Integration of Computational Fluid Dynamics into the Clinical Setting of Coronary Artery Disease
Blood flow induced mechanical forces (e.g., wall shear stress; WSS) have been implicated in coronary artery disease (CAD) development and aid in explaining the spatial distribution of the disease, in the presence of systemic risk factors. Most recently, computational hemodynamics has garnered significant clinical attention as a potential prognostic marker to assist in diagnosis, prognosis, and guiding treatment strategies. Our investigations are focused on developing computational method to quantifying the hemodynamic environment in the clinical setting of CAD and correlating these data to with in vivo parameters of CAD progression. Clinical imaging data (angiography, intravascular ultrasound, optical coherence tomography) are collected in patients undergoing invasive physiologic evaluation for non-obstructive CAD in the cardiac catheterization laboratory. Imaging data are utilized to construct patient-specific computational models to quantify the flow field and compute, for example, WSS (Fig. 1). Follow-up invasive evaluation (6 or 12 months) allows for quantification of disease progression, which includes changes in plaque area, composition, and phenotype and vascular remodelling. Our studies have shown that WSS adds incremental value in predicting regional plaque progression and identification of a vulnerable phenotype (Fig. 2). In addition, we have extended our developed techniques to retrospectively investigate other CAD pathologies. For example, despite fundamental pathologic differences in native CAD and cardiac allograft vasculopathy, a form of occlusive atherosclerosis unique to heart transplant patients, the similarity in localization with regions of low and oscillatory WSS is quite extraordinary.
In collaboration with Don P. Giddens (Biomedical Engineering) and Habib Samady (Cardiology)
Funding Agency: American Heart Association, Wallace H. Coulter Foundation
Grant Type: Postdoc Fellowship, Translational Seed Grant
Funding Period: 7/1/11 - 6/3/13