[논문]관상동맥 내의 나선형 유동이 협착도에 따라 분획 혈류 예비능에 미치는 영향에 관한 수치해석

이경은; 김국태; 류아진; 심은보

doi:10.6112/kscfe.2017.22.1.015

관상동맥 내의 나선형 유동이 협착도에 따라 분획 혈류 예비능에 미치는 영향에 관한 수치해석
THE INFLUENCES OF SWIRL FLOW ON FRACTIONAL FLOW RESERVE IN MILD/MODERATE/SEVERE STENOTIC CORONARY ARTERIAL MODELS 원문보기

한국전산유체공학회지 = Journal of computational fluids engineering, v.22 no.1 = no.76, 2017년, pp.15 - 25

이경은 (강원대학교 기계의용공학과) , 김국태 (강원대학교 기계의용공학과) , 류아진 (강원대학교 기계의용공학과) , 심은보 (강원대학교 기계의용공학과)

Abstract ▼ AI-Helper

Swirl flow is often found in proximal coronary arteries, because the aortic valves can induce swirl flows in the coronary artery due to vortex formation. In addition, the curvature and tortuosity of arterial configurations can also produce swirl flows. The present study was performed to investigate fractional flow reserve alterations in a post-stenotic distal part due to the presence of pre-stenotic swirl flow by computational fluid dynamics analysis for virtual stenotic models by quantifying fractional flow reserve(FFR). Simplified stenotic coronary models were divided into those with and without pre-stenotic swirl flow. Various degrees of virtual stenosis were grouped into three grades: mild, moderate, and severe, with degree of stenosis of 0 ~ 40%, 50 ~ 60%, and 70 ~ 90%, respectively. In this study, three-dimensional computational hemodynamic simulations were performed under hyperemic conditions in virtual stenotic coronary models by coupling with a zero-dimensional lumped parameter model. The results showed that the influence of pre-stenotic swirl inflow is dominant on FFR alteration in mild stenosis, whereas stenosis is dominant on FFR alteration in moderate/severe stenosis. The decrease in FFR caused by swirl flow is more significant in mild stenosis than moderate/severe stenosis. Biomechanical modeling is useful for clinicians to provide insight for medical intervention strategies. This hemodynamic-based parameter study could play a critical role in the development of a non-invasive imaging-based strategy-support system for percutaneous transluminal angioplasty in cases of mild/moderate stenosis.

주제어

AI 본문요약
AI-Helper

* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.

문제 정의

The present inductive study, with the assumption of the presence or absence of pre-stenotic swirl flow in various grades of stenosis, provides a better understanding of this issue. This study was performed to investigate how pre-stenotic swirl flow affects post-stenotic distal FFR alterations and distal flow behavior under various virtual grades of stenosis progression in a patient. In the present study, we examined pulsatile flow in simplified straight stenotic and helical stenotic coronary arterial models using the 0-D 3-D-coupled Navier-Stokes solver.
Here, we present clinically significant FFR associated with pressure and velocity-related mechanical factors. This study was performed to investigate how the presence of pre-stenotic swirl flow influences the post-stenotic local FFR alteration. In particular, we focus on investigating quantitative as well as qualitative characteristics of the effects of swirl flow on the FFR in various mild/ moderate/severe stenotic models using a physiologically more correct zero-dimensional(0-D)- three-dimensional(3-D) coronary circulation simulation.

제안 방법

This study has several limitations. First, the effects of patient-specific physiological data (e.g., systolic pressure, diastolic pressure, heart rate, stroke volume, vortex magnitude, anatomically correct vascular configuration) were not considered in simplified modeling. Therefore, qualitative analysis of FFR could be more applicable than quantitative analysis.
where u is velocity, p is pressure, ρ is density, and μ is dynamic viscosity. The outlet condition of 3-D computational fluid dynamics is coupled to the inlet condition of 0-D lumped parameter model by an iteration method that updates the pressure and velocity as the iteration processes. The coupling calculation continues until the velocity and pressure between the two models converge, using a successive over-relaxation(SOR)-based iterative solver.
Accordingly, many groups have investigated the influences of swirl flows on downstream flow fields, mainly on velocity patterns and wall shear stress distributions[10-16]. These studies indicated that the common swirl/helical flow promotes blood flow transport, mass transport, mixing phenomena, and helically twisted ribbon-shaped distributions of both pressure and wall shear stress distributions.

이론/모형

In this study, computational hemodynamic simulations were performed under hyperemic conditions in 3-D stenotic coronary models by coupling with a 0-D lumped parameter model. Blood flow was described by a continuity equation for mass conservation and a Navier-Stokes equation for pulsatile state in Eq.
Pulsatile flows in simplified stenotic coronary models, with and without pre-stenotic swirl flow, were simulated by 0-D 3-D-coupled multi-scale modeling based on Navier-Stoke equations. We analyzed a physiologically significant biomechanical factor(FFR) respects to stenosis severity in a non-swirl flow model and a swirl flow model.

