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Myocardial perfusion distribution and coronary arterial pressure and flow signals: clinical relevance in relation to multiscale modeling, a review

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Abstract

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.

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Notes

  1. Data from patients presented in this paper were obtained from study protocols approved by the Medical Ethics Committees of the AMC and KCL, and all patients gave written informed consent.

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Acknowledgments

The authors acknowledge funding from the European Community’s Seventh Framework Program (FP7-ICT-2007-224495: euHeart), the Netherlands Heart Foundation (grants 2000.090 and 2006B186) and Engineering and Physical Sciences Research Council (EP/G007527/2).

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Authors and Affiliations

  1. Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Froukje Nolte, Cristina Rolandi, Pepijn van Horssen, Jeroen P. H. M. van den Wijngaard, Tim van de Hoef, Maria Siebes & Jos A. E. Spaan

  2. Imaging Sciences and Biomedical Engineering Division, St Thomas’ Hospital, King’s College London, London, SE17EH, UK

    Eoin R. Hyde, Jack Lee, Andrew N. Cookson, Radomir Chabiniok, Christian Michler & Nic P. Smith

  3. Division of Imaging Sciences, BHF Centre of Research Excellence, The Rayne Institute, St. Thomas’ Hospital, London, UK

    Kal Asrress, Reza Razavi & Eike Nagel

  4. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Tim van de Hoef & Jan J. Piek

  5. Philips Research, Eindhoven, The Netherlands

    Gilion L. T. F. Hautvast & Marcel Breeuwer

  6. Philips Healthcare, Imaging Systems, MR Clinical Science, Best, The Netherlands

    Gilion L. T. F. Hautvast

  7. Eindhoven University of Technology, Biomedical Engineering, Biomedical Image Analysis, Eindhoven, The Netherlands

    Marcel Breeuwer

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  1. Froukje Nolte
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  2. Eoin R. Hyde
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  17. Eike Nagel
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  18. Nic P. Smith
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  19. Jos A. E. Spaan
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Correspondence to Jos A. E. Spaan.

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Nolte, F., Hyde, E.R., Rolandi, C. et al. Myocardial perfusion distribution and coronary arterial pressure and flow signals: clinical relevance in relation to multiscale modeling, a review. Med Biol Eng Comput 51, 1271–1286 (2013). https://doi.org/10.1007/s11517-013-1088-8

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  • DOI: https://doi.org/10.1007/s11517-013-1088-8

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