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A Generalized Outflow Boundary Condition Impedance Model for Non-Invasive Prediction of Ischemia in Diseased Coronary Arteries

[+] Author and Article Information
Iyad A. Fayssal

Computational Mechanics Laboratory, Mechanical Engineering Department, American University of Beirut, Riad El-Solh, 1107 2020 Beirut, Lebanon
iaf04@aub.edu.lb

Fadl Moukalled

Mechanical Engineering Department, American University of Beirut, Riad El-Solh, 1107 2020 Beirut, Lebanon
fmukalled@aub.edu.lb

Samir Alam

Department of Internal Medicine, American University of Beirut, Riad El-Solh, 1107 2020 Beirut, LebanonDepartment of Internal Medicine, American University of Beirut, Riad El-Solh, 1107 2020 Beirut, Lebanon
salam@aub.edu.lb

Hussain Isma’eel

Division of Cardiology, Department of Internal Medicine, American University of Beirut, Riad El-Solh, 1107 2020 Beirut, LebanonVascular Medicine Program, Division of Cardiology at the Faculty of Medicine, American University of Beirut Medical Center
hi09@aub.edu.lb

1Corresponding author.

ASME doi:10.1115/1.4038250 History: Received April 14, 2017; Revised October 16, 2017

Abstract

This paper reports on a new boundary condition formulation to model the total coronary myocardial flow and impedance characteristics of the myocardial vascular bed for any specific patient when considered for non-invasive diagnosis of fractional flow reserve (FFR). The developed boundary condition model inherits an implicit representation of the downstream truncated vascular bed and is based on integrating patient-specific physiologic parameters that can be non-invasively extracted for each patient to account for blood flow demand to the myocardium at rest and hyperemic conditions. The model is coupled to a three-dimensional (3D) collocated pressure-based finite volume method and used to characterize the “functional behavior” of a patient diseased coronary artery segment without the need for predicting the details of blood flow dynamics in the entire arterial system. Predictions generated with this boundary condition provided a deeper understanding of the embedded challenges behind non-invasive image-based diagnostic techniques when applied to human diseased coronary arteries. The overall numerical method and formulated boundary condition model are validated via two computational-based procedures and benchmarked with available measured data. The newly developed boundary condition is used via a designed computational methodology to (a) confirm the need for integrating patient-specific physiologic parameters when modeling the downstream vascular impedance, (b) interpret the embodied inaccuracies of computed FFRCT outcomes reported in the literature, and (c) discuss the current limitations and future challenges in shifting to non-invasive assessment of FFR.

Copyright (c) 2017 by ASME
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