CORONARY ATHEROSCLEROSIS ASSESSMENT: A NEW ANATOMICAL, FUNCTIONAL, MORPHOLOGICAL AND BIO-MECHANICAL APPROACH

The aims of this work are to investigate and compare two different flow dynamics techniques (steady state - pulsatile flow) for endothelial shear stress calculation, compare lesion specific smartFFR and ESS values, as well as total vessel smartFFR and ESS values, and investigate the relationship between smartFFR and ESS to stress MBF (myocardial blood flow) and MFR (myocardial flow reserve). A total of 10 coronary vessels of 6 patients with intermediate pre-test likelihood for coronary artery disease, who have undergone both CTCA and PET-MPI with 15O-water or 13N-ammonia, were included in the study. Seven (7) cases had normal stress MBF and MFR values and three (3) had abnormal ones. PET was considered abnormal when > 1 contiguous segments showed both stress MBF ≤2.3mL/g/min and MFR ≤2.5 for 15O-water or 1.79 mL/g/min and ≤2.0 for 13N-ammonia, respectively. The ESS at the luminal surface of the artery was calculated as the product of viscosity and the gradient of blood velocity near the vessel wall. To calculate the smartFFR, we performed a transient simulation for each case. We used a pressure of 100 mmHg as a boundary condition at the inlet (i.e. mean human aortic pressure). At the outlet, a flow profile of 4 timesteps with a timestep duration of 0.25 sec was used. In each timestep, a volumetric flow rate of 1, 2, 3 and 4 ml/s are applied as outlet boundary conditions. The cut-off value for a pathological smartFFR is 0.83. There is a difference in total vessel calculated smartFFR results compared to the corresponding values of lesion specific smartFFR (0.88 vs 0.97, p=0.01). For ESS there is a negligible difference between lesion specific and total vessel values (2.22 vs 2.74, p = 0.9). There is a moderate negative correlation between both lesions specific (r = -0.543) and total vessel smartFFR and ESS (r = -0.915). ESS values were higher in vessels where vessel smartFFR was considered abnormal (1.97 vs 5.52, p = 0.01). Total vessel length smartFFR was lower in vessels with abnormal PET-MPI compared to the normal vessels (0.75 vs 0.93, p = 0.01). ESS is higher in vessels with pathological stress MBF and CFR (5.5 vs 2.0, p = 0.02). The total vessel length smartFFR and lesion ESS appear to assess the functional significance of the vessel well, when compared to the PET-MPI measurements.