Predictors of Myocardial Ischemia in Patients with Kawasaki Disease: Insights from Patient-Specific Simulations of Coronary Hemodynamics.
Predictors of Myocardial Ischemia in Patients with Kawasaki Disease: Insights from Patient-Specific Simulations of Coronary Hemodynamics.
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川崎病患者心肌缺血的预测因素：冠状动脉血流动力学的患者特异性模拟的见解。
DOI：
10.1007/s12265-023-10374-w
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发表时间：
2023
影响因子：
3.4
通讯作者：
Marsden,AlisonL
中科院分区：
文献类型：
--
作者：
Menon,Karthik;Seo,Jongmin;Fukazawa,Ryuji;Ogawa,Shunichi;Kahn,AndrewM;Burns,JaneC;Marsden,AlisonL
目前对川崎病（KD）引起的冠状动脉瘤的治疗主要基于动脉瘤的大小。这忽略了影响心肌缺血风险的血流动力学因素。我们对15名KD患者进行了患者特异性的计算血流动力学模拟，参数调整为患者的动脉压和心功能。通过模拟分数血流储备（FFR）、壁剪切应力和停留时间评估153条冠状动脉的缺血风险。FFR与动脉瘤评分（相关系数，）相关性较弱，但与最大/最小动脉瘤腔直径之比（）相关性较好。FFR在动脉瘤远端下降更快，这与管腔直径比（）比评分（）更相关。墙体剪应力与径比（）的相关性较好，而停留时间与径比（）的相关性较好。总体而言，最大与最小直径比预测缺血性风险优于评分。虽然离动脉瘤远端的FFR不显著，但其快速下降的速度表明风险升高。图形抽象
Current treatments for patients with coronary aneurysms caused by Kawasaki disease (KD) are based primarily on aneurysm size. This ignores hemodynamic factors influencing myocardial ischemic risk. We performed patient-specific computational hemodynamics simulations for 15 KD patients, with parameters tuned to patients’ arterial pressure and cardiac function. Ischemic risk was evaluated in 153 coronary arteries from simulated fractional flow reserve (FFR), wall shear stress, and residence time. FFR correlated weakly with aneurysm-scores (correlation coefficient,) but correlated better with the ratio of maximum-to-minimum aneurysmal lumen diameter (). FFR dropped more rapidly distal to aneurysms, and this correlated more with the lumen diameter ratio () than-score (). Wall shear stress correlated better with the diameter ratio (), while residence time correlated more with-score (). Overall, the maximum-to-minimum diameter ratio predicted ischemic risk better than-score. Although FFR immediately distal to aneurysms was nonsignificant, its rapid rate of decrease suggests elevated risk.Graphical Abstract