성능/효과

In the normal model (SD = 0%) shown in Fig. 6(c), FFR reduction caused by the swirl flow was significant in the pre-stenotic region, and a parallel downward slope of FFR was observed in the post-stenotic region. In the case of mild stenosis (SD = 20% and 40%) in Fig.
First, FFR alterations caused by pre-stenotic non-swirl flow and swirl flow were clearly observed in mild stenosis (SD < 50%), but FFR remained nearly the same over SD = 50% (Fig. 5).
In mild stenotic models, the role of swirl flow in reducing FFR was verified by computational comparative simulation studies using pre-stenotic straight and helical models. The results indicated that the presence of pre-stenotic swirl flow notably alters FFR and induces reduction of FFR in mild stenotic geometries. The influence of pre-stenotic swirl flow was not significant as the degree of stenosis increased.

참고문헌 (46)

1996, Frazin, L.J., Vonesh, M.J., Chandran, K.B., Shipkowitz, T., Yaacoub, A.S. and McPherson, D.D., "Confirmation and Initial Documentation of Thoracic and Abdominal Aortic Helical Flow: An Ultrasound Study," Journal of the American Society for Artificial Internal Organs, Vol.42, No.6, pp.951-956.

상세보기
2007, Frydrychowicz, A., Winterer, J.T., Zaitsev, M., Jung, B., Henning, J., Langer, M. and Markl, M., "Visualization of iliac and proximal femoral artery hemodynamics using time-resolved 3-D phase contrast MRI at 3T," Journal of Magnetic Resonance Imaging, Vol.25, No.5, pp.1085-1092.

상세보기
2001, Kaazempur-Mofrad, M.R. and Ethier, C.R., "Mass transport in an anatomically realistic human right coronary artery," Annals of Biomedical Engineering, Vol.29, No.2, pp.121-127.

상세보기
1993, Kilner, P.J., Yang, G.Z., Mohiaddin, R.H., Firmin, D.N. and Longmore, D.B., "Helical and retrograde secondary flow patterns in the aortic arch studied by three-directional magnetic resonance velocity mapping," Circulation, Vol.88, No.5, pp.2235-2247.

상세보기
2014, Ha, H. and Lee, S.J., "Effect of swirling inlet condition on the flow field in a stenosed arterial vessel model," Medical Engineering & Physics, Vol.36, No.1, pp.119-128.

상세보기
2003, Houston, J.G., Gandy, S.T., Sheppard, D.G., Dick, J.B., Belch, J.J. and Stonebridge, P.A., "Two-dimensional flow quantitative MRI of aortic arch blood flow patterns: Effect of age, sex, and presence of carotid atheromatous disease on prevalence of spiral blood flow," Journal of Magnetic Resonance Imaging, Vol.18, No.2, pp.169-174.

상세보기
2009, Liu, X., Pu, F., Fan, Y., Deng, X., Li, D. and Li, S., "A numerical study on the flow of blood and the transport of LDL in the human aorta: the physiological significance of the helical flow in the aortic arch," American Journal of Physiology-Heart and Circulatory Physiology, Vol.297, No.1, pp.H163-H170.

상세보기
2008, Verhey, J.F. and Bara, C., "Influence on fluid dynamics of coronary artery outlet angle variation in artificial aortic root prosthesis," Biomed Engineering Online, Vol.7, No.9, pp.1-9.

상세보기
2011, Morbiducci, U., Ponzini, R., Rizzo, G., Cadioli, M., Esposito, A., Montevecchi, F.M. and Redaelli, A., "Mechanistic insight into the physiological relevance of helical blood flow in the human aorta: an in vivo study," Biomechanics and Modeling in Mechanobiology, Vol.10, No.3, pp.339-355.

상세보기
2011, Lee, K.E., Lee, J.S. and Yoo, J.Y., "A numerical study on steady flow in helically sinuous vascular prostheses," Medical Engineering & Physics, Vol.33, No.1, pp.38-46.

상세보기
2015, Liu, X., Sun, A., Fan, Y. and Deng, X., "Physiological significance of helical flow in the arterial system and its potential clinical applications," Annals of Biomedical Engineering, Vol.43, No.1, pp.3-15.

상세보기
2009, Paul, M.C. and Larman, A., "Investigation of spiral blood flow in a model of arterial stenosis," Medical Engineering & Physics, Vol.31, No.9, pp.1195-1203.

상세보기
1996, Caro, C.G., Doorly, D.J., Tarnawski, M., Scott, K.T., Long, Q. and Dumoulin, C.L., "Non-planar curvature and branching of arteries and non-planar-type flow," Proceedings of the Royal Society of London A: Mathematical, Physical and Engineering Sciences. The Royal Society, Vol.452, No.1944, pp.185-197.

