Quantifying the effect of side branches in endothelial shear stress estimates

Andreas A. Giannopoulos, Ioannis S Chatzizisis, Pal Maurovich-Horvat, Antonios P. Antoniadis, Udo Hoffmann, Michael L. Steigner, Frank J. Rybicki, Dimitrios Mitsouras

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and aims Low and high endothelial shear stress (ESS) is associated with coronary atherosclerosis progression and high-risk plaque features. Coronary ESS is currently assessed via computational fluid dynamic (CFD) simulation of coronary blood flow in the lumen geometry determined from invasive imaging such as intravascular ultrasound and optical coherence tomography. This process typically omits side branches of the target vessel in the CFD model as invasive imaging of those vessels is not usually clinically-indicated. The purpose of this study was to determine the extent to which this simplification affects the determination of those regions of the coronary endothelium subjected to pathologic ESS. Methods We determined the diagnostic accuracy of ESS profiling without side branches to detect pathologic ESS in the major coronary arteries of 5 hearts imaged ex vivo with computed tomography angiography (CTA). ESS of the three major coronary arteries was calculated both without (test model), and with (reference model) inclusion of all side branches >1.5 mm in diameter, using previously-validated CFD approaches. Diagnostic test characteristics (accuracy, sensitivity, specificity and negative and positive predictive value [NPV/PPV]) with respect to the reference model were assessed for both the entire length as well as only the proximal portion of each major coronary artery, where the majority of high-risk plaques occur. Results Using the model without side branches overall accuracy, sensitivity, specificity, NPV and PPV were 83.4%, 54.0%, 96%, 95.9% and 55.1%, respectively to detect low ESS, and 87.0%, 67.7%, 90.7%, 93.7% and 57.5%, respectively to detect high ESS. When considering only the proximal arteries, test characteristics differed for low and high ESS, with low sensitivity (67.7%) and high specificity (90.7%) to detect low ESS, and low sensitivity (44.7%) and high specificity (95.5%) to detect high ESS. Conclusions The exclusion of side branches in ESS vascular profiling studies greatly reduces the ability to detect regions of the major coronary arteries subjected to pathologic ESS. Single-conduit models can in general only be used to rule out pathologic ESS.

Original languageEnglish (US)
Pages (from-to)213-218
Number of pages6
JournalAtherosclerosis
Volume251
DOIs
StatePublished - Aug 1 2016

Fingerprint

Coronary Vessels
Hydrodynamics
Sensitivity and Specificity
Optical Coherence Tomography
Routine Diagnostic Tests
Endothelium
Blood Vessels
Coronary Artery Disease
Arteries

Keywords

  • Computational fluid dynamics
  • Coronary computed tomography
  • Endothelial shear stress
  • Side branches

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Giannopoulos, A. A., Chatzizisis, I. S., Maurovich-Horvat, P., Antoniadis, A. P., Hoffmann, U., Steigner, M. L., ... Mitsouras, D. (2016). Quantifying the effect of side branches in endothelial shear stress estimates. Atherosclerosis, 251, 213-218. https://doi.org/10.1016/j.atherosclerosis.2016.06.038

Quantifying the effect of side branches in endothelial shear stress estimates. / Giannopoulos, Andreas A.; Chatzizisis, Ioannis S; Maurovich-Horvat, Pal; Antoniadis, Antonios P.; Hoffmann, Udo; Steigner, Michael L.; Rybicki, Frank J.; Mitsouras, Dimitrios.

In: Atherosclerosis, Vol. 251, 01.08.2016, p. 213-218.

