Patient-Specific Coronary Hemodynamics by 3D Printing

摘要。尽管针对减少疾病负担的治疗方法有所改进，但CAD仍然困扰着 > 1600万美国成年人，占所有死亡人数的1/3以上，造成约120万人死亡。 每年住院。冠状动脉血运重建术仍然是治疗CAD的主要手段， 在美国每年进行的经皮介入治疗达100万例。之前的多中心试验已经证明 通过分流进行缺血引导血运重建的患者的有利结局 血流储备分数（FFR）-一种确定冠状动脉狭窄生理意义的侵入性“金”标准。 最近，我们研究了FFR的非侵入性CT替代方法（称为FFRCT）的准确性。 虽然这种新方法是中等准确，但它具有几个局限性，例如假设 冠状动脉是刚性的并且流动是非脉动的。因此，我们确定了一种替代方法， 通过3D打印评估冠状动脉血流动力学，允许对冠状动脉血流进行物理测量 使用真实的组织力学和脉动流。在此应用中，我们将优化硬件，软件， 工作流程和分析，以基于患者CT图像构建和评估冠状动脉血流动力学。 广泛的临床成像数据，包括15 O-H2O标记的PET成像，将用于验证 这些模型用于预测冠状动脉血流动力学。最后，这些3D打印模型将用于开发 临床上有用的报告可以提供仅使用 非侵入性CT成像。

ABSTRACT. Despite improvements in therapies targeted at reducing disease burden, CAD continues to afflict >16 million US adults, accounting for more than 1/3 of all deaths and responsible for ~1.2 million hospitalizations annually. Coronary revascularization remains a mainstay of treatment for CAD, with >1.2 million percutaneous interventions performed annually in the US. Prior multicenter trials have demonstrated propitious outcomes for individuals with who undergo ischemia-guided revascularization by fractional flow reserve (FFR)—an invasive “gold” standard that determines the physiologic significance of coronary stenoses. More recently we have studied the accuracy of a non-invasive CT-based alternative to FFR, termed FFRCT. While this new method is moderately accurate, it possesses several limitations such as assuming the walls of the coronaries are rigid and flow is non-pulsatile. Therefore, we have determined an alternative approach to assessing coronary hemodynamics via 3D printing, which allows physical measurements of coronary flow using realistic tissue mechanics and pulsatile flow. In this application, we will optimize the hardware, software, workflows, and analysis to build and evaluate coronary hemodynamics based on patient CT images. Extensive clinical imaging data, including 15O-H2O labeled PET imaging will be used to validate the accuracy of these models for predicting coronary hemodynamics. Finally, these 3D printed models will be used to develop clinically useful reports that can provide diagnostic determination of a patient's level of ischemia using only non-invasive CT imaging.