A Fluid-Structure Interaction Study on Vulnerability of Different Coronary Plaques to Blood Flow Increase During Physical Exercise

Document Type : Research Article

Author

Mechanical Engineering Department, Babol Noshirvani University of Technology, Babol, Iran

Abstract

Pathological studies have shown that coronary atherosclerotic plaques are more prone to rupture under physical exercise. In this paper, using a fully coupled fluid-structure interaction (FSI) analysis based on arbitrary Lagrangian-Eulerian (ALE) finite element method, the effect of the coronary blood flow rate increase during physical exercise on the plaque rupture risk is investigated for different plaque types. It is proved that the increase in coronary blood flow rate during physical exercise considerably increases the maximum stress in the plaque fibrous cap which can potentially lead to the plaque rupture. The issue is investigated for different plaque shapes and their vulnerability to exercise condition is compared. It is observed that the diffused plaque type which experiences the maximum stress of 187.9 kPa at rest and 544 kPa at exercise is the most critical plaque type. Because it is subjected to the highest stress in both of these conditions. However, the descending plaque type exhibits the highest susceptibility to physical activity, since its maximum stress increases from 68.9 kPa at rest to 280.5 kPa at exercise which means an increase of about 308%.

Keywords


[1] O.Y. Hung, A.J. Brown, S.G. Ahn, A. Veneziani, D.P. Giddens, H. Samady, Association of Wall Shear Stress with Coronary Plaque Progression and Transformation, Interventional Cardiology Clinics, 4 (2015) 491-502.
[2] D.R. Obaid, P.A. Calvert, A. Brown, D. Gopalan, N.E.J. West, J.H.F. Rudd, M.R. Bennett, Coronary CT angiography features of ruptured and high-risk atherosclerotic plaques: Correlation with intra-vascular ultrasound, Journal of Cardiovascular Computed Tomography, (2017) 42-51.
[3] T. Yonetsu, T. Lee, T. Murai, M. Suzuki, A. Matsumura, Y. Hashimoto, T. Kakuta, Plaque morphologies and the clinical prognosis of acute coronary syndrome caused by lesions with intact fibrous cap diagnosed by optical coherence tomography, International Journal of Cardiology, 203 (2016) 766-774.
[4] M. Cilla, E. Peña, M.A. Martínez, 3D computational parametric analysis of eccentric atheroma plaque: influence of axial and circumferential residual stresses, Biomechanics and Modeling in Mechanobiology, 11 (2012) 1001-1013.
[5] J.R. Doherty, D.M. Dumont, G.E. Trahey, M.L. Palmeri, Acoustic radiation force impulse imaging of vulnerable plaques: a finite element method parametric analysis, Journal of Biomechanics, 46 (2013) 83-90.
[6] M. Cilla, E. Peña, M.A. Martínez, D.J. Kelly, Comparison of the vulnerability risk for positive versus negative atheroma plaque morphology, Journal of Biomechanics, 46 (2013) 1248-1254.
[7] W.J.S. Dolla, J.A. House, S.P. Marso, Stratification of risk in thin cap fibroatheromas using peak plaque stress estimates from idealized finite element models, Medical Engineering & Physics, 34 (2012) 1330-1338.
[8] Z. Teng, U. Sadat, Z. Li, X. Huang, C. Zhu, V.E. Young, M.J. Graves, J.H. Gillard, Arterial luminal curvature and fibrous-cap thickness affect critical stress conditions within atherosclerotic plaque: an in vivo MRI-based 2D finite-element study, Annals of Biomedical Engineering, 38 (2010) 3096-3101.
[9] G. Finet, J. Ohayon, G. Rioufol, Biomechanical interaction between cap thickness, lipid core composition and blood pressure in vulnerable coronary plaque: impact on stability or instability, Coronary Artery Disease, 15 (2004) 13-20.
