CORONARY ARTERY DYNAMIC GEOMETRY AND ATHEROSCLEROSIS

本研究的长期目标是：（1）确定血管系统的几何特征，这些特征增强了动脉对动脉粥样硬化疾病的易感性，并可用于早期识别相应的风险个体，以及（2）了解机械因素在动脉粥样硬化定位和病理生物学中的作用。 为了实现第一个目标，在人体冠状动脉的几何特征的体内测量和血管的病理之间的关系，重点是早期病变。 通过计算选定血管段中流体动力学和壁内应力的分布，并寻找这些变量与体内测量的血管内膜和中膜厚度之间的相关性，进一步实现了第二个目标。将对俄亥俄州州立大学和维克森林大学医学院60名患者的临床双平面冠状动脉电影血管造影片进行数字化处理，以重建左前降支和右冠状动脉树选定节段的中轴线的三维（3-D）过程。将使用客观计算机算法从轴获得节段的定量几何参数，包括动脉几何形状的静态和动态测量以及血管运动学测量。 将评估个体之间的几何形状变化。 将获得并处理相同节段的血管内超声（IVUS）记录，以获得与血管轴并列的血管形态测量的详细测量结果。还将采集多普勒血流数据和相位压力。将寻求来自血管造影片的几何变量与来自IVUS记录的形态测量参数之间的关系;分析将考虑动脉粥样硬化传统风险因素的个体差异。血管造影片的动态数据将用于模型计算，以估计血管运动和弯曲对流场和壁应力的影响。 对于12例病例，血管造影和IVUS记录将用于描述血管腔中一部分血管的三维管腔和壁。 将使用多普勒和压力数据作为输入，对该区域的流场和壁面应力进行数值模拟;第一次流量计算将通过实验进行验证。 通过比较作用于血管段上和血管段中的应力的计算分布与内膜/中膜厚度的计算分布，将得出关于机械力与人类动脉粥样硬化相关的作用的推论。

The long-term objectives of this research are: (1) to identify geometric features of the vasculature that enhance arterial susceptibility to atherosclerotic disease and can be used for early identification of individuals accordingly at risk, and (2) to understand the role of mechanical factors in the localization and pathobiology of atherosclerosis. To achieve the first objective, relationships are sought between in vivo measurements of the geometric features of human coronary arteries and the pathology of the vessels, with a focus on the early lesion. The second objective is furthered by computing the distribution of fluid dynamic and intramural stresses in selected vessel segments, and seeking correlations between these variables and the thicknesses of the vascular intima and media, as measured in vivo. Clinical biplane coronary cineangiograms of sixty patients at The Ohio State University and Wake Forest University School of Medicine will be processed digitally to reconstruct the three- dimensional (3-D) course of the medial axes of selected segments of the left anterior descending and right coronary artery trees. Quantitative geometric parameters of the segments, including both static and dynamic measures of arterial geometry and measures of vessel kinematics, will be obtained from the axes using objective computer algorithms. Variations in geometry among individuals will be assessed. Intravascular ultrasound (IVUS) records of the same segments will be obtained and processed to yield detailed measurements of vessel morphometry collocated to the vessel axes. Doppler flow data and phasic pressure will also be acquired. Relations will be sought between the geometric variables from the angiograms and morphometric parameters derived from the IVUS records; and analysis will take into account individual variability with respect to the traditional risk factors for atherosclerosis. The dynamic data from the angiograms will be used in model calculations to estimate the effect of vessel motion and bending on the flow fieled and wall stresses. For twelve cases, the angiographic and IVUS records will be used to describe the 3-D lumen and wall of a portion of the vessel in diastole. The flow fieled and wall stresses in this region will be simulated numerically, using the Doppler and pressure data as input; the first flow calculation will be validated experimentally. By comparing the computed distribution of stresses acting on and in the vessel segment against that of intima/media thickness, inferences will be drawn regarding the role of mechanical forces in relation to human atherosclerosis.