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Simultaneous evaluation of plaque stability and ischemic potential of coronary lesions in a fluid–structure interaction analysis

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Abstract

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.

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Abbreviations

CFD:

Computational fluid dynamics

DS%:

Percent diameter stenosis

FEA:

Finite element analysis

FFR:

Fractional flow reserve

FSI:

Fluid–structure interaction

MLD:

Minimum lumen diameter

rSWS:

Relative superficial wall stress

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Funding

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).

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Authors and Affiliations

  1. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

    Xinlei Wu, Su Zhang, Daixin Ding, Jiayue Huang & Shengxian Tu

  2. Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China

    Xinlei Wu, Su Zhang, Daixin Ding, Jiayue Huang & Shengxian Tu

  3. Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands

    Clemens von Birgelen

Authors
  1. Xinlei Wu
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  2. Clemens von Birgelen
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  3. Su Zhang
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  4. Daixin Ding
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  5. Jiayue Huang
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  6. Shengxian Tu
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Corresponding author

Correspondence to Shengxian Tu.

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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.

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Electronic supplementary material

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10554_2019_1611_MOESM1_ESM.avi

Supplementary material 1 Video 1: Dynamic relative superficial wall stress of fluid-structure interaction analysis of 10 mm-long lipid-rich plaques with 50% diameter stenosis and without arterial remodeling (AVI 5668 kb)

10554_2019_1611_MOESM2_ESM.avi

Supplementary material 2 Video 2: Blood flow velocity of fluid-structure interaction analysis of 10 mm-long lipid-rich plaques with 50% diameter stenosis and without arterial remodeling (AVI 371 kb)

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Wu, X., von Birgelen, C., Zhang, S. et al. Simultaneous evaluation of plaque stability and ischemic potential of coronary lesions in a fluid–structure interaction analysis. Int J Cardiovasc Imaging 35, 1563–1572 (2019). https://doi.org/10.1007/s10554-019-01611-y

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  • DOI: https://doi.org/10.1007/s10554-019-01611-y

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