Numerical Analysis on the Hemodynamic Effects of Asymmetric Stenosis at High Heart Rate in the Left Coronary Artery Bifurcation
Keywords:
Atherosclerosis, Computational fluid dynamics, Coronary artery, Hemodynamics, Stenosis.Abstract
The branches of the left coronary artery are more critical compared with the right counterpart from the perspective of atherosclerosis and associated heart diseases. Most of the preceding research works studied axisymmetric stenosis shapes in coronary artery bifurcation. However, recent studies indicate that coronary artery blockages are often asymmetric in structures. The present work carries out a novel numerical investigation on the effects of asymmetric degree of stenosis (DOS) having the more typical cosine shape by considering the branches of the left coronary main (LCM) artery, namely, the left circumflex (LCx) and left anterior descending (LAD). The results are analysed to correlate the influence of stenosis in LCx and LAD to the disease severity and progression in terms of hemodynamic parameters including wall shear stress (WSS) profiles, oscillatory shear index (OSI), and pressure drop (PD). The computations reveal that WSS attains lower values over wider regions in the post-stenotic regions in LAD compared with LCx. The values of OSI in the LAD are also higher compared to LCx in all the cases. The peak value of the OSI decreases with the increase in the DOS. However, for higher stenosis degrees, the prominence of OSI is observed even at larger distances in the post-stenosis region. At a given DOS, PD is more in LAD compared with LCx. These effects are found to increase with DOS.References
World Health Organization, Cardiovascular diseases (CVDs) (website). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds), 2021 (accessed 21.03.2023).
I. O. Starodumov, S. Y. Sokolov, D. V. Alexandrov, A. Y. Zubarev, I. S. Bessonov, V. V. Chestukhin and F.A Blyakhman, Modelling of hemodynamics in bifurcation lesions of coronary arteries before and after myocardial revascularization, Philosophical Transactions of the Royal Society A, 380(2217), 2022, 20200303.
P. Jhunjhunwala, P. Padole and S. Thombre, CFD analysis of pulsatile flow and non-Newtonian behavior of blood in arteries, MCB: Molecular & Cellular Biomechanics, 12(1), 2015, 37-47.
B. Zhang, Y. Jin, X. Wang, T. Zeng and L.Wang. Numerical simulation of transient blood flow through the left coronary artery with varying degrees of bifurcation angles, Journal of Mechanics in Medicine and Biology, 17(01), 2017, 1750005.
A. Athani, N. N. N. Ghazali, I. A. Badruddin, S. Kamangar, A. E. Anqi and A. Algahtani, Investigation of two-way fluid-structure interaction of blood flow in a patient-specific left coronary artery, Bio-Medical Materials and Engineering, 33(1), 2022, 13-30.
T. Chaichana, Z. Sun and J. Jewkes, Hemodynamic impacts of various types of stenosis inthe left coronary artery bifurcation: A patient-specific analysis, Physica Medica, 29(5), 2013, 447-452.
E. Miranda, L. C. Sousa, C. C. António, C. F. Castro and S. I. S. Pinto, Role of the left coronary artery geometry configuration in atherosusceptibility: CFD simulations considering sPTT model for blood, Computer Methods in Biomechanics and Biomedical Engineering, 24(13), 2021, 1488-1503.
N. Pinho, C. F Castro, C. C. António, N. Bettencourt, L. C. Sousa and S. I. S. Pinto, Correlation between geometric parameters of the left coronary artery and hemodynamic descriptors of atherosclerosis: FSI and statistical study, Medical & Biological Engineering & Computing, 57, 2019, 715-729.
S. I. S. Pinto and J. B. L. M. Campos, Numerical study of wall shear stress-based descriptors in the human left coronary artery, Computer Methods in Biomechanics and Biomedical Engineering, 19(13), 2016, 1443-1455.
K. C. Ang and J. N. Mazumdar, Mathematical modelling of three-dimensional flow through an asymmetric arterial stenosis, Mathematical and Computer Modelling, 25(1), 1997, 19-29.
J. Frattolin, M. M. Zarandi, C. Pagiatakis, O. F. Bertrand and R. Mongrain, Numerical study of stenotic side branch hemodynamics in true bifurcation lesions, Computers in Biology and Medicine, 57, 2015, 130-138.
