Abstract
BackgroundThe stenosis of the coronary arteries is usually caused by atherosclerosis. Hemodynamic significance of patient-specific coronary stenoses and the risk of its progression may be assessed by comparing the hemodynamic effects induced by flow disorders. The present study shows how stenosis degree and variable flow conditions in coronary artery affect the oscillating shear index, residence time index, pressure drop coefficient and fractional flow reserve. We assume that changes in the hemodynamic indices in relation to variable flow conditions and geometries evaluated using the computational fluid dynamics may be an additional factor for a non-invasive assessment of the coronary stenosis detected on multi-slice computed tomography.MethodsThe local-parametrised models of basic shapes of the vessels, such as straight section, bend, and bifurcation as well as the global-patient-specific models of left coronary artery were used for numerical simulation of flow in virtually reconstructed stenotic vessels. Calculations were carried out for vessels both without stenosis, and vessels of 10 to 95% stenosis. The flow rate varied within the range of 20 to 1000 ml/min, and heart rate frequency within the range of 30 to 210 cycles/min.The computational fluid dynamics based on the finite elements method verified by the experimental measurements of the velocity profiles was used to analyse blood flow in the coronary arteries.ResultsThe results confirm our preliminary assumptions. There is significant variation in the coronary hemodynamic indices value caused by disturbed flow through stenosis in relation to variable flow conditions and geometry of vessels.ConclusionVariations of selected hemodynamic indexes induced by change of flow rate, heart rate and vessel geometry, obtained during a non-invasive study, may assist in evaluating the risk of stenosis progression and in carrying out the assessment of the hemodynamic significance of coronary stenosis. However, for a more accurate assessment of the variability of indices and coronary stenosis severity both local (near the narrowing) and global (in side branches) studies should be used.
Highlights
The stenosis of the coronary arteries is usually caused by atherosclerosis
The separation area depends on the geometry of the stenosis and Reynolds number
There is significant variation in the coronary hemodynamic indices value caused by disturbed flow through narrowed vessels in relation to variable flow conditions and geometries
Summary
The stenosis of the coronary arteries is usually caused by atherosclerosis. Hemodynamic significance of patient-specific coronary stenoses and the risk of its progression may be assessed by comparing the hemodynamic effects induced by flow disorders. CAD occurs when the coronary arteries become narrowed or blocked as a result of the build-up of fat, cholesterol and other substances within the artery wall One of them is the fact that two-dimensional images of the atherosclerotic plaque is different in different planes of the projection In this case the visual assessment of stenosis in coronary angiography is subject to error and does not express the functional significance of the lesion [2]. Some lesions that are considered hemodynamically insignificant may cause a reduction in coronary flow reserve (CFR) For these reasons, especially in the case of intermediate stenosis, in which the reduction of the arterial light is in the range of 50 to 70% (“borderline stenosis”), the fractional flow reserve (FFR) measurement should be performed [2, 3]
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