Enhancing computational fluid dynamics simulation for coronary artery disease analysis through spatial iterative modeling

Abstract Background Endothelial shear stress (ESS) critically influences the pathogenesis of coronary artery disease (CAD) by modulating the formation and progression of atherosclerotic lesions. Despite the use of 3D modeling in computational fluid dynamics (CFD) simulations to calculate ESS, the precision of these models significantly depends on the method of reconstruction. Spatial Iterative Method (SIM) extends the iterative approach in computer science to spatial data, using recurring algorithms to refine 3D models and analyses. Iterative approach executes a sequence of instructions repeatedly until a certain condition is met, enabling progressive problem-solving. Purpose In this study, we investigated the application of the SIM to estimate ESS in coronary arteries and explored Atherosclerotic Plaque Areas (APA) in patients with CAD. Methods We analyzed fifteen patients (9 males, mean age of 63 ± 10.56 years) with atherosclerotic plaque on coronary arteries. The eighteen images captured from an anterior viewpoint in 10-degree increments of the coronary artery obtained from Coronary Computed Tomography Angiography at the best diastolic phase for each patient were used. We implemented the SIM for 3D model reconstruction, facilitating ninety comparisons across all iterations to evaluate ESS estimations accurately. (Figure 1.) Results In our study, we evaluated ESS contours from CFD simulations for a total of 282 APA (200 calcified and 82 soft plaques) across ninety spatial iterations. We categorized ESS into three groups: low (162 APA cases with ESS of less than 1 Pascal (Pa)), medium (67 APA cases with ESS between 1 and 2 Pa), and high (53 APA cases with ESS greater than 2 Pa). There was a significant association between ESS categories and plaque types (p < 0.0001, Figure 2.). The calcified plaques were formed in areas with low ESS (%80 of calcified plaques) and soft plaques in areas with medium and high ESS (%97 percent of soft plaques). Conclusion The significant association between ESS categories and plaque types shows the potential of SIM in hemodynamic analysis. This finding highlights the potential of SIM in enhancing the understanding of hemodynamic influences on plaque formation, offering a promising direction for future cardiovascular research.Figure 1.Sample Iteration of the SIMFigure 2.Heatmap of ESS vs. APA