[10] M.X. Li, J.J. Beech-Brandt, L.R. John, P.R. Hoskins, W.J. Easson, Numerical analysis of pulsatile blood flow and vessel wall mechanics in different degrees of stenoses, Journal of Biomechanics, 40 (2007) 3715-3724.
[11] A. Valencia, F. Baeza, Numerical simulation of fluid–structure interaction in stenotic arteries considering two layer nonlinear anisotropic structural model, International Communications in Heat and Mass Transfer, 36 (2009) 137-142.
[12] J. Ohayon, G. Finet, A.M. Gharib, D.A. Herzka, P. Tracqui, J. Heroux, G. Rioufol, M.S. Kotys, A. Elagha, R.I. Pettigrew, Necrotic core thickness and positive arterial remodeling index: emergent biomechanical factors for evaluating the risk of plaque rupture, American Journal of Physiology. Heart and Circulatory Physiology, 295 (2008) H717-727.
[13] A.C. Akyildiz, L. Speelman, H. van Brummelen, M.A. Gutiérrez, R. Virmani, A. van der Lugt, A.F. van der Steen, J.J. Wentzel, F.J. Gijsen, Effects of intima stiffness and plaque morphology on peak cap stress, Biomedical Engineering Online, 10 (2011) 25-35.
[14] D. Tang, Z. Teng, G. Canton, T.S. Hatsukami, L. Dong, X. Huang, C. Yuan, Local critical stress correlates better than global maximum stress with plaque morphological features linked to atherosclerotic plaque vulnerability: an in vivo multi-patient study, BioMedical Engineering OnLine, 8 (2009) 15-28.
[15] T. Belzacq, S. Avril, E. Leriche, A. Delache, A numerical parametric study of the mechanical action of pulsatile blood flow onto axisymmetric stenosed arteries, Medical Engineering & Physics, 34 (2012) 1483-1495.
[16] A.M. Varnava, P.G. Mills, M.J. Davies, Relationship between coronary artery remodeling and plaque vulnerability, Circulation, 105 (2002) 939-943.
[17] Z. Teng, U. Sadat, G. Ji, C. Zhu, V.E. Young, M.J. Graves, J.H. Gillard, Lumen irregularity dominates the relationship between mechanical stress condition, fibrous-cap thickness, and lumen curvature in carotid atherosclerotic plaque, Journal of Biomechanical Engineering, 133 (2011) 34-43.
[18] M.J. Lipinski, J.C. Frias, Z.A. Fayad, Advances in detection and characterization of atherosclerosis using contrast agents targeting the macrophage, Journal of Nuclear Cardiology, 13 (2006) 699-709.
[19] Y. Fukumoto, T. Hiro, T. Fujii, G. Hashimoto, T. Fujimura, J. Yamada, T. Okamura, M. Matsuzaki, Localized elevation of shear stress is related to coronary plaque rupture: a 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution, Journal of the American College of Cardiology, 51 (2008) 645-650.
[20] E. Cecchi, C. Giglioli, S. Valente, C. Lazzeri, G.F. Gensini, R. Abbate, L. Mannini, Role of hemodynamic shear stress in cardiovascular disease, Atherosclerosis, 214 (2011) 249-256.
[21] J. Ohayon, O. Dubreuil, P. Tracqui, S. Le Floc’h, G. Rioufol, L. Chalabreysse, F. Thivolet, R.I. Pettigrew, G. Finet, Influence of residual stress/strain on the biomechanical stability of vulnerable coronary plaques: potential impact for evaluating the risk of plaque rupture, American Journal of Physiology. Heart and Circulatory Physiology, 293 (2007) 1987-1996.
[22] S.H. Fertels, D.R. Heller, A. Maniet, A. Zalewski, Acute myocardial infarction due to exercise-induced plaque rupture, Clinical Cardiology, 21 (1998) 767-768.
[23] R.V. Kalaga, A. Malik, P.D. Thompson, Exercise-related spontaneous coronary artery dissection: case report and literature review, Medicine and Science in Sports and Exercise, 39 (2007) 1218-1220.
