Patient-Specific Computational Analysis of Hemodynamics and Wall Mechanics and Their Interactions in Pulmonary Arterial Hypertension.
Patient-Specific Computational Analysis of Hemodynamics and Wall Mechanics and Their Interactions in Pulmonary Arterial Hypertension.
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DOI：
10.3389/fbioe.2020.611149
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发表时间：
2020
影响因子：
5.7
通讯作者：
Baek S
中科院分区：
文献类型：
--
作者：
Zambrano BA;McLean N;Zhao X;Tan JL;Zhong L;Figueroa CA;Lee LC;Baek S
血管壁硬度和血流动力学参数是检测肺动脉高压(PAH)的潜在生物力学指标。然而，以前的计算分析没有考虑血流和管壁变形之间的相互作用。在这里，我们应用了一个已建立的计算框架，该框架利用患者特定的血流动力学和管壁变形测量来分析6名PAH患者和5名对照受试者近端肺动脉(PA)中流体-血管壁的耦合作用。具体地说，我们量化了PA近端的线性化硬度(E)、相对面积变化(RAC)、舒张期内径(D)、返流流量和时间平均壁切应力(TAWSS)，以及远端肺血管的总动脉阻力(RT)和顺应性(Ct)。结果发现，与对照组相比，肺动脉高压组的近端PA较硬[中位数：297kPa四分位数范围(IQR)：202kPavs中位数：75kPA，IQR5.25 mm vs中位数：25 mm，IQR：2 mm；P=0.007]，RAC降低(中位数：0.22IQR0.10vs.中位数：0.42IQR0.04；P=0.004)。总阻力(RT；中位数：6.89 mm Hg×min/L，IQR：2.16 mm Hg×min/L vs中位数：3.99 mm Hg×min/L；IQR：1.15 mm Hg×min/L；P=0.002)和较低的总顺应性(Ct；中位数：0.13ml/mm Hg，IQR：0.15ml/mm Hg对中位数：0.85ml/mm Hg；P=0.041)。此外，与对照组相比，PAH患者PA主要动脉(MPA)的TAWSS值降低(中位数：0.81Pa.IQR：0.47Pavs中位数：1.56Pa.IQR0.89Pa.P=0.026)。组内相关分析发现E与PA返流呈正相关(r=0.84，P=0.018)，与TAWSS呈负相关(r=−0.72，P=0.051)。结果提示，估计的弹性模数E可能与肺动脉高压的血流动力学变化密切相关。
Vascular wall stiffness and hemodynamic parameters are potential biomechanical markers for detecting pulmonary arterial hypertension (PAH). Previous computational analyses, however, have not considered the interaction between blood flow and wall deformation. Here, we applied an established computational framework that utilizes patient-specific measurements of hemodynamics and wall deformation to analyze the coupled fluid–vessel wall interaction in the proximal pulmonary arteries (PA) of six PAH patients and five control subjects. Specifically, we quantified the linearized stiffness (E), relative area change (RAC), diastolic diameter (D), regurgitant flow, and time-averaged wall shear stress (TAWSS) of the proximal PA, as well as the total arterial resistance (Rt) and compliance (Ct) at the distal pulmonary vasculature. Results found that the average proximal PA was stiffer [median: 297 kPa, interquartile range (IQR): 202 kPa vs. median: 75 kPa, IQR: 5 kPa; P = 0.007] with a larger diameter (median: 32 mm, IQR: 5.25 mm vs. median: 25 mm, IQR: 2 mm; P = 0.015) and a reduced RAC (median: 0.22, IQR: 0.10 vs. median: 0.42, IQR: 0.04; P = 0.004) in PAH compared to our control group. Also, higher total resistance (Rt; median: 6.89 mmHg × min/l, IQR: 2.16 mmHg × min/l vs. median: 3.99 mmHg × min/l, IQR: 1.15 mmHg × min/l; P = 0.002) and lower total compliance (Ct; median: 0.13 ml/mmHg, IQR: 0.15 ml/mmHg vs. median: 0.85 ml/mmHg, IQR: 0.51 ml/mmHg; P = 0.041) were observed in the PAH group. Furthermore, lower TAWSS values were seen at the main PA arteries (MPAs) of PAH patients (median: 0.81 Pa, IQR: 0.47 Pa vs. median: 1.56 Pa, IQR: 0.89 Pa; P = 0.026) compared to controls. Correlation analysis within the PAH group found that E was directly correlated to the PA regurgitant flow (r = 0.84, P = 0.018) and inversely related to TAWSS (r = −0.72, P = 0.051). Results suggest that the estimated elastic modulus E may be closely related to PAH hemodynamic changes in pulmonary arteries.