Thrombotic risk stratification using computational modeling in patients with coronary artery aneurysms following Kawasaki disease.
Kawasaki disease (KD) is the leading cause of acquired heart disease in children and can result in life-threatening coronary artery aneurysms in up to 25 % of patients. These aneurysms put patients at risk of thrombus formation, myocardial infarction, and sudden death. Clinicians must therefore decide which patients should be treated with anticoagulant medication, and/or surgical or percutaneous intervention. Current recommendations regarding initiation of anticoagulant therapy are based on anatomy alone with historical data suggesting that patients with aneurysms [Formula: see text]8 mm are at greatest risk of thrombosis. Given the multitude of variables that influence thrombus formation, we postulated that hemodynamic data derived from patient-specific simulations would more accurately predict risk of thrombosis than maximum diameter alone. Patient-specific blood flow simulations were performed on five KD patients with aneurysms and one KD patient with normal coronary arteries. Key hemodynamic and geometric parameters, including wall shear stress, particle residence time, and shape indices, were extracted from the models and simulations and compared with clinical outcomes. Preliminary fluid structure interaction simulations with radial expansion were performed, revealing modest differences in wall shear stress compared to the rigid wall case. Simulations provide compelling evidence that hemodynamic parameters may be a more accurate predictor of thrombotic risk than aneurysm diameter alone and motivate the need for follow-up studies with a larger cohort. These results suggest that a clinical index incorporating hemodynamic information be used in the future to select patients for anticoagulant therapy.
Department of Mechanical and Aerospace Engineering, University of California San Diego, 9500 Gilman Dr., La Jolla, CA , 92037, USA.
Dibyendu
D
Sengupta
Andrew M
AM
Kahn
Ethan
E
Kung
Mahdi
M
Esmaily Moghadam
Olga
O
Shirinsky
Galina A
GA
Lyskina
Jane C
JC
Burns
Alison L
AL
Marsden
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003323:Coronary Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008955:Models, Cardiovascular; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D033081:Shear Strength; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome