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      A multi-scale model of the coronary circulation applied to investigate transmural myocardial flow

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          Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease.

          With MRI, an index of myocardial perfusion reserve (MPRI) can be determined. We assessed the value of this technique for the noninvasive detection of coronary artery disease (CAD) in patients with suspected CAD. Eighty-four patients referred for a primary diagnostic coronary angiography were examined with a 1.5 T MRI tomograph (Philips-ACS). For each heartbeat, 5 slices were acquired during the first pass of 0.025 mmol gadolinium-diethylenetriamine pentaacetic acid/kg body weight before and during adenosine vasodilation by using a turbo-gradient echo/echo-planar imaging-hybrid sequence. MPRI was determined from the alteration of the upslope of the myocardial signal intensity curves for 6 equiangular segments per slice. Receiver operating characteristics were performed for different criteria to differentiate ischemic and nonischemic segments. Prevalence of CAD was 51%. Best results were achieved when only the 3 inner slices were assessed and a threshold value of 1.1 was used for the second smallest value as a marker for significant CAD. This approach yielded a sensitivity of 88%, specificity of 90%, and accuracy of 89%. The determination of MPRI with MRI yields a high diagnostic accuracy in patients with suspected CAD.
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            Computer simulation of arterial flow with applications to arterial and aortic stenoses.

            A computer model for simulating pressure and flow propagation in the human arterial system is developed. The model is based on the one-dimensional flow equations and includes nonlinearities arising from geometry and material properties. Fifty-five arterial segments, representing the various major arteries, are combined to form the model of the arterial system. Particular attention is paid to the development of peripheral pressure and flow pulses under normal flow conditions and under conditions of arterial and aortic stenoses. Results show that the presence of severe arterial stenoses significantly affects the nature of the distal pressure and flow pulses. Aortic stenoses also have a profound effect on central and peripheral pressure pulse formation. Comparison with the published experimental data suggests that the model is capable of simulating arterial flow under normal flow conditions as well as conditions of stenotic obstructions in a satisfactory manner.
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              Coronary microvascular dysfunction: mechanisms and functional assessment.

              Obstructive disease of the epicardial coronary arteries was recognized as the cause of angina pectoris >2 centuries ago, and sudden thrombotic occlusion of an epicardial coronary artery has been established as the cause of acute myocardial infarction for >100 years. In the past 2 decades, dysfunction of the coronary microvasculature emerged as an additional mechanism of myocardial ischaemia that bears important prognostic implications. The coronary microvasculature (vessels <300 μm in diameter) cannot be directly imaged in vivo, but a number of invasive and noninvasive techniques, each with relative advantages and pitfalls, can be used to assess parameters that depend directly on coronary microvascular function. These methods include invasive or noninvasive measurement of Doppler-derived coronary blood flow velocity reserve, assessment of myocardial blood flow and flow reserve using noninvasive imaging, and calculation of microcirculatory resistance indexes during coronary catheterization. These advanced techniques for assessment of the coronary microvasculature have provided novel insights into the pathophysiological role of coronary microvascular dysfunction in the development of myocardial ischaemia in different clinical conditions.
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                Author and article information

                Journal
                International Journal for Numerical Methods in Biomedical Engineering
                Int J Numer Meth Biomed Engng
                Wiley
                20407939
                October 2018
                October 2018
                July 19 2018
                : 34
                : 10
                : e3123
                Affiliations
                [1 ]School of Naval Architecture, Ocean and Civil Engineering; Shanghai Jiao Tong University; Shanghai 200240 China
                [2 ]Collaborative Innovation Center for Advanced Ship and Deep-Sea Exploration (CISSE); Shanghai Jiao Tong University; Shanghai 200240 China
                [3 ]Department of Cardiology, Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai 200011 China
                [4 ]Institute of Numerical Mathematics, Russian Academy of Sciences; Moscow 119333 Russia
                [5 ]Moscow Institute of Physics and Technology; Dolgoprudny 141700 Russia
                [6 ]Sechenov University; Moscow 119991 Russia
                Article
                10.1002/cnm.3123
                © 2018

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