Research output: Contribution to journalArticle

Giannopoulos, AA, Chatzizisis, IS, Maurovich-Horvat, P, Antoniadis, AP, Hoffmann, U, Steigner, ML, Rybicki, FJ & Mitsouras, D 2016, 'Quantifying the effect of side branches in endothelial shear stress estimates', Atherosclerosis, vol. 251, pp. 213-218. https://doi.org/10.1016/j.atherosclerosis.2016.06.038
Giannopoulos AA, Chatzizisis IS, Maurovich-Horvat P, Antoniadis AP, Hoffmann U, Steigner ML et al. Quantifying the effect of side branches in endothelial shear stress estimates. Atherosclerosis. 2016 Aug 1;251:213-218. https://doi.org/10.1016/j.atherosclerosis.2016.06.038
Giannopoulos, Andreas A. ; Chatzizisis, Ioannis S ; Maurovich-Horvat, Pal ; Antoniadis, Antonios P. ; Hoffmann, Udo ; Steigner, Michael L. ; Rybicki, Frank J. ; Mitsouras, Dimitrios. / Quantifying the effect of side branches in endothelial shear stress estimates. In: Atherosclerosis. 2016 ; Vol. 251. pp. 213-218.
@article{87a77dc6e73049bfb652bd5d33e98292,
title = "Quantifying the effect of side branches in endothelial shear stress estimates",
abstract = "Background and aims Low and high endothelial shear stress (ESS) is associated with coronary atherosclerosis progression and high-risk plaque features. Coronary ESS is currently assessed via computational fluid dynamic (CFD) simulation of coronary blood flow in the lumen geometry determined from invasive imaging such as intravascular ultrasound and optical coherence tomography. This process typically omits side branches of the target vessel in the CFD model as invasive imaging of those vessels is not usually clinically-indicated. The purpose of this study was to determine the extent to which this simplification affects the determination of those regions of the coronary endothelium subjected to pathologic ESS. Methods We determined the diagnostic accuracy of ESS profiling without side branches to detect pathologic ESS in the major coronary arteries of 5 hearts imaged ex vivo with computed tomography angiography (CTA). ESS of the three major coronary arteries was calculated both without (test model), and with (reference model) inclusion of all side branches >1.5 mm in diameter, using previously-validated CFD approaches. Diagnostic test characteristics (accuracy, sensitivity, specificity and negative and positive predictive value [NPV/PPV]) with respect to the reference model were assessed for both the entire length as well as only the proximal portion of each major coronary artery, where the majority of high-risk plaques occur. Results Using the model without side branches overall accuracy, sensitivity, specificity, NPV and PPV were 83.4{\%}, 54.0{\%}, 96{\%}, 95.9{\%} and 55.1{\%}, respectively to detect low ESS, and 87.0{\%}, 67.7{\%}, 90.7{\%}, 93.7{\%} and 57.5{\%}, respectively to detect high ESS. When considering only the proximal arteries, test characteristics differed for low and high ESS, with low sensitivity (67.7{\%}) and high specificity (90.7{\%}) to detect low ESS, and low sensitivity (44.7{\%}) and high specificity (95.5{\%}) to detect high ESS. Conclusions The exclusion of side branches in ESS vascular profiling studies greatly reduces the ability to detect regions of the major coronary arteries subjected to pathologic ESS. Single-conduit models can in general only be used to rule out pathologic ESS.",
keywords = "Computational fluid dynamics, Coronary computed tomography, Endothelial shear stress, Side branches",
author = "Giannopoulos, {Andreas A.} and Chatzizisis, {Ioannis S} and Pal Maurovich-Horvat and Antoniadis, {Antonios P.} and Udo Hoffmann and Steigner, {Michael L.} and Rybicki, {Frank J.} and Dimitrios Mitsouras",
year = "2016",
month = "8",
day = "1",
doi = "10.1016/j.atherosclerosis.2016.06.038",
language = "English (US)",
volume = "251",
pages = "213--218",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Quantifying the effect of side branches in endothelial shear stress estimates

AU - Giannopoulos, Andreas A.

AU - Chatzizisis, Ioannis S

AU - Maurovich-Horvat, Pal

AU - Antoniadis, Antonios P.

AU - Hoffmann, Udo

AU - Steigner, Michael L.

AU - Rybicki, Frank J.

