Thrombotic risk stratification using computational modeling in patients with coronary artery aneurysms following Kawasaki disease.
Thrombotic risk stratification using computational modeling in patients with coronary artery aneurysms following Kawasaki disease.
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DOI：
10.1007/s10237-014-0570-z
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发表时间：
2014-11
影响因子：
3.5
通讯作者：
Marsden AL
中科院分区：
文献类型：
--
作者：
Sengupta D;Kahn AM;Kung E;Esmaily Moghadam M;Shirinsky O;Lyskina GA;Burns JC;Marsden AL
川崎病 (KD) 是儿童获得性心脏病的主要原因，可导致高达 25% 的患者出现危及生命的冠状动脉瘤。这些动脉瘤使患者面临血栓形成、心肌梗塞和猝死的风险。因此，临床医生必须决定哪些患者应该接受抗凝药物和/或手术或经皮干预治疗。目前关于开始抗凝治疗的建议仅基于解剖学，历史数据表明动脉瘤≥8毫米的患者血栓形成的风险最大。考虑到影响血栓形成的变量众多，我们假设从患者特异性模拟中获得的血流动力学数据比单独使用最大直径更能准确地预测血栓形成的风险。对五名患有动脉瘤的川崎病患者和一名患有正常冠状动脉的川崎病患者进行了患者特异性血流模拟。从模型和模拟中提取关键的血流动力学和几何参数，包括壁剪切应力、颗粒停留时间和形状指数，并与临床结果进行比较。进行了径向膨胀的初步流体结构相互作用模拟，揭示了与刚性壁情况相比壁剪切应力的适度差异。模拟提供了令人信服的证据，表明血流动力学参数可能比单独的动脉瘤直径更准确地预测血栓形成风险，并激发了对更大队列进行后续研究的需要。这些结果表明，未来可以使用结合血流动力学信息的临床指标来选择接受抗凝治疗的患者。
Kawasaki disease (KD) is the leading cause of acquired heart disease in children and can result in life-threatening coronary artery aneurysms in up to 25 % of patients. These aneurysms put patients at risk of thrombus formation, myocardial infarction, and sudden death. Clinicians must therefore decide which patients should be treated with anticoagulant medication, and/or surgical or percutaneous intervention. Current recommendations regarding initiation of anticoagulant therapy are based on anatomy alone with historical data suggesting that patients with aneurysms ≥8 mm are at greatest risk of thrombosis. Given the multitude of variables that influence thrombus formation, we postulated that hemodynamic data derived from patient-specific simulations would more accurately predict risk of thrombosis than maximum diameter alone. Patient-specific blood flow simulations were performed on five KD patients with aneurysms and one KD patient with normal coronary arteries. Key hemodynamic and geometric parameters, including wall shear stress, particle residence time, and shape indices, were extracted from the models and simulations and compared with clinical outcomes. Preliminary fluid structure interaction simulations with radial expansion were performed, revealing modest differences in wall shear stress compared to the rigid wall case. Simulations provide compelling evidence that hemodynamic parameters may be a more accurate predictor of thrombotic risk than aneurysm diameter alone and motivate the need for follow-up studies with a larger cohort. These results suggest that a clinical index incorporating hemodynamic information be used in the future to select patients for anticoagulant therapy.