Patient-Specific Computational Analysis of Hemodynamics in Adult Pulmonary Hypertension.
Patient-Specific Computational Analysis of Hemodynamics in Adult Pulmonary Hypertension.
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DOI：
10.1007/s10439-021-02884-y
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发表时间：
2021-12
影响因子：
3.8
通讯作者：
Finol EA
中科院分区：
文献类型：
--
作者：
Pillalamarri NR;Piskin S;Patnaik SS;Murali S;Finol EA
肺动脉高压(PH)是一种进展性疾病，其特征是肺动脉压力升高和血管阻力增加。在美国，每年有近25万人住院治疗，PH是主要或次要的疾病。明确的诊断需要右心导管术(RHC)，以及胸部计算机断层扫描、步行试验等。虽然RHC是诊断PH的金标准，但它是侵入性的，具有固有的风险和禁忌症。在这项工作中，我们描述了不同PH WHO组患者特定的肺血流动力学。我们根据平均肺动脉压将患者分为三个疾病严重程度组：高危(18≤≤mPAP；25 mm Hg，用A表示)、轻度(25 mm Hg≥mPAP；40 mm Hg，用M表示)和重度(mPAP mPAP 40 mm Hg，用S表示)。使用定制OpenFOAM库(V5.0，OpenFOAM Foundation)开发的流动求解器，通过计算三维Navier-Stokes方程组来模拟脉动流的血流动力学。准患者特定的边界条件是使用沃姆斯利入口速度分布和瞬时阻力流出条件来实现的。血流动力学指标包括空间平均壁切应力(SAWSS)、壁切应力梯度(WSSG)、时间平均壁切应力(TAWSS)、振荡剪切指数(OSI)和相对停留时间(RRT)以及临床指标肺血管阻力(PVR)、每搏输出量(SV)和顺应性(C)，以评估可能的时空相关性。我们观察到SAWSS、WSSG和TAWSS在统计学上显著降低，而OSI和RRT随着疾病的严重程度而增加。在心动周期中切迹阶段，PVR与SAWSS和RRT中度相关，这些指数是使用整体肺动脉几何来计算的。在一个长期目标的背景下，这些结果是有希望的，即识别可以作为PH侵入性诊断方案的替代物的计算生物标记物。
Pulmonary hypertension (PH) is a progressive disease characterized by elevated pressure and vascular resistance in the pulmonary arteries. Nearly 250,000 hospitalizations occur annually in the U.S. with PH as the primary or secondary condition. A definitive diagnosis of PH requires right heart catheterization (RHC) in addition to a chest computed tomography, a walking test, and others. While RHC is the gold standard for diagnosing PH, it is invasive and posseses inherent risks and contraindications. In this work, we characterized the patient-specific pulmonary hemodynamics in silico for diverse PH WHO groups. We grouped patients on the basis of mean pulmonary arterial pressure (mPAP) into three disease severity groups: at-risk (18 mmHg ≤ mPAP < 25 mmHg, denoted with A), mild (25 mmHg ≤ mPAP < 40 mmHg, denoted with M), and severe (mPAP ≥ 40 mmHg, denoted with S). The pulsatile flow hemodynamics was simulated by evaluating the three-dimensional Navier–Stokes system of equations using a flow solver developed by customizing OpenFOAM libraries (v5.0, The OpenFOAM Foundation). Quasi patient-specific boundary conditions were implemented using a Womersley inlet velocity profile and transient resistance outflow conditions. Hemodynamic indices such as spatially averaged wall shear stress (SAWSS), wall shear stress gradient (WSSG), time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT), were evaluated along with the clinical metrics pulmonary vascular resistance (PVR), stroke volume (SV) and compliance (C), to assess possible spatiotemporal correlations. We observed statistically significant decreases in SAWSS, WSSG, and TAWSS, and increases in OSI and RRT with disease severity. PVR was moderately correlated with SAWSS and RRT at the mid-notch stage of the cardiac cycle when these indices were computed using the global pulmonary arterial geometry. These results are promising in the context of a long-term goal of identifying computational biomarkers that can serve as surrogates for invasive diagnostic protocols of PH.
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