S. Kamangar, N. J. Salman Ahmed, I. A. Badruddin, N. Al-Rawahi, A. Husain, K. Govindaraju and Y. Khan, Effect of stenosis on hemodynamics in left coronary artery based on patient-specific CT scan, Bio-Medical Materials and Engineering, 30(4), 2019, 463-473.
J. Song, S. Kouidri and F.Bakir, Numerical study of hemodynamic and diagnostic parameters affected by stenosis in bifurcated artery, Computer Methods in Biomechanics and Biomedical Engineering, 23(12), 2020, 894-905.
F. B. Tian, L. Zhu, P. W. Fok and X.Y. Lu, Simulation of a pulsatile non-Newtonian flow past a stenosed 2D artery with atherosclerosis, Computers in Biology and Medicine, 43(9), 2013, 1098-1113.
T. Sood, S. Roy and M. Pathak, Effect of pulse rate variation on blood flow through axisymmetric and asymmetric stenotic artery models, Mathematical Biosciences, 298, 2018, 1-18.
B. Thomas, K.S. Sumam and N. Sajikumar, Patient specific modelling of blood flow in coronary artery, Journal of Applied Fluid Mechanics, 14(5), 2021, 1469-1482.
M. Timofeeva, A. Ooi, E. K. Poon and P. Barlis, Numerical simulation of the blood flow through the coronary artery stenosis: Effects of varying eccentricity, Computers in Biology and Medicine, 146, 2022, 105672.
M. P. Tulppo, A. M. Kiviniemi, M. Lahtinen, O. Ukkola, T. Toukola, J. Perkiömäki, M. J. Junttila and H. V. Huikuri, Physical activity and the risk for sudden cardiac death in patients with coronary artery disease, Circulation: Arrhythmia and Electrophysiology, 13(6), 2020, e007908.
E. Marijon, M. Tafflet, D. S. Celermajer, F. Dumas, M. C. Perier, H. Mustafic, J. F. Toussaint, M. Desnos, M. Rieu, N. Benameur and J. Y. Le Heuzey, Sports-related sudden death in the general population, Circulation, 124(6), 2011, 672-681.
F. J. Ha, H. C. Han, P. Sanders, A. La Gerche, A. W. Teh, O. Farouque and H. S. Lim, Sudden cardiac death related to physical exercise in the young: A nationwide cohort study of Australia, Internal Medicine Journal, 53(4), 2023, 497-502.
M. Owais, A. Y. Usmani and K. Muralidhar, Effect of a bend on vortex formation and evolution in a three-dimensional stenosed geometry during pulsatile flow, Physics of Fluids, 35(3), 2023.
B. Liu and D. Tang, Influence of distal stenosis on blood flow through coronary serial stenoses: A numerical study. International Journal of Computational Methods, 16(03), 2019, 1842003.
S. Bahrami and M. Norouzi, A numerical study on hemodynamics in the left coronary bifurcation with normal and hypertension conditions, Biomechanics and Modeling in Mechanobiology, 17(6), 2018, 1785-1796.
M. Biglarian, B. Firoozabadi and M. S. Saidi, Atheroprone sites of coronary artery bifurcation: Effect of heart motion on hemodynamics-dependent monocytes deposition. Computers in Biology and Medicine, 133, 2021, 104411.
P. J. Blanco, G. H .V. Dos Santos, C. A. Bulant, A. M. Alvarez, F.A. Oliveira, G. Cunha-Lima and P. A. Lemos, Scaling laws and the left main coronary artery bifurcation. A combination of geometric and simulation analyses. Medical Engineering & Physics, 99, 2022, 103701.
J. T. Dodge Jr, B. G. Brown, E. L. Bolson and H. T. Dodge, Lumen diameter of normal human coronary arteries: Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation, Circulation, 86(1), 1992, 232-246.
N. Freidoonimehr, R. Chin, A. Zander and M. Arjomandi, Effect of shape of the stenosis on the hemodynamics of a stenosed coronary artery, Physics of Fluids, 33(8), 2021.
Y. Zhou, C. Lee and J. Wang, The computational fluid dynamics analyses on hemodynamic characteristics in stenosed arterial models. Journal of Healthcare Engineering, 2018, 4312415.