상세보기
2013, Caro, C.G., Seneviratne, A., Heraty, K.B., Monaco, C., Burke, M.G., Krams, R., Chang, C.C., Coppola, G. and Gilson, P., "Intimal hyperplasia following implantation of helical-centreline and straight-centreline stents in common carotid arteries in healthy pigs: influence of intraluminal flow," Journal of the Royal Society Interface, Vol.10, No.89, p.20130578.

상세보기
2009, Cookson, A.N., Doorly, D.J. and Sherwin, S.J., "Mixing through stirring of steady flow in small amplitude helical tubes," Annals of Biomedical Engineering, Vol.37, No.4, pp.710-721.

상세보기
2009, Sung, K.H., Ro, K.C. and Ryou, H.S., "Numerical investigation on the blood flow characteristics considering the axial rotation in stenosed artery," Korea-Australia Rheology Journal, Vol.21, No.2, pp.119-126.

원문보기 상세보기
2013, Keshavarz-Motamed, Z., Garcia, J. and Kadem, L., "Fluid dynamics of coarctation of the aorta and effect of bicuspid aortic valve," PLoS One, Vol.8, No.8, p.e72394.

상세보기
2004, Stonebridge, P.A., Buckley, C., Thompson, A. and Dick, J., "Non spiral and spiral (helical) flow patterns in stenoses: in vitro observations using spin and gradient echo magnetic resonance imaging (MRI) and computational fluid dynamic modeling," International Angiology, Vol.23, No.3, p.276.

상세보기
2014, Kwon, S.S., Chung, E.C., Park, J.S., Kim, G.T., Kim, J.W., Kim, K.H., Shin, E.S. and Shim, E.B., "A novel patient-specific model to compute coronary fractional flow reserve," Progress in Biophysics and Molecular Biology, Vol.116, No.1 pp.48-55.

상세보기
2015, Iori, F., Grechy, L., Corbett, R.W., Gedroyc, W., Duncan, N., Caro, C.G. and Vincent, P.E., "The effect of in-plane arterial curvature on blood flow and oxygen transport in arterio-venous fistulae," Physics of Fluids, Vol.27, No.3, p.031903.

상세보기
2008, Achenbach, S., "Quantification of Coronary Artery Stenoses by Computed Tomography," JACC: Cardiovascular Imaging, Vol.1, pp.472-474.

상세보기
2013, Cury, R.C., Feuchtner, G.M., Batlle, J.C., Pena, C.S., Janowitz, W., Katzen, B.T. and Ziffer, J.A., "Triage of patients presenting with chest pain to the emergency department: implementation of coronary CT angiography in a large urban health care system," American Journal of Roentgenology, Vol.200, No.1, pp.57-65.

상세보기
1973, Young, D.F. and Tsai, F.Y., "Flow characteristics in models of arterial stenosis I. steady flow," Journal of biomechanics, Vol.6, No.4, pp.395-410.

상세보기
2012, Klabunde, R., "Cardiovascular Physiology concepts," The 2nd Edition, Lippincott Williams & Wilkins.
2016, Lee, K.E., Kim, G.T., Lee, J.S., Chung, J.H., Shin, E.S. and Shim, E.B., "A patient-specific virtual stenotic model of the coronary artery to analyze the relationship between fractional flow reserve and wall shear stress," International Journal of Cardiology, Vol.222, pp.799-805.

상세보기
1992, Kelly, R. and Fitchett, D., "Noninvasive determination of aortic input impedance and external left ventricular power output: a validation and repeatability study of a new technique," Journal of the American College of Cardiology, Vol.20, No.4, pp.952-963.

상세보기
2006, Laurent, S., Cockcroft, J., Van Bortel, L., Boutouyrie, P., Giannattasio, C., Hayoz, D., Pannier, B., Vlachopoulos, C., Wilkinson, I. and Struijker-Boudier, H., "Expert consensus document on arterial stiffness: methodological issues and clinical applications," Eur Heart J, Vol.27, No.21, pp.2588-2605.

상세보기
2005, Verbeke, F., Segers, P., Heireman, S., Vanholder, R., Verdonck, P. and Van Bortel, L.M., "Noninvasive assessment of local pulse pressure: importance of brachial-to-radial pressure amplification," Hypertension, Vol.46, No.1, pp.244-248.

상세보기
2012, Sankaran, S., Moghadam, M.E., Kahn, A.M., Tseng, E.E., Guccione, J.M. and Marsden, A.L., "Patient-specific multiscale modeling of blood flow for coronary artery bypass graft surgery," Annals of Biomedical Engineering, Vol.40, No.10, pp.2228-2242.

