Date on Master's Thesis/Doctoral Dissertation

12-2019

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Chemical Engineering

Degree Program

Chemical Engineering, PhD

Committee Chair

Berson, R. Eric

Committee Co-Chair (if applicable)

Ghafghazi, Shahab

Committee Member

Ghafghazi, Shahab

Committee Member

Fu, Xiao-An

Committee Member

Jaeger, Vance

Committee Member

Moore IV, Joseph

Author's Keywords

computational fluid dynamics; coronary artery stenosis; blood residence time; coronary angiography

Abstract

Coronary artery stenosis is an abnormal narrowing of a coronary artery caused by an atherosclerotic lesion that reduces lumen space. Fractional flow reserve (FFR) is the gold standard method to determine the severity of coronary stenosis based on the determination of rest and hyperemic pressure fields, but requires an invasive medical procedure. Normal FFR is 1.0 and FFR RT, to account for varying volume and flow rate of individual segments. BloodRT was computed in 100 patients who had undergone the pressure-wire FFR procedure, and a threshold for BloodRT was determined to assess the physiological significance of a stenosis, analogous to the diagnostic threshold for FFR. The threshold exhibited excellent discrimination in detecting significant from non-significant stenosis compared to the gold standard pressure-wire FFR, with sensitivity of 98% and specificity of 96%. When applied to clinical practice, this could potentially allow practicing cardiologists to accurately assess and quantify the severity of coronary stenosis without resorting to invasive catheter-based techniques. The first 100 patient study required a clinically determined blood flow rate as a key model input. To create a more non-invasive process, a multiple linear regression approach was employed to determine blood flow rate entering a given artery segment. To validate this method, BloodRT was computed for a new set of 100 patients using the regression derived blood flow rate. The sensitivity and specificity were 95% and 97%, respectively, indicating similar discrimination compared to the clinically derived flow rate. The method was also applied to a succession of stenosis in series. When BloodRT of each individual stenosis was well above the threshold for significance, the cumulative effect of all stenoses led to an overall BloodRT below the threshold of hemodynamic significance.

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