Model-based evaluation of local hemodynamic effects of enhanced external counterpulsation
Model-based evaluation of local hemodynamic effects of enhanced external counterpulsation
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基于模型的体外反搏增强局部血流动力学效应评价
DOI：
10.1016/j.cmpb.2021.106540
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发表时间：
2021-11
影响因子：
6.1
通讯作者：
Ke Xu;Bao Li;Jincheng Liu;M. Chen;Liyuan Zhang;Boyan Mao;Xiaolu Xi;Hao Sun;Zhe Zhang;Youjun Liu
中科院分区：
文献类型：
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作者：
Ke Xu;Bao Li;Jincheng Liu;M. Chen;Liyuan Zhang;Boyan Mao;Xiaolu Xi;Hao Sun;Zhe Zhang;Youjun Liu
背景和目的增强型体外反搏（EECP）的治疗效果在很大程度上取决于血流动力学。体外反搏的整体血流动力学可引起循环系统的血流重新分布，而局部血流动力学效应则作用于血管内皮细胞（VEC）。EECP对血管内皮细胞的局部血流动力学影响在动脉粥样硬化的治疗中很重要，但目前无法评估。在此，我们的目标是建立基于整体血流动力学指标的局部血流动力学效应评价模型.MethodsWe建立了两名健康人冠状动脉和脑动脉的0 D/3D几何多尺度血流动力学模型，计算整体血流动力学指标和局部血流动力学效应.进行临床EECP试验以验证多尺度血流动力学模型的准确性。整体血流动力学指标包括舒张压/收缩压（Q=D/S）、平均动脉压（MAP）、颈内动脉血流量（ICAF）和脑血流量（CBF），局部血流动力学指标包括时间平均壁面切应力（TAWSS）。通过Pearson相关系数分析这些指标之间的相关性。选取相关性显著的指标进行曲线拟合，建立冠状动脉和脑动脉的评价模型。结果冠状动脉TAWSS与Q =D/S、ICAF相关（P< 0.05），脑动脉TAWSS与MAP、CBF相关（P <0.05）。冠状动脉和大脑动脉TAWSS的评价模型评价值与0 D/3D模型计算值的均方误差（MSE）分别为5.4%和1.0%。应用于真实的患者的评价模型的MSE大于应用于健康人的MSE，但在可接受的范围内。基于所建立的评价模型，可以利用整体血流动力学指标评价当前反搏模式下的局部血流动力学效应。以4-7 Pa的TAWSS范围作为目标范围，可以进一步优化EECP策略。
Background and ObjectivesThe treatment benefits of enhanced external counterpulsation (EECP) heavily depends on hemodynamics. Global hemodynamics of EECP can cause blood flow redistribution in the circulatory system whereas local hemodynamic effects act on vascular endothelial cells (VECs). Local hemodynamic effects of EECP on VECs are important in the treatment of atherosclerosis, but currently cannot be not evaluated. Herein we aim to establish evaluation models of local hemodynamic effects based on the global hemodynamic indicators.MethodsWe established 0D/3D geometric multi-scale hemodynamic models of the coronary and cerebral artery of two healthy individuals to calculate the global hemodynamic indicators and the local hemodynamic effects. Clinical EECP trials were performed to verify the accuracy of the multi-scale hemodynamic model. The global hemodynamic indicators included diastolic blood pressure/systolic blood pressure (Q=D/S), mean arterial pressure (MAP), internal carotid artery flow (ICAF) and cerebral blood flow (CBF), whereas local hemodynamic effects focused on time-averaged wall shear stress (TAWSS). The correlation between these indicators was analyzed via Pearson correlation coefficient. Significantly related indicators were selected for curve-fitting to establish evaluation models of the coronary and cerebral artery. Moreover, clinical data of a coronary heart disease patient and a cerebral ischemic stroke patient were collected to verify the effectiveness of the application of the established evaluation models to real patients.ResultsFor coronary artery, TAWSS was correlated toQ=D/S and ICAF (P< 0.05), whereas for cerebral artery, TAWSS was correlated to MAP and CBF (P< 0.05). The mean square error (MSE) between the evaluated values using evaluation model and the calculated values using 0D/3D model of TAWSS of the coronary and cerebral artery were 5.4% and 1.0%, respectively. The MSE of evaluation model applied to real patients was greater than that applied to healthy individuals, but within an acceptable range.ConclusionsThe presented error demonstrated validity and accuracy of the evaluation models in clinical patients. Based on the evaluation models, global hemodynamic indicators could be used to evaluate the local hemodynamic effects under the current counterpulsation mode. With TAWSS range of 4–7 Pa as the target range, EECP strategies can further be optimized.