Tortuosity of Coronary Bifurcation as a Potential Local Risk Factor for Atherosclerosis: CFD Steady State Study Based on In Vivo Dynamic CT Measurements

M. Malvè, A. M. Gharib, S. K. Yazdani, G. Finet, M. A. Martínez, R. Pettigrew, J. Ohayon

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

The purpose of the present study was to determine whether in vivo bifurcation geometric factors would permit prediction of the risk of atherosclerosis. It is worldwide accepted that low or oscillatory wall shear stress (WSS) is a robust hemodynamic factor in the development of atherosclerotic plaque and has a strong correlation with the local site of plaque deposition. However, it still remains unclear how coronary bifurcation geometries are correlated with such hemodynamic forces. Computational fluid dynamics simulations were performed on left main (LM) coronary bifurcation geometries derived from CT of eight patients without significant atherosclerosis. WSS amplitudes were accurately quantified at two high risk zones of atherosclerosis, namely at proximal left anterior descending artery (LAD) and at proximal left circumflex artery (LCx), and also at three high WSS concentration sites near the bifurcation. Statistical analysis was used to highlight relationships between WSS amplitudes calculated at these five zones of interest and various geometric factors. The tortuosity index of the LM-LAD segment appears to be an emergent geometric factor in determining the low WSS amplitude at proximal LAD. Strong correlations were found between the high WSS amplitudes calculated at the endothelial regions close to the flow divider. This study not only demonstrated that CT imaging studies of local risk factor for atherosclerosis could be clinically performed, but also showed that tortuosity of LM-LAD coronary branch could be used as a surrogate marker for the onset of atherosclerosis.

Original languageEnglish (US)
Pages (from-to)82-93
Number of pages12
JournalAnnals of Biomedical Engineering
Volume43
Issue number1
DOIs
StatePublished - Jan 2014

Keywords

  • Atherosclerosis
  • CFD
  • Coronary bifurcation
  • Hemodynamics
  • Tortuosity
  • Wall shear stress

ASJC Scopus subject areas

  • Biomedical Engineering

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