The role of wall shear stress in the assessment of right ventricle hydraulic workload
The role of wall shear stress in the assessment of right ventricle hydraulic workload
复制标题
DOI：
10.1086/679703
复制
发表时间：
2015-03-01
影响因子：
2.6
通讯作者：
Finol, Ender
中科院分区：
文献类型：
--
作者：
Kheyfets, Vitaly;Thirugnanasambandam, Mirunalini;Finol, Ender
肺动脉高压（PH）是一种破坏性疾病，每百万人中约有15-50人受到影响，女性发病率较高。PH死亡率主要归因于右心室（RV）衰竭，这是由于液压负荷过重导致的RV萎缩所致。本研究的目的是将壁面切应力（WSS）与血流动力学指标相关联，血流动力学指标通常被认为是RV工作负荷的临床指标，并与疾病结局密切相关。分析20例PH患者的回顾性右心导管数据，以获得肺血管阻力（PVR）、动脉顺应性（C）和波反射指数（Gamma）。患者特异性对比增强计算机断层扫描胸部图像用于重建个体肺动脉树，直至第七代。对每个血管模型进行了模拟收缩期峰值血流的计算流体动力学分析，以计算肺动脉内皮表面上的WSS分布。WSS随PVR升高和C降低而成比例降低。空间平均WSS（SAWSS）与PVR（R-2 = 0.66）、C（R-2 = 0.73）和G（R-2 = 0.5）呈正相关，并与RV几何特征初步相关。在近端脉管系统（主动脉、右肺动脉和左肺动脉）的随机横截面上评价WSS，这种类型的数据可以从相位对比磁共振成像中获得，但没有显示出相同的相关性。总之，我们发现WSS有可能成为PH疾病进展和RV健康的可行和临床有用的无创指标。未来的工作应侧重于评估SAWSS是否在PH的管理中具有预后价值，以及它是否可以用作快速反应性评估工具，这将有助于选择适当的治疗方法。
Pulmonary hypertension (PH) is a devastating disease affecting approximately 15-50 people per million, with a higher incidence in women. PH mortality is mostly attributed to right ventricle (RV) failure, which results from RV hypotrophy due to an overburdened hydraulic workload. The objective of this study is to correlate wall shear stress (WSS) with hemodynamic metrics that are generally accepted as clinical indicators of RV workload and are well correlated with disease outcome. Retrospective right heart catheterization data for 20 PH patients were analyzed to derive pulmonary vascular resistance (PVR), arterial compliance (C), and an index of wave reflections (Gamma). Patient-specific contrast-enhanced computed tomography chest images were used to reconstruct the individual pulmonary arterial trees up to the seventh generation. Computational fluid dynamics analyses simulating blood flow at peak systole were conducted for each vascular model to calculate WSS distributions on the endothelial surface of the pulmonary arteries. WSS was found to be decreased proportionally with elevated PVR and reduced C. Spatially averaged WSS (SAWSS) was positively correlated with PVR (R-2 = 0.66), C (R-2 = 0.73), and G (R-2 = 0.5) and also showed promising preliminary correlations with RV geometric characteristics. Evaluating WSS at random cross sections in the proximal vasculature (main, right, and left pulmonary arteries), the type of data that can be acquired from phase-contrast magnetic resonance imaging, did not reveal the same correlations. In conclusion, we found that WSS has the potential to be a viable and clinically useful noninvasive metric of PH disease progression and RV health. Future work should be focused on evaluating whether SAWSS has prognostic value in the management of PH and whether it can be used as a rapid reactivity assessment tool, which would aid in selection of appropriate therapies.