.03]. Higher ESS was observed in the complex lesion group (7.0 ± 4.7 Pa) than in simple lesion group (4.8 ± 3.6 Pa). Complex coronary lesions have higher ESS compared to simple lesions, such differential hemodynamic evaluation can provide much the needed insight into the increase in adverse outcomes for such patients and has incremental prognostic value over traditional pressure-based indices, such as FFR.

Original languageEnglish
Article number8145
JournalScientific Reports
Volume11
Issue number1
DOIs
StatePublished - Dec 2021

Funding

We thank Duke OIT for their help with the Duke Compute Cluster runs and members of the Randles lab. We also thank Drs Peter Balogh and Marianna Pepona for their careful review and feedback on this work. Computing support for this work came from the Lawrence Livermore National Laboratory Institutional Computing Grand Challenge program. Research reported in this publication was supported by the Office of the Director, National Institutes of Health under Award Number DP5OD019876. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by American Heart Association Predoctoral Fellowship and ACM/IEEE-CS George Michael Memorial High Performance Computing Fellowship. This manuscript has been authored by UT-Battelle, LLC under Contract No. DE-AC05-00OR22725 with the U.S. Department of Energy. The United States Government retains and the publisher, by accepting the article for publication, acknowledges that the United States Government retains a non-exclusive, paid-up, irrevocable, world-wide license to publish or reproduce the published form of this manuscript, or allow others to do so, for United States Government purposes. The Department of Energy will provide public access to these results of federally sponsored research in accordance with the DOE Public Access Plan (http://energy.gov/downloads/doe-public-access-plan).

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