AU - Mitsouras, Dimitrios

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background and aims Low and high endothelial shear stress (ESS) is associated with coronary atherosclerosis progression and high-risk plaque features. Coronary ESS is currently assessed via computational fluid dynamic (CFD) simulation of coronary blood flow in the lumen geometry determined from invasive imaging such as intravascular ultrasound and optical coherence tomography. This process typically omits side branches of the target vessel in the CFD model as invasive imaging of those vessels is not usually clinically-indicated. The purpose of this study was to determine the extent to which this simplification affects the determination of those regions of the coronary endothelium subjected to pathologic ESS. Methods We determined the diagnostic accuracy of ESS profiling without side branches to detect pathologic ESS in the major coronary arteries of 5 hearts imaged ex vivo with computed tomography angiography (CTA). ESS of the three major coronary arteries was calculated both without (test model), and with (reference model) inclusion of all side branches >1.5 mm in diameter, using previously-validated CFD approaches. Diagnostic test characteristics (accuracy, sensitivity, specificity and negative and positive predictive value [NPV/PPV]) with respect to the reference model were assessed for both the entire length as well as only the proximal portion of each major coronary artery, where the majority of high-risk plaques occur. Results Using the model without side branches overall accuracy, sensitivity, specificity, NPV and PPV were 83.4%, 54.0%, 96%, 95.9% and 55.1%, respectively to detect low ESS, and 87.0%, 67.7%, 90.7%, 93.7% and 57.5%, respectively to detect high ESS. When considering only the proximal arteries, test characteristics differed for low and high ESS, with low sensitivity (67.7%) and high specificity (90.7%) to detect low ESS, and low sensitivity (44.7%) and high specificity (95.5%) to detect high ESS. Conclusions The exclusion of side branches in ESS vascular profiling studies greatly reduces the ability to detect regions of the major coronary arteries subjected to pathologic ESS. Single-conduit models can in general only be used to rule out pathologic ESS.

AB - Background and aims Low and high endothelial shear stress (ESS) is associated with coronary atherosclerosis progression and high-risk plaque features. Coronary ESS is currently assessed via computational fluid dynamic (CFD) simulation of coronary blood flow in the lumen geometry determined from invasive imaging such as intravascular ultrasound and optical coherence tomography. This process typically omits side branches of the target vessel in the CFD model as invasive imaging of those vessels is not usually clinically-indicated. The purpose of this study was to determine the extent to which this simplification affects the determination of those regions of the coronary endothelium subjected to pathologic ESS. Methods We determined the diagnostic accuracy of ESS profiling without side branches to detect pathologic ESS in the major coronary arteries of 5 hearts imaged ex vivo with computed tomography angiography (CTA). ESS of the three major coronary arteries was calculated both without (test model), and with (reference model) inclusion of all side branches >1.5 mm in diameter, using previously-validated CFD approaches. Diagnostic test characteristics (accuracy, sensitivity, specificity and negative and positive predictive value [NPV/PPV]) with respect to the reference model were assessed for both the entire length as well as only the proximal portion of each major coronary artery, where the majority of high-risk plaques occur. Results Using the model without side branches overall accuracy, sensitivity, specificity, NPV and PPV were 83.4%, 54.0%, 96%, 95.9% and 55.1%, respectively to detect low ESS, and 87.0%, 67.7%, 90.7%, 93.7% and 57.5%, respectively to detect high ESS. When considering only the proximal arteries, test characteristics differed for low and high ESS, with low sensitivity (67.7%) and high specificity (90.7%) to detect low ESS, and low sensitivity (44.7%) and high specificity (95.5%) to detect high ESS. Conclusions The exclusion of side branches in ESS vascular profiling studies greatly reduces the ability to detect regions of the major coronary arteries subjected to pathologic ESS. Single-conduit models can in general only be used to rule out pathologic ESS.

KW - Computational fluid dynamics

KW - Coronary computed tomography

KW - Endothelial shear stress

KW - Side branches

UR - http://www.scopus.com/inward/record.url?scp=84976542011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84976542011&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2016.06.038

DO - 10.1016/j.atherosclerosis.2016.06.038

M3 - Article

VL - 251

SP - 213

EP - 218

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -