TY - JOUR
T1 - Myocardial perfusion distribution and coronary arterial pressure and flow signals
T2 - clinical relevance in relation to multiscale modeling, a review
AU - Nolte, Froukje
AU - Hyde, Eoin R
AU - Rolandi, Cristina
AU - Lee, Jack
AU - van Horssen, Pepijn
AU - Asrress, Kal
AU - van den Wijngaard, Jeroen P H M
AU - Cookson, Andrew N
AU - van de Hoef, Tim
AU - Chabiniok, Radomir
AU - Razavi, Reza
AU - Michler, Christian
AU - Hautvast, Gilion L T F
AU - Piek, Jan J
AU - Breeuwer, Marcel
AU - Siebes, Maria
AU - Nagel, Eike
AU - Smith, Nic P
AU - Spaan, Jos A E
PY - 2013/11
Y1 - 2013/11
N2 - Coronary artery disease, CAD, is associated with both narrowing of the epicardial coronary arteries and microvascular disease, thereby limiting coronary flow and myocardial perfusion. CAD accounts for almost 2 million deaths within the European Union on an annual basis. In this paper, we review the physiological and pathophysiological processes underlying clinical decision making in coronary disease as well as the models for interpretation of the underlying physiological mechanisms. Presently, clinical decision making is based on non-invasive magnetic resonance imaging, MRI, of myocardial perfusion and invasive coronary hemodynamic measurements of coronary pressure and Doppler flow velocity signals obtained during catheterization. Within the euHeart project, several innovations have been developed and applied to improve diagnosis-based understanding of the underlying biophysical processes. Specifically, MRI perfusion data interpretation has been advanced by the gradientogram, a novel graphical representation of the spatiotemporal myocardial perfusion gradient. For hemodynamic data, functional indices of coronary stenosis severity that do not depend on maximal vasodilation are proposed and the Valsalva maneuver for indicating the extravascular resistance component of the coronary circulation has been introduced. Complementary to these advances, model innovation has been directed to the porous elastic model coupled to a one-dimensional model of the epicardial arteries. The importance of model development is related to the integration of information from different modalities, which in isolation often result in conflicting treatment recommendations.
AB - Coronary artery disease, CAD, is associated with both narrowing of the epicardial coronary arteries and microvascular disease, thereby limiting coronary flow and myocardial perfusion. CAD accounts for almost 2 million deaths within the European Union on an annual basis. In this paper, we review the physiological and pathophysiological processes underlying clinical decision making in coronary disease as well as the models for interpretation of the underlying physiological mechanisms. Presently, clinical decision making is based on non-invasive magnetic resonance imaging, MRI, of myocardial perfusion and invasive coronary hemodynamic measurements of coronary pressure and Doppler flow velocity signals obtained during catheterization. Within the euHeart project, several innovations have been developed and applied to improve diagnosis-based understanding of the underlying biophysical processes. Specifically, MRI perfusion data interpretation has been advanced by the gradientogram, a novel graphical representation of the spatiotemporal myocardial perfusion gradient. For hemodynamic data, functional indices of coronary stenosis severity that do not depend on maximal vasodilation are proposed and the Valsalva maneuver for indicating the extravascular resistance component of the coronary circulation has been introduced. Complementary to these advances, model innovation has been directed to the porous elastic model coupled to a one-dimensional model of the epicardial arteries. The importance of model development is related to the integration of information from different modalities, which in isolation often result in conflicting treatment recommendations.
KW - Arterial Pressure
KW - Coronary Artery Disease/diagnosis
KW - Databases, Factual
KW - Diagnostic Techniques, Cardiovascular
KW - Echocardiography, Doppler
KW - Humans
KW - Magnetic Resonance Imaging
KW - Models, Cardiovascular
KW - Myocardial Perfusion Imaging
KW - Percutaneous Coronary Intervention
U2 - 10.1007/s11517-013-1088-8
DO - 10.1007/s11517-013-1088-8
M3 - Review article
C2 - 23892889
SN - 0140-0118
VL - 51
SP - 1271
EP - 1286
JO - Medical & Biological Engineering & Computing
JF - Medical & Biological Engineering & Computing
IS - 11
ER -