Left and right coronary artery blood flow distribution method based on dominant type

Abstract

The purpose of the current study was to investigate the effects of left/right coronary artery flow distribution on calculation of fractional flow reserve derived from coronary computed tomography angiography (FFRct) in different dominant types. First, 195 patients were collected to count the distribution ratios of the three categories: right dominance (RD), balanced dominance (BD), and left dominance (LD). Ratios of diameters of the left/right coronary arteries (DLCA:DRCA) of the three types were calculated and used to represent the ratio of flow distribution (QLCA:QRCA) in the dominant type method. The other method was known as the fixed ratio method (QLCA:QRCA = 6:4). Second, a total of 73 patients with coronary artery disease (CAD) were enrolled for numerical calculation. A 0D/3D geometric multiscale model was used for the numerical simulation of FFR and the results of the fixed ratio method and the dominant type method were recorded as F‐FFRct and D‐FFRct. Lastly, invasive FFR(clinic‐FFR)was used as a standard to evaluate the consistency and diagnostic performance of F‐FFRct and D‐FFRct. Corresponding flow distributions for the dominant type method were QLCA:QRCA = 5:5 for RD, QLCA:QRCA = 5.5:4.5 for BD, and QLCA:QRCA = 6:4 for LD. D‐FFRct showed a better correlation than F‐FFRct (r = 0.85 vs. r = 0.81, both p < .001); the AUC (95%CI) were 0.974 (0.906–0.997, p < .0001) and 0.960 (0.886–0.992, p < .0001). Accuracy, specificity, sensitivity, positive predictive value (PPV) and negative predictive values (NPV) for D‐FFRct and F‐FFRct were 94.52%, 93.75%, 94.74%, 83.33%, 98.18% and 90.41%, 87.50%, 91.23%, 73.68%, 96.30%, respectively. Overall, the left/right coronary artery flow distribution was affected by the dominant type and the dominant type method was superior to the fixed ratio method in detecting coronary ischemic lesions.

Assessment of the Dimensions of Coronary Arteries for the Manifestation of Coronary Artery Disease

“…There was a clear dominance of LCx and RCA diameter patterns. It was also speculated that coronary artery dominance can also influence the diameter of LCx and RCA [ 25 ]. Few studies yet have been published that report coronary artery diameter.…”

Impact of minimal lumen segmentation uncertainty on patient‐specific coronary simulations: A look at FFRCT

“…However, this ratio is related to the individual, and the left coronary artery flow rate can range from 86% to 48% 53 . Recently, a dynamic flow distribution method depending on the patient's dominance has been proposed to improve the simulation accuracy 54 . However, all patients in this study have right dominance, and it is not necessary to perform multiple simulations varying the flow distribution.…”

“…53 Recently, a dynamic flow distribution method depending on the patient's dominance has been proposed to improve the simulation accuracy. 54 However, all patients in this study have right dominance, and it is not necessary to perform multiple simulations varying the flow distribution. Depending on the populational sample, other fixed ratios could have been employed (65%-35% in Simakov et al 53 and 60%-40% Sengupta et al 55 ) to test the method sensibility.…”

Recent advances in computational methods for cardiovascular and musculoskeletal biomechanics and biomedicine

“…The papers in the special issue address a wide range of problems spanning the diagnosis or treatment of vascular diseases, optimization of artificial heart valves, and evaluation of orthokeratology lens therapy. Among the eight papers focused on biomechanical problems, two papers are devoted to improving the modeling methods for predicting coronary fractional flow reserve based on medical images 1,2 ; two papers investigate the influences of vascular anatomy, operative method, or device selection on the risk of complications following interventional treatments of aortic arch aneurysms or abdominal aortic aneurysms 3,4 ; two papers address hemodynamic changes induced by the interventional treatment or drug therapy of venous diseases 5,6 ; one paper is dedicated to optimizing the fatigue performance of polymeric heart valve 7 ; and one paper explores the biomechanical responses of cornea to orthokeratology lens therapy 8 . In addition, there is one paper dealing with medical image processing where a new algorithm is proposed to segment pelvic bone tumors based on multimodal images 9…”