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Arterial geometry on the development of heart disease

MAR 29, 2024
Trifurcations at the left coronary artery cause disturbances in blood flow, which can contribute to plaque development
Arterial geometry on the development of heart disease internal name

Arterial geometry on the development of heart disease lead image

Coronary artery disease is a common heart disease caused by the deposition of fat and cholesterol on the inner lining of arteries, forming plaque in a process called atherosclerosis. Certain anatomical variations may be more prone to plaque deposition.

In most patients, the left coronary artery (LCA) bifurcates into the left anterior descending artery (LAD) and the left circumflex artery (LCX), which supply oxygen-rich blood to the left ventricle and atrium of the heart. In around 20% of cases, however, the LCA trifurcates, forming an additional branch called the ramus intermedius (RI). The presence of an RI has been suggested to indirectly increase the risk of atherosclerosis.

To investigate how geometrical variations in the heart affect coronary hemodynamics, Singhal et al. constructed 3D models from computed tomography angiography images of patients. They compared blood flow in the 3D rigid models with and without the presence of an RI through computational fluid dynamics (CFD) simulations.

“Patient-specific models of coronary arteries can be used to calculate outcomes of revascularization procedures and identify patients at risk of heart attacks,” said author Raghvendra Gupta.

The team found that the presence of an RI leads to reduced blood supply to the LAD, as well as recirculation and flow separation in regions in the LAD and LCX, causing low wall shear stress associated with atherosclerosis.

The authors are looking to expand their research on hemodynamics, in particular the effect of fluid flow on the contraction and dilation of coronary arteries.

“Our goal is to develop a large database of coronary artery geometries,” said Gupta. “Eventually, we hope to develop digital twins of the cardiovascular systems for training and treatment planning in clinical settings.”

Source: “Hemodynamics in left coronary artery with ramus intermedius: A patient-specific computational study,” by Mudrika Singhal, Raghvendra Gupta, Bishwajeet Saikia, Amit Malviya, Amitav Sarma, Pranjal Phukan, and Donboklang Lynser, Physics of Fluids (2024). The article can be accessed at https://doi.org/10.1063/5.0187790 .

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