Simultaneous evaluation of plaque stability and ischemic potential of coronary lesions in a fluid–structure interaction analysis
The measurement of fractional flow reserve (FFR) and superficial wall stress (SWS) identifies inducible myocardial ischemia and plaque vulnerability, respectively. A simultaneous evaluation of both FFR and SWS is still lacking, while it may have a major impact on therapy. A new computational model of one-way fluid–structure interaction (FSI) was implemented and used to perform a total of 54 analyses in virtual coronary lesion models, based on plaque compositions, arterial remodeling patterns, and stenosis morphologies under physiological conditions. Due to a greater lumen dilation and more induced strain, FFR in the lipid-rich lesions (0.81 ± 0.15) was higher than that in fibrous lesions (0.79 ± 0.16, P = 0.001) and calcified lesions (0.79 ± 0.16, P = 0.001). Four types of lesions were further defined, based on the combination of cutoff values for FFR (0.80) and maximum relative SWS (30 kPa): The level of risk increased from (1) plaques with mild-to-moderate stenosis but negative remodeling for lipid-rich (Type A: non-ischemic, stable) to (2) lipid-rich plaques with mild-to-moderate stenosis and without-to-positive remodeling (Type B: non-ischemic, unstable) or plaques with severe stenosis but negative remodeling for lipid-rich (Type C: ischemic, stable) to (3) lipid-rich plaques with severe stenosis and without-to-positive remodeling (Type D: ischemic, unstable). The analysis of FSI to simultaneously evaluate inducible myocardial ischemia and plaque stability may be useful to identify coronary lesions at a high risk and to ultimately optimize treatment. Further research is warranted to assess whether a more aggressive treatment may improve the prognosis of patients with non-ischemic, intermediate, and unstable lesions.
KeywordsPlaque stability Myocardial ischemia Fractional flow reserve Fluid–structure interaction Cardiovascular biomechanics
Computational fluid dynamics
Percent diameter stenosis
Finite element analysis
Fractional flow reserve
Minimum lumen diameter
Relative superficial wall stress
This study was funded by the National Natural Science Foundation of China (Grant No. 81871460), Program of Shanghai Technology Research Leader, and research programs from Shanghai Jiao Tong University (YG2016ZD09 and YG2015ZD04).
Compliance with ethical standards
Conflict of interest
ST has received a research grant from Medis medical imaging and Pulse medical imaging technology. CvB indicated institutional research grants to the research department of TC Twente by Abbott Vascular, Boston Scientific, Biotronik and Medtronic (not related to the present study). XW declares that he has no conflict of interest. SZ declares that she has no conflict of interest. DX declares that she has no conflict of interest. JH declares that she has no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
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