title: A mathematical model for the vessel recruitment in coronary microcirculation in the absence of active autoregulation.
abstract: This paper proposes a mathematical model for vessel recruitment in the microvascular coronary network. The model is based on microvascular network units (MVNUs), where we define a MVNU as a portion of the microvascular network comprising seven generations of identical, parallel-arranged vessels (upstream arteries, large and small arterioles, capillaries, small and large venules, and downstream veins). The model implements a new mechanism to describe the variation in the number of MVNU in response to sudden variations of the local input pressure. In particular, it describes a recruitment mechanism dependent on distal pressure which operates in the coronary microcirculatory network even in maximally dilated conditions. We apply the model to interpret data from 29 patients who underwent revascularization by percutaneous coronary intervention (PCI). Treated vessels were the left anterior descending coronary artery, the left circumflex and the right coronary artery in 26, 2 and 1 patients, respectively. Following intracoronary adenosine administration, distal coronary pressure and blood flow were 48 ± 18 mmHg and 45 ± 30 ml/min before PCI, respectively, and significantly increased afterwards to 80 ± 17 mmHg and 68 ± 32 ml/min (p<0.001). The model predicts an increase in MVNU number in patients with preserved wall motion in the myocardial region which underwent PCI. On the contrary, a decrease in MVNU number is predicted by the model in patients with regional dysfunction and implies a relatively lower response of maximal flow to revascularization.
authors.affiliation: Department of Electrical, Electronic, Telecommunications Engineering and Naval Architecture - DITEN, University of Genoa, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Saracco
authors.affiliation: Nuclear Medicine, Dept. of Health Science, IRCCS-AOU San Martino-IST, Genoa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bauckneht
authors.affiliation: Department of Cardiology, Cardiac Catheterization Lab., Ospedale di Circolo e Fondazione Macchi, University Hospital, Varese, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Verna
authors.affiliation: Department of Cardiology, Cardiac Catheterization Lab., Ospedale di Circolo e Fondazione Macchi, University Hospital, Varese, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Ghiringhelli
authors.affiliation: Department of Civil, Chemical and Environmental Engineering - DICCA, University of Genoa, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Repetto
authors.affiliation: Nuclear Medicine, Dept. of Health Science, IRCCS-AOU San Martino-IST, Genoa, Italy.
authors.forename: Gianmario
authors.initials: G
authors.lastname: Sambuceti
authors.affiliation: Department of Cardiology, Cardiac Catheterization Lab., Ospedale di Circolo e Fondazione Macchi, University Hospital, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Provasoli
authors.affiliation: Department of Electrical, Electronic, Telecommunications Engineering and Naval Architecture - DITEN, University of Genoa, Italy. Electronic address: marco.storace@unige.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Storace
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology*; D003331:Coronary Vessels / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006706:Homeostasis; D006801:Humans; D008297:Male; D055641:Mathematical Concepts; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D055806:Microvessels / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D008955:Models, Cardiovascular; D062645:Percutaneous Coronary Intervention
chemical_list: D000241:Adenosine
keywords: Capillary pressure; Coronary microcirculation; Mathematical model of microcirculation; Vessels recruitment