Evaluation of models of sequestration flow in coronary arteries—Physiology versus anatomy?

Myocardial ischaemia results from insufficient coronary blood flow. Computed virtual fractional flow reserve (vFFR) allows quantification of proportional flow loss without the need for invasive pressure-wire testing. In the current study, we describe a novel, conductivity model of side branch flow,...

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Published in:Computers in biology and medicine Vol. 173; p. 108299
Main Authors: Taylor, Daniel J., Saxton, Harry, Halliday, Ian, Newman, Tom, Feher, Jeroen, Gosling, Rebecca, Narracott, Andrew J., van Kemenade, Denise, van’t Veer, Marcel, Tonino, Pim A.L., Rochette, Michel, Hose, D. Rodney, Gunn, Julian P., Morris, Paul D.
Format: Journal Article
Language:English
Published: United States Elsevier Ltd 01-05-2024
Elsevier Limited
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Summary:Myocardial ischaemia results from insufficient coronary blood flow. Computed virtual fractional flow reserve (vFFR) allows quantification of proportional flow loss without the need for invasive pressure-wire testing. In the current study, we describe a novel, conductivity model of side branch flow, referred to as ‘leak’. This leak model is a function of taper and local pressure, the latter of which may change radically when focal disease is present. This builds upon previous techniques, which either ignore side branch flow, or rely purely on anatomical factors. This study aimed to describe a new, conductivity model of side branch flow and compare this with established anatomical models. The novel technique was used to quantify vFFR, distal absolute flow (Qd) and microvascular resistance (CMVR) in 325 idealised 1D models of coronary arteries, modelled from invasive clinical data. Outputs were compared to an established anatomical model of flow. The conductivity model correlated and agreed with the reference model for vFFR (r = 0.895, p < 0.0001; +0.02, 95% CI 0.00 to + 0.22), Qd (r = 0.959, p < 0.0001; −5.2 mL/min, 95% CI −52.2 to +13.0) and CMVR (r = 0.624, p < 0.0001; +50 Woods Units, 95% CI −325 to +2549). Agreement between the two techniques was closest for vFFR, with greater proportional differences seen for Qd and CMVR. The conductivity function assumes vessel taper was optimised for the healthy state and that CMVR was not affected by local disease. The latter may be addressed with further refinement of the technique or inferred from complementary image data. The conductivity technique may represent a refinement of current techniques for modelling coronary side-branch flow. Further work is needed to validate the technique against invasive clinical data. [Display omitted] •We describe a conductivity model of side branch flow, incorporating local pressure•The model computed coronary flow, pressure, and microvascular resistance•The model correlated with established, anatomy dependent, side branch flow techniques•This new technique may enhance coronary side branch flow simulations
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ISSN:0010-4825
1879-0534
DOI:10.1016/j.compbiomed.2024.108299