Computational Network Model Prediction of Hemodynamic Alterations Due to Arteriolar Rarefaction and Estimation of Skeletal Muscle Perfusion in Peripheral Arterial Disease.
Computational Network Model Prediction of Hemodynamic Alterations Due to Arteriolar Rarefaction and Estimation of Skeletal Muscle Perfusion in Peripheral Arterial Disease.
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DOI：
10.1111/micc.12203
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发表时间：
2015-07
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影响因子：
--
通讯作者：
Price RJ
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文献类型：
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作者：
Heuslein JL;Li X;Murrell KP;Annex BH;Peirce SM;Price RJ
评估运动和/或经皮介入治疗后外周动脉疾病（PAD）患者输入压和小动脉稀疏对腓肠肌灌注的相对影响。腓肠肌微循环的计算网络模型被适配为反映基于PAD患者的小动脉密度测量的稀疏，有和没有运动。在供血动脉处施加标准化输入压力，以模拟PAD条件下踝臂指数（ABI）的降低和恢复。在小动脉稀疏的模拟中，阻力随着稀疏而非线性地增加，导致灌注的异常大的下降。此外，随着稀疏程度的增加，灌注对输入压力的变化不太敏感。PAD患者的小动脉密度降低，运动3个月后改善33.8%。在PAD的模型模拟中，ABI恢复仅使灌注恢复到基线的66%。当通过减少稀疏来模拟运动训练时，ABI恢复将灌注增加到基线的80%。微血管阻力随着微动脉稀疏程度的增加而非线性增加。因此，随着小动脉稀疏增加，肌肉灌注对ABI恢复的敏感性降低。这些结果强调了在PAD治疗中恢复微血管结构和上游输入压力的重要性。
To estimate the relative influence of input pressure and arteriole rarefaction on gastrocnemius muscle perfusion in patients with peripheral arterial disease (PAD) after exercise and/or percutaneous interventions. A computational network model of the gastrocnemius muscle microcirculation was adapted to reflect rarefaction based on arteriolar density measurements from PAD patients, with and without exercise. A normalized input pressure was applied at the feeder artery to simulate both reduced and restored ankle-brachial index (ABI) in the PAD condition. In simulations of arteriolar rarefaction, resistance increased non-linearly with rarefaction, leading to a disproportionally large drop in perfusion. Additionally, perfusion was less sensitive to changes in input pressure as the degree of rarefaction increased. Reduced arteriolar density was observed in PAD patients and improved 33.8% after 3 months of exercise. In model simulations of PAD, ABI restoration yielded perfusion recovery to only 66% of baseline. When exercise training was simulated by reducing rarefaction, ABI restoration increased perfusion to 80% of baseline. Microvascular resistance increases non-linearly with increasing arteriole rarefaction. Therefore, muscle perfusion becomes disproportionally less sensitive to ABI restoration as arteriole rarefaction increases. These results highlight the importance of restoring both microvascular structure and upstream input pressure in PAD therapy.