Hemodynamics of Enhanced External Counterpulsation with Different Coronary Stenosis
Hemodynamics of Enhanced External Counterpulsation with Different Coronary Stenosis
复制标题
不同冠状动脉狭窄程度下强化体外反搏的血流动力学
DOI：
10.31614/cmes.2018.04133
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Liu Youjun
中科院分区：
文献类型：
--
作者：
Chen Sihan;Li Bao;Yang Haisheng;Du Jianhang;Lie Xiaoling;Liu Youjun
增强体外反搏（EECP）能够治疗心肌缺血，这通常是由冠状动脉狭窄引起的。然而，关于该技术治疗心肌缺血有效的潜在机制尚不清楚，临床上也没有针对不同冠状动脉狭窄率的患者特异性反搏模式。本研究旨在探讨不同冠状动脉狭窄率使用EECP时的血流动力学影响，以及考虑不同冠状动脉狭窄率时采用靶向反搏模式的必要性。生成冠脉狭窄率分别为55%（模型1）、65%（模型2）和75%（模型3）的3个三维冠脉模型，并与血液循环系统的0维（0D）集总参数化模型相结合。将EECP应用于0D/3D耦合模型，研究冠状动脉血流动力学反应。在相同的反搏模式下，3种模型反搏时舒张压与收缩压之比均为1.4，心排血量和冠状动脉流速均显著增加。低壁剪切应力（WSS）和高振荡剪切指数（OSI）区主要位于狭窄和冠状动脉分叉的后端。此外，随着冠状动脉狭窄率的增加，冠状动脉狭窄的血流率增加百分比和面积平均WSS下降。本研究建立的几何多尺度模型可以有效地模拟EECP应用后心血管系统的血流动力学特性。可以观察到冠状动脉狭窄的局部精确血流动力学效应。从血流动力学因素分析发现，冠状动脉狭窄率越低，血管内皮重构越好。因此，有必要针对冠状动脉狭窄的不同情况，采用患者特异性的反搏模式。
Enhanced external counterpulsation (EECP) is able to treat myocardial ischemia, which is usually caused by coronary artery stenosis. However, the underlying mechanisms regarding why this technique is effective in treating myocardial ischemia remains unclear and there is no patient-specific counterpulsation mode for different rates of coronary artery stenosis in clinic. This study sought to investigate the hemodynamic effect of varied coronary artery stenosis rates when using EECP and the necessity of adopting targeted counterpulsation mode to consider different rates of coronary artery stenosis. Three 3-dimensional (3D) coronary models with different stenosis rates, including 55% (Model 1), 65% (Model 2), and 75% (Model 3), were generated, then coupled with a 0-dimensional (0D) lumped parametric model of the blood circulatory system. EECP was applied to the 0D/3D coupled models to study the hemodynamic response of the coronary artery. Under the same counterpulsation mode, the ratio of diastolic blood pressure to systolic blood pressure of 3 models during counterpulsation was 1.4, and the cardiac output and coronary artery flow rate increased significantly. The low wall shear stress (WSS) and high oscillatory shear index (OSI) areas were mainly located at the posterior end of the stenosis and coronary artery bifurcation. Moreover, with an increase in the rate of coronary artery stenosis, the increased percentage of flow rate through the coronary artery stenosis and area-averaged WSS decreased. The geometric multiscale model in this study can be used to effectively simulate the hemodynamic characteristics of cardiovascular system following the application of EECP. Local precise hemodynamic effect of the coronary artery stenosis can be observed. It was found from the hemodynamic factors that the coronary artery with lower stenosis rate more likely led to better vascular endothelial remodeling. Thus, it is necessary to adopt patient-specific counterpulsation mode accounting for different condition of coronary artery stenosis.
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DOI：
10.1016/j.amjcard.2011.01.021
发表时间：
2011-05-15
期刊：
The American journal of cardiology
影响因子：
--
作者：
Casey DP;Beck DT;Nichols WW;Conti CR;Choi CY;Khuddus MA;Braith RW
通讯作者：
Braith RW
DOI：
--
发表时间：
1999
期刊：
--
影响因子：
--
作者：
K. E. Bottom
通讯作者：
K. E. Bottom
影响因子：
37.8
作者：
Carlier, SG;van Damme, LCA;Krams, R
通讯作者：
Krams, R
影响因子：
2.4
作者：
Wentzel, JJ;Gijsen, FJH;Krams, R
通讯作者：
Krams, R
影响因子：
4.8
作者：
Michaels, AD;Raisinghani, A;Beller, G
通讯作者：
Beller, G