A. Equbal and P. Kalita, Numerical Analysis to Investigate the Effect of Stenosis Shape on the Hemodynamics of Flow Through a Straight-Cylindrical Artery, International Conference in Fluid, Thermal and Energy Systems, 2022, 109-119.
M. K. Christiansen, J. M. Jensen, B. L. Nørgaard, D. Dey, H. E. Bøtker and H. K. Jensen, Coronary plaque burden and adverse plaque characteristics are increased in healthy relatives of patients with early onset coronary artery disease. Cardiovascular Imaging, 10(10 Part A), 2017, 1128-1135.
P. Basavaraja, A. Surendran, A. Gupta, L. Saba, J. R. Laird, A. Nicolaides, E. E. Mtui, H. Baradaran, F. Lavra and J. S. Suri, Wall shear stress and oscillatory shear index distribution in carotid artery with varying degree of stenosis: Journal of Mechanics in Medicine and Biology, 17(02), 2017, 1750037.
S. Bahrami and M. Norouzi, Hemodynamic impacts of hematocrit level by two-way coupled FSI in the left coronary bifurcation, Clinical Hemorheology and Microcirculation, 76(1), 2020, 9-26.
M. Abbasian, M. Shams, Z. Valizadeh, A. Moshfegh, A. Javadzadegan and S. Cheng, Effects of different non-Newtonian models on unsteady blood flow hemodynamics in patient-specific arterial models with in-vivo validation, Computer Methods and Programs in Biomedicine, 186, 2020, 105185.
Y. Zhao, H. Wang, W. Chen, W. Sun, X. Yu, C. Sun and G. Hua, Time-resolved simulation of blood flow through left anterior descending coronary artery: effect of varying extent of stenosis on hemodynamics, BMC Cardiovascular Disorders, 23(1), 2023, 156.
M. Ferdows, K. E. Hoque, M. Z. I. Bangalee and M. A. Xenos, Wall shear stress indicators influence the regular hemodynamic conditions in coronary main arterial diseases: cardiovascular abnormalities, Computer Methods in Biomechanics and Biomedical Engineering, 26(2), 2023, 235-248.
S. Yagi, T. Sasaki, T. Fukuhara, K. Fujii, M. Morita, Y. Suyama, K. Fukuoka, T. Nishino and I. Hisatome, Hemodynamic analysis of a microanastomosis using computational fluid dynamics, Yonago Acta Medica, 63(4), 2020, 308-312.
S. Sandeep and S. R. Shine, Effect of stenosis and dilatation on the hemodynamic parameters associated with left coronary artery, Computer Methods and Programs in Biomedicine, 204, 2021, 106052.
F. Gijsen, Y. Katagiri, P. Barlis, C. Bourantas, C. Collet, U. Coskun, J. Daemen, J. Dijkstra, E. Edelman, P. Evans and K. Van Der Heiden, Expert recommendations on the assessment of wall shear stress in human coronary arteries: Existing methodologies, technical considerations, and clinical applications, European Heart Journal, 40(41), 2019, 3421-3433.
D. N. Ku, D. P. Giddens, C. K. Zarins and S. Glagov, Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low and oscillating shear stress, Arteriosclerosis, 5(3), 1985, 293-302.
A. Bit, A. Alblawi, H. Chattopadhyay, Q. A. Quais, A. C. Benim, M. Rahimi-Gorji and H.T. Do, Three dimensional numerical analysis of hemodynamic of stenosed artery considering realistic outlet boundary conditions, Computer Methods and Programs in Biomedicine, 185, 2020, 105163.
N. Freidoonimehr, R. Chin, A. Zander and M. Arjomandi, An experimental model for pressure drop evaluation in a stenosed coronary artery, Physics of Fluids, 32(2), 2020.
X. Chen, J. Zhuang, H. Huang and Y. Wu, Fluid–structure interactions (FSI) based study of low-density lipoproteins (LDL) uptake in the left coronary artery, Scientific Reports, 11(1), 2021, 4803.
R. Jahromi, H. A. Pakravan, M. S. Saidi and B. Firoozabadi, Primary stenosis progression versus secondary stenosis formation in the left coronary bifurcation: A mechanical point of view, Biocybernetics and Biomedical Engineering, 39(1), 2019, 188-198.
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