[24] A.P. Burke, A. Farb, G.T. Malcom, Y. Liang, J.E. Smialek, R. Virmani, Plaque rupture and sudden death related to exertion in men with coronary artery disease, JAMA, 281 (1999) 921-926.
[25] D.J. Duncker, R.J. Bache, Regulation of coronary blood flow during exercise, Physiological Reviews, 88 (2008) 1009-1086.
[26] M.H. Laughlin, R.J. Korthuis, D.J. Duncker, R.J. Bache, Control of Blood Flow to Cardiac and Skeletal Muscle During Exercise, in: Comprehensive Physiology, John Wiley & Sons, Inc., 2010.
[27] J.D. Rossen, M.D. Winniford, Effect of increases in heart rate and arterial pressure on coronary flow reserve in humans, Journal of the American College of Cardiology, 21 (1993) 343-348.
[28] S. Bernhard, S. Möhlenkamp, A. Tilgner, Transient integral boundary layer method to calculate the translesional pressure drop and the fractional flow reserve in myocardial bridges, Biomedical Engineering Online, 5 (2006) 42-60.
[29] H. Afrasiab, M.R. Movahhedy, A. Assempour, Fluid–structure interaction analysis in microfluidic devices: A dimensionless finite element approach, International Journal for Numerical Methods in Fluids, 68 (2012) 1073-1086.
[30] H. Afrasiab, M.R. Movahhedy, Treatment of the small time instability in the finite element analysis of fluid structure interaction problems, International Journal for Numerical Methods in Fluids, 71 (2013) 756-771.
[31] R. Beaumont, K. Bhaganagar, B. Segee, O. Badak, Using fuzzy logic for morphological classification of IVUS-based plaques in diseased coronary artery in the context of flow-dynamics, Soft Computing, 14 (2010) 265-276.
[32] J.C. Wang, S.-L.T. Normand, L. Mauri, R.E. Kuntz, Coronary artery spatial distribution of acute myocardial infarction occlusions, Circulation, 110 (2004) 278-284.
[33] R. Virmani, A.P. Burke, F.D. Kolodgie, A. Farb, Vulnerable plaque: the pathology of unstable coronary lesions, Journal of Interventional Cardiology, 15 (2002) 439-446.
[34] B.C. Konala, A. Das, R.K. Banerjee, Influence of arterial wall-stenosis compliance on the coronary diagnostic parameters, Journal of Biomechanics, 44 (2011) 842-847.
[35] S.R.H. Barrett, M.P.F. Sutcliffe, S. Howarth, Z.Y. Li, J.H. Gillard, Experimental measurement of the mechanical properties of carotid atherothrombotic plaque fibrous cap, Journal of Biomechanics, 42 (2009) 1650-1655.
[36] S.A. Kock, J.V. Nygaard, N. Eldrup, E.-T. Fründ, A. Klærke, W.P. Paaske, E. Falk, W. Yong Kim, Mechanical stresses in carotid plaques using MRI-based fluid–structure interaction models, Journal of Biomechanics, 41 (2008) 1651-1658.
[37] H.G. Matthies, J. Steindorf, Partitioned strong coupling algorithms for fluid–structure interaction, Computers & Structures, 81 (2003) 805-812.
[38] A. Karimi, M. Navidbakhsh, A. Shojaei, S. Faghihi, Measurement of the uniaxial mechanical properties of healthy and atherosclerotic human coronary arteries, Materials Science & Engineering. C, Materials for Biological Applications, 33 (2013) 2550-2554.
[39] K. Stein, T. Tezduyar, R. Benney, Mesh Moving Techniques for Fluid-Structure Interactions With Large Displacements, Journal of Applied Mechanics, 70 (2003) 58-63.
[40] R.K. Stoelting, S.C. Hillier, Pharmacology and Physiology in Anesthetic Practice, Lippincott Williams & Wilkins, 2012.
[41] Y. Bazilevs, V.M. Calo, Y. Zhang, T.J.R. Hughes, Isogeometric Fluid–structure Interaction Analysis with Applications to Arterial Blood Flow, Computational Mechanics, 38 (2006) 310-322.
[42] C.J. Greenshields, H.G. Weller, A unified formulation for continuum mechanics applied to fluid–structure interaction in flexible tubes, International Journal for Numerical Methods in Engineering, 64 (2005) 1575-1593