Myocardial Perfusion Simulation for Coronary Artery Disease: A Coupled Patient-Specific Multiscale Model
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Annals of Biomedical Engineering (Ó 2020) https://doi.org/10.1007/s10439-020-02681-z
Original Article
Myocardial Perfusion Simulation for Coronary Artery Disease: A Coupled Patient-Specific Multiscale Model LAZAROS PAPAMANOLIS,1 HYUN JIN KIM,2 CLARA JAQUET,3 MATTHEW SINCLAIR,2,6 MICHIEL SCHAAP,2,6 IBRAHIM DANAD,4 PEPIJN VAN DIEMEN,4 PAUL KNAAPEN,4 LAURENT NAJMAN,3 HUGUES TALBOT,3,5 CHARLES A. TAYLOR,2 and IRENE VIGNON-CLEMENTEL 1 1
Inria, Paris, France; 2HeartFlow Inc., Redwood City, USA; 3LIGM, Universite´ Gustave Eiffel, CNRS, ESIEE Paris, 77454 Marne-la-Valle, France; 4Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 5CentraleSupe´lec, Universite´ Paris-Saclay, Inria, Gif-sur-Yvette, France; and 6Imperial College London, London, UK (Received 7 May 2020; accepted 25 October 2020) Associate Editor Merryn Tawhai oversaw the review of this article.
Abstract—Patient-specific models of blood flow are being used clinically to diagnose and plan treatment for coronary artery disease. A remaining challenge is bridging scales from flow in arteries to the micro-circulation supplying the myocardium. Previously proposed models are descriptive rather than predictive and have not been applied to human data. The goal here is to develop a multiscale patient-specific model enabling blood flow simulation from large coronary arteries to myocardial tissue. Patient vasculatures are segmented from coronary computed tomography angiography data and extended from the image-based model down to the arteriole level using a space-filling forest of synthetic trees. Blood flow is modeled by coupling a 1D model of the coronary arteries to a single-compartment Darcy myocardium model. Simulated results on five patients with nonobstructive coronary artery disease compare overall well to [15 O]H2 O PET exam data for both resting and hyperemic conditions. Results on a patient with severe obstructive disease link coronary artery narrowing with impaired myocardial blood flow, demonstrating the model’s ability to predict myocardial regions with perfusion deficit. This is the first report of a computational model for simulating blood flow from the epicardial coronary arteries to the left ventricle myocardium applied to and validated on human data. Keywords—Heart, Hemodynamics, MBF (Myocardial blood flow), Coronary artery disease, PET perfusion map.
Address correspondence to Irene Vignon-Clementel, Inria, Paris, France. Electronic mail: [email protected]
INTRODUCTION Coronary artery disease (CAD), affecting millions of people each year, is the leading cause of death world-wide. Numerous cardiac exams are in clinical use for assessment of CAD, often relying on medical imaging to quantify anatomical and physiological measures prognostic for patient risk. Non-invasive testing modalities most widely utilized have demonstrated only modest diagnostic performance resulting in unnecessary hospital procedures37 costing billions of dollars annually. Some diagnostic modalities involve invasive protocols, putting patients at increased ris
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