Dhawan, Saurabh S.

Eshtehardi, Parham

Giddens, Don P.

McDaniel, Michael

Oshinski, John

Samady, Habib

Suo, Jin

Timmins, Lucas

English

Engineering Conferences International

Engineering Conferences InternationalECI Digital ArchivesComputational Fluid Dynamics (CFD) in MedicineAnd Biology in Conjunction With the SeventhInternational Biofluid Mechanics SymposiumProceedingsSpring 3-28-2012Biomechanics and Plaque Progression in HumanCoronary ArteriesDon P. GiddensGeorgia Institute of Technology, Emory University School of MedicineHabib SamadyGeorgia Institute of Technology, Emory University School of MedicineJin SuoGeorgia Institute of Technology, Emory University School of MedicineParham EshtehardiGeorgia Institute of Technology, Emory University School of MedicineMichael McDanielGeorgia Institute of Technology, Emory University School of MedicineSee next page for additional authorsFollow this and additional works at: http://dc.engconfintl.org/cfdmedicinePart of the Biomedical Engineering and Bioengineering CommonsThis Conference Proceeding is brought to you for free and open access by the Proceedings at ECI Digital Archives. It has been accepted for inclusion inComputational Fluid Dynamics (CFD) in Medicine And Biology in Conjunction With the Seventh International Biofluid Mechanics Symposium by anauthorized administrator of ECI Digital Archives. For more information, please contact franco@bepress.com.Recommended CitationDon P. Giddens, Habib Samady, Jin Suo, Parham Eshtehardi, Michael McDaniel, Saurabh S. Dhawan, Lucas Timmins, and JohnOshinski, "Biomechanics and Plaque Progression in Human Coronary Arteries" in "Computational Fluid Dynamics (CFD) inMedicine And Biology in Conjunction With the Seventh International Biofluid Mechanics Symposium", D. Elad, Tel Aviv Univ.; D.Bluestein, Stony Brook Univ.; D. Dooly, Imperial College London; M. Gharib, California Inst. Of Technology; P. Hunter, The Univ. ofAuckland; M. Engelman, ANSYS, Inc. Eds, ECI Symposium Series, (2013). http://dc.engconfintl.org/cfdmedicine/4AuthorsDon P. Giddens, Habib Samady, Jin Suo, Parham Eshtehardi, Michael McDaniel, Saurabh S. Dhawan, LucasTimmins, and John OshinskiThis conference proceeding is available at ECI Digital Archives: http://dc.engconfintl.org/cfdmedicine/4Biomechanics and Plaque Progression in Human Coronary ArteriesDon P. Giddens, Ph.D., Habib Samady, M.D.Jin Suo, Ph.D., Parham Eshtehardi, M.D., Michael McDaniel, M.D., Saurabh S. Dhawan, M.D., Lucas Timmins, Ph.D., John Oshinski, Ph.D.Georgia Institute of Technology, Emory University School of MedicineAtlanta, GA Patients referred to Cath Lab for evaluation of CADEvaluation of coronary arteries by angiography, physiology, IVUS, and CFDStudy Overview Methods: Subject PopulationAtorvastatin 80mg a day for 6 monthsRepeat angiography, physiology, and IVUS at 6 months?Imaging Methods: Angiography, IVUSComputational MethodsDiagonalSeptalSeptalDiagonalSeptalSeptalAtherosclerosis Progression by Virtual Histology IVUSdistal distalBaseline 6 months LaterLMLADLCXLMLADLCXAnalysis of Pooled Baseline Data• WSS averaged over cardiac cycle to obtain mean WSS on surface• WSS then averaged around circumference to obtain WSS as a function of axial location• Image data for each slice were obtained to show lumen area (LA), plaque area (PA), vessel area (area within IEL), and plaque burden (PB)Lumen Area vs Plaque BurdenPooled Baseline Data – 18 SubjectsWSS vs Lumen AreaPooled Baseline Data – 18 SubjectsWSS vs Plaque BurdenPooled Baseline Data – 18 SubjectsIn patients with symptomatic coronary artery disease, population data show:• Trends between WSS, lumen area, and plaque burden follow intuition•Conclusions – BaselineStatistical work ongoing to determine significance, etc.• Considerable individual variabilityDISTAL   PROXIMALDISTAL   PROXIMALDISTAL   PROXIMALDISTAL   PROXIMALResults – LongitudinalChange in Plaque Area Over Six MonthsLow WSS (<10 dynes/cm2); Intermediate (10-25); High (>25){Change in Plaque Composition in Low (<10), Intermediate (10-25), and High (>25) WSS Segments over 6 MonthsResults – LongitudinalSamady & Giddens et al. Circulation. 2011 Aug 16;124(7):779-88.In patients with coronary artery disease: • Coronary segments with low WSS develop greater total plaque progression as well as more constrictive remodeling compared to intermediate or high WSS segments.Conclusions - Longitudinal• Coronary segments with intermediate (physiologic) WSS show overall plaque regression.• Coronary segments with high WSS demonstrate no significant change in total plaque area, but suggest a plaque phenotype transformation (increase in necrotic core and calcium, and decrease in fibrous and fibro-fatty tissue). Some Common Misconceptions• WSS can be estimated from looking at angiographic images so why do CFD?• Blood pressure, viscosity and non-Newtonian rheology matter a lot• IVUS, angiography, CFD are very accurate• A correlation shows a cause-effect relationship• Data taken at a single time point can be generalizedSo why bother with WSS anyway?• Evidence that WSS relates to atherogenesis• Evidence that WSS relates to plaque progression• WSS, along with the intravascular pressure field, creates mechanical forces on plaques• Knowing an individual’s WSS patterns may suggest pre-emptive and/or therapeutic measuresAcknowledgements and Disclosures• Pfizer Inc.• Volcano Therapeutics• St. Jude Medical• Toshiba• Forrest Pharmaceuticals• Emory University Research Committee• Wallace H. Coulter Biomedical Sciences Grant• Georgia Research AllianceA Big Happy Birthday to ShmuelandA Big Thank You to David!

Biomechanics and Plaque Progression in Human Coronary Arteries

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Biomechanics and Plaque Progression in Human Coronary Arteries

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