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Ultrasound Based Computational Fluid Dynamics Assessment of Brachial Artery Wall Shear Stress in Preeclamptic Pregnancy

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Abstract

Purpose

Preeclampsia (PE) is a pregnancy complication of abnormally elevated blood pressure and organ damage where endothelial function is impaired. Wall shear stress (WSS) strongly effects endothelial cell morphology and function but in PE the WSS values are unknown. WSS calculations from ultrasound inaccurately assume cylindrical arteries and patient specific computational fluid dynamics (CFD) typically require time-consuming 3D imaging such as CT or MRI.

Methods

Two-dimensional (2D) B-mode ultrasound images were lofted together to create simplified three-dimensional (3D) geometries of the brachial artery (BA) that incorporate artery curvature and non-circular cross sections. This process was efficient and on average took 120 ± 10 s. Patient specific CFD was then performed to quantify BA WSS for a small cohort of PE (n = 5) and normotensive pregnant patients (n = 5) and compared against WSS calculations assuming a cylindrical artery.

Results

For several WSS metrics (time averaged WSS (TAWSS), peak systolic WSS, oscillatory shear index (OSI), OSI/TAWSS and relative residence time) CFD on the simplified arterial geometries calculated large spatial differences in WSS that assuming a cylindrical artery cannot calculate. Bland–Altman and intra-class correlation (ICC) analyses found assuming a cylindrical artery both underestimated (p < 0.05) and had poor agreement (ICC < 0.5) with the maximum WSS values from CFD. WSS values that were abnormal compared to the normotensive patients (OSI = 0.014 ± 0.026) appear related to the pregnancy complications fetal growth restriction (n = 2, OSI = 0.14, 0.25) and gestational diabetes (n = 1, OSI = 0.23).

Conclusion

Creating 3D artery geometries from 2D ultrasound images can be used for CFD simulations to calculate WSS from ultrasound without assuming cylindrical arteries. This approach requires minimal time for both medical imaging and CFD analysis.

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Abbreviations

CFD:

Computational fluid dynamics

PE:

Preeclampsia

WSS:

Wall shear stress

BA:

Brachial artery

NT:

Normotensive

TAWSS:

Time average wall shear stress

OSI:

Oscillatory shear index

RRT:

Relative residence time

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Acknowledgments

This investigation was supported by R&D funding from the University of Wisconsin – Madison Obstetrics and Gynecology department and by the NIH Ruth L. Kirschstein National Research Service Award T32 HL 007936 from the National Heart Lung and Blood Institute to the University of Wisconsin-Madison Cardiovascular Research Center (RP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Biomedical Engineering, University of Wisconsin – Madison, Madison, USA

    Ryan J. Pewowaruk & Alejandro Roldán-Alzate

  2. Maternal and Fetal Medicine, University of Wisconsin – Madison, Madison, USA

    Jenna Racine & J. Igor Iruretagoyena

  3. Mechanical Engineering, University of Wisconsin – Madison, Madison, USA

    Alejandro Roldán-Alzate

  4. Radiology, University of Wisconsin – Madison, Madison, USA

    Alejandro Roldán-Alzate

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  1. Ryan J. Pewowaruk
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Correspondence to Alejandro Roldán-Alzate.

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Pewowaruk, R.J., Racine, J., Iruretagoyena, J.I. et al. Ultrasound Based Computational Fluid Dynamics Assessment of Brachial Artery Wall Shear Stress in Preeclamptic Pregnancy. Cardiovasc Eng Tech 11, 760–768 (2020). https://doi.org/10.1007/s13239-020-00488-6

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