Non-invasive characterization of complex coronary lesions

Abstract Conventional invasive diagnostic imaging techniques do not adequately resolve complex Type B and C coronary lesions, which present unique challenges, require personalized treatment and result in worsened patient outcomes. These lesions are often excluded from large-scale non-invasive clinic...

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Autores principales:	Madhurima Vardhan, John Gounley, S. James Chen, Eric C. Chi, Andrew M. Kahn, Jane A. Leopold, Amanda Randles
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1e96e5341ee647abbc9a8c04788e3e3e
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spelling	oai:doaj.org-article:1e96e5341ee647abbc9a8c04788e3e3e2021-12-02T18:02:47ZNon-invasive characterization of complex coronary lesions10.1038/s41598-021-86360-62045-2322https://doaj.org/article/1e96e5341ee647abbc9a8c04788e3e3e2021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86360-6https://doaj.org/toc/2045-2322Abstract Conventional invasive diagnostic imaging techniques do not adequately resolve complex Type B and C coronary lesions, which present unique challenges, require personalized treatment and result in worsened patient outcomes. These lesions are often excluded from large-scale non-invasive clinical trials and there does not exist a validated approach to characterize hemodynamic quantities and guide percutaneous intervention for such lesions. This work identifies key biomarkers that differentiate complex Type B and C lesions from simple Type A lesions by introducing and validating a coronary angiography-based computational fluid dynamic (CFD-CA) framework for intracoronary assessment in complex lesions at ultrahigh resolution. Among 14 patients selected in this study, 7 patients with Type B and C lesions were included in the complex lesion group including ostial, bifurcation, serial lesions and lesion where flow was supplied by collateral bed. Simple lesion group included 7 patients with lesions that were discrete, $$<10\hbox {mm}$$ < 10 mm long and readily accessible. Intracoronary assessment was performed using CFD-CA framework and validated by comparing to clinically measured pressure-based index, such as FFR. Local pressure, endothelial shear stress (ESS) and velocity profiles were derived for all patients. We validates the accuracy of our CFD-CA framework and report excellent agreement with invasive measurements ( $$n=14, R^2 = 0.6, p = 0.0013$$ n = 14 , R 2 = 0.6 , p = 0.0013 ). Ultra-high resolution achieved by the model enable physiological assessment in complex lesions and quantify hemodynamic metrics in all vessels up to 1mm in diameter. Importantly, we demonstrate that in contrast to traditional pressure-based metrics, there is a significant difference in the intracoronary hemodynamic forces, such as ESS, in complex lesions compared to simple lesions at both resting and hyperemic physiological states [n = 14, $$p=0.03$$ p = 0.03 ]. Higher ESS was observed in the complex lesion group ( $$7.0\pm 4.7$$ 7.0 ± 4.7 Pa) than in simple lesion group ( $$4.8\pm 3.6$$ 4.8 ± 3.6 Pa). Complex coronary lesions have higher ESS compared to simple lesions, such differential hemodynamic evaluation can provide much the needed insight into the increase in adverse outcomes for such patients and has incremental prognostic value over traditional pressure-based indices, such as FFR.Madhurima VardhanJohn GounleyS. James ChenEric C. ChiAndrew M. KahnJane A. LeopoldAmanda RandlesNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Madhurima Vardhan John Gounley S. James Chen Eric C. Chi Andrew M. Kahn Jane A. Leopold Amanda Randles Non-invasive characterization of complex coronary lesions
description	Abstract Conventional invasive diagnostic imaging techniques do not adequately resolve complex Type B and C coronary lesions, which present unique challenges, require personalized treatment and result in worsened patient outcomes. These lesions are often excluded from large-scale non-invasive clinical trials and there does not exist a validated approach to characterize hemodynamic quantities and guide percutaneous intervention for such lesions. This work identifies key biomarkers that differentiate complex Type B and C lesions from simple Type A lesions by introducing and validating a coronary angiography-based computational fluid dynamic (CFD-CA) framework for intracoronary assessment in complex lesions at ultrahigh resolution. Among 14 patients selected in this study, 7 patients with Type B and C lesions were included in the complex lesion group including ostial, bifurcation, serial lesions and lesion where flow was supplied by collateral bed. Simple lesion group included 7 patients with lesions that were discrete, $$<10\hbox {mm}$$ < 10 mm long and readily accessible. Intracoronary assessment was performed using CFD-CA framework and validated by comparing to clinically measured pressure-based index, such as FFR. Local pressure, endothelial shear stress (ESS) and velocity profiles were derived for all patients. We validates the accuracy of our CFD-CA framework and report excellent agreement with invasive measurements ( $$n=14, R^2 = 0.6, p = 0.0013$$ n = 14 , R 2 = 0.6 , p = 0.0013 ). Ultra-high resolution achieved by the model enable physiological assessment in complex lesions and quantify hemodynamic metrics in all vessels up to 1mm in diameter. Importantly, we demonstrate that in contrast to traditional pressure-based metrics, there is a significant difference in the intracoronary hemodynamic forces, such as ESS, in complex lesions compared to simple lesions at both resting and hyperemic physiological states [n = 14, $$p=0.03$$ p = 0.03 ]. Higher ESS was observed in the complex lesion group ( $$7.0\pm 4.7$$ 7.0 ± 4.7 Pa) than in simple lesion group ( $$4.8\pm 3.6$$ 4.8 ± 3.6 Pa). Complex coronary lesions have higher ESS compared to simple lesions, such differential hemodynamic evaluation can provide much the needed insight into the increase in adverse outcomes for such patients and has incremental prognostic value over traditional pressure-based indices, such as FFR.
format	article
author	Madhurima Vardhan John Gounley S. James Chen Eric C. Chi Andrew M. Kahn Jane A. Leopold Amanda Randles
author_facet	Madhurima Vardhan John Gounley S. James Chen Eric C. Chi Andrew M. Kahn Jane A. Leopold Amanda Randles
author_sort	Madhurima Vardhan
title	Non-invasive characterization of complex coronary lesions
title_short	Non-invasive characterization of complex coronary lesions
title_full	Non-invasive characterization of complex coronary lesions
title_fullStr	Non-invasive characterization of complex coronary lesions
title_full_unstemmed	Non-invasive characterization of complex coronary lesions
title_sort	non-invasive characterization of complex coronary lesions
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/1e96e5341ee647abbc9a8c04788e3e3e
work_keys_str_mv	AT madhurimavardhan noninvasivecharacterizationofcomplexcoronarylesions AT johngounley noninvasivecharacterizationofcomplexcoronarylesions AT sjameschen noninvasivecharacterizationofcomplexcoronarylesions AT ericcchi noninvasivecharacterizationofcomplexcoronarylesions AT andrewmkahn noninvasivecharacterizationofcomplexcoronarylesions AT janealeopold noninvasivecharacterizationofcomplexcoronarylesions AT amandarandles noninvasivecharacterizationofcomplexcoronarylesions
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Non-invasive characterization of complex coronary lesions

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