Non-Invasive Assessment of Coronary Microvascular Dysfunction Using Vascular Deformation-Based Flow Estimation

• Published in: IEEE transactions on biomedical engineering Vol. 71; no. 10; pp. 3000 - 3013
• Main Authors: Xue, Xiaofei, Deng, Dan, Zhang, Heye, Gao, Zhifan, Zhu, Ping, Hau, William Kongto, Zhang, Zhihui, Liu, Xiujian
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.10.2024; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Accuracy; Aged; Angiography; Blood flow; Blood vessels; Computational fluid dynamics; Computational modeling; Computed tomography; Computed Tomography Angiography - methods; Constraints; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Circulation - physiology; coronary computed tomography angiography; coronary microvascular dysfunction; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiology; Coronary Vessels - physiopathology; Deformation; Estimation; Female; Humans; index of microcirculatory resistance; Inverse problems; Male; Mathematical models; Microcirculation - physiology; Microvasculature; Middle Aged; Models, Cardiovascular; Problem solving; Segments
• ISSN: 0018-9294; 1558-2531; 1558-2531
• DOI: 10.1109/TBME.2024.3406416

Objective: Non-invasive computation of the index of microcirculatory resistance from coronary computed tomography angiography (CTA), referred to as IMR<inline-formula><tex-math notation="LaTeX">_\text{CT}</tex-math></inline-formula>, is a promising approach for quantitative assessment of coronary microvascular dysfunction (CMD). However, the computation of IMR<inline-formula><tex-math notation="LaTeX">_\text{CT}</tex-math></inline-formula> remains an important unresolved problem due to its high requirement for the accuracy of coronary blood flow. Existing CTA-based methods for estimating coronary blood flow rely on physiological assumption models to indirectly identify, which leads to inadequate personalization of total and vessel-specific flow. Methods: To overcome this challenge, we propose a vascular deformation-based flow estimation (VDFE) model to directly estimate coronary blood flow for reliable IMR<inline-formula><tex-math notation="LaTeX">_\text{CT}</tex-math></inline-formula> computation. Specifically, we extract the vascular deformation of each vascular segment from multi-phase CTA. The concept of inverse problem solving is applied to implicitly derive coronary blood flow based on the physical constraint relationship between blood flow and vascular deformation. The vascular deformation constraints imposed on each segment within the vascular structure ensure sufficient individualization of coronary blood flow. Results: Experimental studies on 106 vessels collected from 89 subjects demonstrate the validity of our VDFE, achieving an IMR<inline-formula><tex-math notation="LaTeX">_\text{CT}</tex-math></inline-formula> accuracy of 82.08<inline-formula><tex-math notation="LaTeX">\%</tex-math></inline-formula>. The coronary blood flow estimated by VDFE has better reliability than the other four existing methods. Conclusion: Our proposed VDFE is an effective approach to non-invasively compute IMR<inline-formula><tex-math notation="LaTeX">_\text{CT}</tex-math></inline-formula> with excellent diagnostic performance. Significance: The VDFE has the potential to serve as a safe, effective, and cost-effective clinical tool for guiding CMD clinical treatment and assessing prognosis.