Unique value of real-time shear stress to enhance coronary disease management

实时剪切应力对于加强冠心病管理的独特价值

• 批准号: 10065016
• 负责人: Peter Howard Stone
• 金额: $ 81.1万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10065016
• 关键词: 3-Dimensional; Algorithms; Anatomy; Angiography; Arterial Fatty Streak; Arteries; Atherosclerosis; Automobile Driving; Behavior; Blood Viscosity; Blood flow; Cardiac; Cardiac Catheterization Procedures; Catheterization; Catheters; Chest Pain; Clinical; Clinical Research; Clinical effectiveness; Computer Models; Computers; Consumption; Coronary; Coronary Arteriosclerosis; Coronary artery; Coronary heart disease; Coupled; Data; Devices; Diagnosis; Disease Management; Drops; Endothelial Cells; Endothelium; Environment; Event; Family suidae; Fluorescence; Friction; Future; Geometry; Goals; Gold; Hour; Human; Hyperemia; Image; Individual; Knowledge; Laboratories; Lead; Lesion; Liquid substance; Low-Density Lipoproteins; Maps; Measurement; Measures; Methods; Modeling; Myocardial Infarction; Natural History; Near-infrared optical imaging; Optical Coherence Tomography; Optics; Outcome; Patient-Focused Outcomes; Patients; Pattern; Permeability; Predictive Value; Prevention; Procedures; Process; Reproducibility; Research; Resources; Role; Running; Scanning; Shapes; Site; Stents; Surface; Syndrome; System; Techniques; Technology; Testing; Time; Ultrasonography; Use Effectiveness; accurate diagnosis; adverse outcome; base; clinical decision-making; clinical practice; coronary event; coronary lesion; coronary plaque; experience; image processing; image registration; improved; improved outcome; in vivo; multimodality; novel; percutaneous coronary intervention; personalized management; point of care; pressure; prevent; prognostic; protein complex; reconstruction; response; shear stress; simulation; single walled carbon nanotube

Management of CAD is hindered by our inability to investigate fundamental pathobiologic processes that lead to individual coronary plaque progression, destabilization, and adverse clinical events. A critical mechanism responsible for plaque behavior is local endothelial shear stress (ESS), the frictional force of blood flowing across the endothelium, which is governed by the artery’s detailed local geometry. Focal regions of low ESS drive a host of proatherogenic, proinflammatory, and prothrombotic processes; it is therefore not surprising that low ESS has now been found to be the most powerful predictor of future coronary events. However, current methods to compute local ESS in vivo require unique expertise and are extremely time- and resource-intensive, involving a lengthy, off-line procedure for reconstructing the 3D artery lumen from separate OCT and angiographic images and a computational fluid dynamics (CFD) simulation that takes many hours. These limitations prevent the use of this vital information to improve the treatment of patients. Our goal is to utilize ESS to guide optimal management during cardiac catheterization for patients with a broad array of coronary syndromes. We will accomplish this goal by developing and validating a single catheter/computer console system that will automatically compute ESS in real time (RT-ESS). Components include a novel, multimodality optical coherence tomography (OCT) catheter that senses its own shape by detecting strain-sensitive changes in fluorescence from single-walled carbon nanotubes (SWCNT) coated inside its sheath. Using OCT images acquired simultaneously with SWCNT fluorescence, we will develop algorithms to automatically create an anatomically-correct 3D artery model for CFD. By accelerating the CFD process, detailed ESS maps from human coronaries will be computed in 1-3 minutes and displayed with anatomic OCT images. The RT-ESS technology will be first validated using a swine coronary atherosclerosis model and then in patients undergoing percutaneous coronary intervention (PCI). In the final Aim, we will conduct a clinical study to determine the relationship between ESS and fractional flow reserve (FFR). The combination of pathobiologic/anatomic RT-ESS data and FFR will likely improve prognostication of individual coronary lesions, leading to more informed clinical decision-making and better patient outcomes.

我们无法调查基本病原体过程的阻碍，使CAD的管理受到阻碍 这导致了个别的冠状斑块进展，不稳定和不良临床事件。批判 负责斑块行为的机制是局部内皮剪应力（ESS），是血液的摩擦力 横穿内皮，由动脉详细的局部几何形状支配。低区域 ESS推动许多促进质，促炎和血栓形成过程；因此不是 令人惊讶的是，现在发现低EST是未来冠状动脉事件的最有力的预测指标。 但是，当前计算本地ESS的方法需要独特的专业知识，并且非常时间和时间 资源密集型，涉及一个冗长的离线程序，用于从单独的三个动脉腔重建3D动脉腔 OCT和血管造影图像以及计算流体动力学（CFD）模拟需要数小时。 这些限制阻止了使用这些重要信息来改善患者的治疗。 我们的目标是利用ESS来指导心脏导管期间的最佳管理 一系列冠状动脉综合征。我们将通过开发和验证一个单一来实现这一目标 导管/计算机控制台系统将自动实时计算ESS（RT-ESS）。成分 包括一种新颖的多模式光学连贯断层扫描（OCT）导管，该导管通过 检测单壁碳纳米管（SWCNT）涂层的荧光应变敏感的变化 内部的鞘。使用仅使用SWCNT荧光获取的OCT图像，我们将发展 算法自动为CFD创建解剖学上的3D动脉模型。通过加速CFD 过程，将在1-3分钟内计算人类冠状动脉的详细ESS地图，并显示 解剖OCT图像。 RT-ESS技术将首先使用猪冠状动脉粥样硬化进行验证 模型，然后是接受经皮冠状动脉干预（PCI）的患者。在最终目标中，我们将 进行临床研究，以确定ESS与分数流储备（FFR）之间的关系。 病原体/解剖学RT-ESS数据和FFR的组合可能会改善个体的提示 冠状动脉病变，导致更明智的临床决策和更好的患者结局。