상세보기
1990, Schreiner, W., Neumann, F. and Mohl, W., "The role of intramyocardial pressure during coronary sinus interventions: a computer model study," IEEE Transactions on Biomedical Engineering, Vol.37, No.10, pp.956-967.

상세보기
1998, Du Toit, C.G., "Finite element solution of the Navier-Stokes equations for incompressible flow using a segregated algorithm," Computer Methods in Applied Mechanics and Engineering, Vol.151, No.1-2, pp.131-141.

상세보기
1993, Haroutunian, V. Engelman, M.S. and Hasbani, I., "Segregated finite element algorithms for the numerical solution of large-scale incompressible flow problems," International Journal for Numerical Methods in Fluids, Vol.17, No.4, pp.323-348.

상세보기
1994, Shim, E.B. and Chang, K.S., "Three-dimensional vortex flow past a tilting disc valve using a segregated finite element scheme," Computational Fluid Dynamics Journal, Vol.3, pp.205-222.
1997, Shim, E.B. and Chang, K.S., "Numerical analysis of three-dimensional Bjork Shiley valvular flow in an aorta," Journal of Biomechanical Engineering, Vol.119, No.1, pp.45-51.

상세보기
1998, White, F.M., "Fluid mechanics. 4Th Ed," McGraw-Hill Higher Education.
1974, Gould, K.L., Lipscomb, K. and Hamilton, G.W., "Physiologic basis for assessing critical coronary stenosis: instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve," The American Journal of Cardiology, Vol.33, No.1, pp.87-94.

상세보기
2010, Bark, D.L. and Ku, D.N., "Wall shear over high degree stenoses pertinent to atherothrombosis," Journal of Biomechanics, Vol.43, No.15, pp.2970-2977.

상세보기
1998, Baumgart, D., Haude, M., Goerge, G., Ge, J., Vetter, S., Dagres, N., Heusch, G. and Erbel, R., "Improved assessment of coronary stenosis severity using the relative flow velocity reserve," Circulation, Vol.98, No.1, pp.40-60.

상세보기
2014, Gaur, S., Bezerra, H.G., Lassen, J.F., Christiansen, E.H., Tanaka, K., Jensen, J.M., Oldroyd, K.G., Leipsic, J., Achenbach, S. and Kaltoft, A.K., "Fractional flow reserve derived from coronary CT angiography: Variation of repeated analyses," Cardiovascular Computed Tomography, Vol.8, No.4, pp.307-314.

상세보기
2011, Koo, B.K., Erglis, A., Doh, J.H., Daniels, D.V., Jegere, S., Kim, H.S., Dunning, A., DeFrance, T., Lansky, A. and Leipsic, J., "Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms: results from the prospective multicenter DISCOVER-FLOW(Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study," The American College of Cardiology, Vol.58, No.19, pp.1989-1997.

상세보기
2013, Nakazato, R., Park, H.B., Berman, D.S., Gransar, H., Koo, B.K., Erglis, A., Lin, F.Y., Dunning, A.M., Budoff, M.J. and Malpeso J., "Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of Intermediate Stenosis Severity Results from the DeFACTO Study," Circulation: Cardiovascular Imaging, Vol.6, No.6, pp.881-889.

상세보기
2014, Norgaard, B.L., Leipsic, J., Gaur, S., Seneviratne, S., Ko, B.S., Ito, H., Jensen, J.M., Mauri, L., De Bruyne, B. and Bezerra, H., "Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps)," The American College of Cardiology, Vol.63, No.12, pp.1145-1155.

상세보기
2014, Renker, M., Schoepf, U.S., Wang, R., Meinel, F.G., Rier, J.D., Bayer, R.R., Mollmann, H., Hamm, C.W., Steinberg, D.H. and Baumann, S., "Comparison of Diagnostic Value of a Novel Noninvasive Coronary Computed Tomography Angiography Method Versus Standard Coronary Angiography for Assessing Fractional Flow Reserve," The American Journal of Cardiology, Vol.114, No.9, pp.1303-1308.

상세보기
2002, Shalman, E., Rosenfeld, M., Dgany, E. and Einav, S., "Numerical modeling of the flow in stenosed coronary artery. The relationship between main hemodynamic parameter," Computers in Biology and Medicine, Vol.32, No.5, pp.329-344.

상세보기
2013, Taylor, C.A., Fonte, T.A. and Min, J.K., "Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis," Journal of the American College of Cardiology, Vol.61, No.22, pp.2233-2241.

상세보기
1995, Tron, C., Donohue, T.J., Bach, R.G., Aguirre, F.V., Caracciolo, E.A., Wolford, T.L., Miller, D.D. and Kern, M.J., "Comparison of pressure-derived fractional flow reserve with poststenotic coronary flow velocity reserve for prediction of stress myocardial perfusion imaging," Journal of American Heart, Vol.130, No.4. pp.723-733.

상세보기

저자의 다른 논문 :

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증