Long-term hemodynamic mechanism of enhanced external counterpulsation in the treatment of coronary heart disease: a geometric multiscale simulation
Long-term hemodynamic mechanism of enhanced external counterpulsation in the treatment of coronary heart disease: a geometric multiscale simulation
复制标题
增强体外反搏治疗冠心病的长期血流动力学机制：几何多尺度模拟
DOI：
10.1007/s11517-019-02028-4
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发表时间：
2019-11-01
影响因子：
3.2
通讯作者：
Liu, Youjun
中科院分区：
文献类型：
--
作者：
Li, Bao;Wang, Wenxin;Liu, Youjun
增强型体外反搏(EECP)是一种作用于血管内皮细胞的冠状动脉粥样硬化的非侵入性治疗方法。影响远期治疗效果的冠脉内血流动力学参数是抑制内膜增生的根本因素，无法实时测量。为了优化冠心病的长期治疗效果，有必要建立一种定量计算体外反搏冠脉内血流动力学参数的方法，以研究体外反搏的长期血流动力学机制。建立了冠状动脉狭窄的零维(0D)集总参数模型和三维(3D)模型耦合的几何多尺度模型，用于冠状动脉内血流动力学环境的模拟。三维模型用于计算壁面切应力(WSS)和振荡剪切指数(OSI)等血流动力学参数，而0D模型用于模拟血液循环系统。在考虑血管塌陷的0D模型中，对小腿、大腿和臀部模块施加顺序压力。将血流动力学性能与临床报告进行比较，以验证该方法的有效性。EECP治疗后舒张压(DBP)、冠脉流量和面积平均WSS显著升高，而狭窄后OSI有所下降。冠状动脉血流波形与临床测量波形有很好的相似性，计算的平均动脉压(MAP)与临床测量的MAP之间的误差在1%以内。改善WSS、降低OSI是EECP治疗冠心病的根本因素。与临床报道相比，即时血流动力学变化证明了该模型的有效性。该方法可获得体外反搏时冠状动脉内血流动力学参数，可用于模拟体外反搏的远期疗效。
Enhanced external counterpulsation (EECP) is a noninvasive treatment method for coronary artery atherosclerosis that acts on the vascular endothelial cells. The intracoronary hemodynamic parameters that influence long-term treatment effect are the fundamental factors for the inhibition of intimal hyperplasia, which cannot be measured in real time. In order to optimize the long-term treatment effect of coronary heart disease, it is necessary to establish a method for quantified calculation of intracoronary hemodynamic parameters during counterpulsation to research the long-term hemodynamic mechanism of EECP. A geometric multiscale model coupled by the zero-dimensional (0D) lumped parameter model and the three-dimensional (3D) model of narrow coronary artery was established for the simulation of intracoronary hemodynamic environment. The 3D model was used to calculate the hemodynamic parameters such as wall shear stress (WSS) and oscillatory shear index (OSI), while the 0D model was used to simulate the blood circulatory system. Sequential pressure was applied to calves, thighs, and buttocks module in 0D model with the consideration of vessel collapse. Hemodynamic performance was compared with clinical reports to verify the effectiveness of the method. There were significant increases of the diastolic blood pressure (DBP), coronary flow, and the area-averaged WSS during application of EECP, while OSI behind stenosis has some decrease. The waveforms of coronary flow has good similarity with the clinical measured waveforms, and the differences between calculated mean arterial pressures (MAPs) and clinical measurements were within 1%. The fundamental factor in the cure of coronary heart disease by EECP is the improvement of WSS and the decrease of OSI. Comparing with the clinical reports, the immediate hemodynamic changes demonstrate the effectiveness of model. Intracoronary hemodynamic parameters during EECP could be acquired and the method could be used to simulate the long-term treatment effect of EECP.Graphical abstract