冠状动脉病变特征对心肌缺血的影响
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国家自然科学基金项目(11832003),国家重点研发计划项目(2020YFC2004400,2021YFA1000200)


Effects of Coronary Artery Lesion Characteristics on Myocardial Ischemia
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    摘要:

    目的 探究狭窄血管的弹性和斑块性质等病变特征对心肌缺血的影响。方法 建立基于流固耦合的几何多尺度冠脉狭窄理想模型,仿真计算血流储备分数(fractional flow reserve, FFR),评估心肌缺血状况。单独考虑血管弹性壁(弹性模量为1 MPa)和刚性壁、斑块类型(富脂、钙化)以及斑块体积对心肌缺血的影响。结果 在所有狭窄率下,弹性壁血管FFRCT计算结果均大于刚性壁。富脂斑块病变的FFRCT高于钙化斑块的FFRCT(P=0.001)。梯形的斑块体积大于余弦形斑块体积,并且其FFRCT小于余弦形斑块(P=0.001)。结论 血管弹性是模拟血管血流动力学的必要因素。在中等狭窄程度下,由于富脂斑块有更大的管腔变形扩张,钙化斑块更容易引发心肌缺血。在狭窄率一定时,斑块体积越大,FFRCT越小,心肌缺血的可能性越大。

    Abstract:

    Objective To investigated the effect of stenosis characteristics (vascular elasticity and plaque properties) on myocardial ischemia. Methods An ideal geometric multi-scale coronary stenosis model based on fluid-structure interaction was established, and the fractional flow reserve (FFR) was simulated to evaluate myocardial ischemia. The effects of vascular elastic wall (elastic modulus of 1 MPa) and rigid wall, plaque types (lipid-rich plaque and calcified plaque) and plaque volume on myocardial ischemia were considered separately. Results The FFRCT simulation result of vessels with elastic wall was larger than that with rigid wall under all stenosis situations. The FFRCT of vessels in lipid-rich lesions was higher than that of calcified plaque (P=0.001). The trapezoidal plaque volume was larger than the cosine plaque volume, and the FFRCT of vessels in trapezoidal plaque was smaller than that of cosine plaque (P=0.001). Conclusions Vascular elasticity is a critical factor to simulate vascular hemodynamics. In moderate stenosis, calcified plaques are more likely to induce myocardial ischemia due to the larger luminal deformation and dilation of rich lipid plaque. When the stenosis is constant, the smaller the plaque volume, the higher the FFRCT and the smaller the possibility of myocardial ischemia.

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席晓璐,李鲍,李娜,刘金城,冯懿俐,刘有军.冠状动脉病变特征对心肌缺血的影响[J].医用生物力学,2023,38(3):458-464

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  • 收稿日期:2022-01-12
  • 最后修改日期:2022-02-18
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  • 在线发布日期: 2023-06-27
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