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

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. and MORRIS, Paul D. (2024). Evaluation of models of sequestration flow in coronary arteries—Physiology versus anatomy? Computers in Biology and Medicine, 173: 108299.

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Open Access URL: https://www.sciencedirect.com/science/article/pii/... (Published version)
Link to published version:: https://doi.org/10.1016/j.compbiomed.2024.108299


Background: 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. Methods and results: 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). Conclusion: 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.

Item Type: Article
Additional Information: ** Article version: AM ** Embargo end date: 31-12-9999 ** From Elsevier via Jisc Publications Router ** Licence for AM version of this article: This article is under embargo with an end date yet to be finalised. **Journal IDs: issn 00104825 **History: issued 18-03-2024; accepted 12-03-2024
Identification Number: https://doi.org/10.1016/j.compbiomed.2024.108299
SWORD Depositor: Colin Knott
Depositing User: Colin Knott
Date Deposited: 26 Mar 2024 13:03
Last Modified: 24 Apr 2024 08:00
URI: https://shura.shu.ac.uk/id/eprint/33452

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