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      Machine learning-based prediction of hemodynamic parameters in left coronary artery bifurcation: A CFD approach

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      Heliyon
      Elsevier

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          Abstract

          Coronary artery disease (CAD) is a leading cause of global mortality, often involving the development of atherosclerotic plaques in coronary arteries, particularly at bifurcation sites. Percutaneous coronary intervention (PCI) of bifurcation lesions presents challenges, necessitating accurate assessment of hemodynamic parameters such as wall shear stress (WSS) and oscillatory shear index (OSI) to predict acute coronary syndrome (ACS) risk. Computational fluid dynamics (CFD) provides valuable insights but is computationally intensive, prompting exploration of machine learning (ML) models for efficient hemodynamics prediction. This study aims to bridge the gap in understanding the influence of stenosis severity and location on hemodynamics in the left coronary artery (LCA) bifurcation by integrating ML algorithms with comprehensive CFD simulations, thereby enhancing non-invasive prediction of complex hemodynamics. An extensive dataset of 6858 synthetic LCA geometries with varying plaque severities and locations was generated for analysis. Hemodynamic parameters (TAWSS and OSI) were computed using CFD simulations and utilized for ML model training. Fourteen ML algorithms were employed for regression analysis, and their performance was evaluated using multiple metrics. The Decision Tree Regressor and K Nearest Neighbors models demonstrated the most effective prediction of TAWSS and OSI parameters, aligning well with CFD simulation results. The Decision Tree Regressor showed minimal prediction discrepancies (TAWSS: R2 = 0.998952, MAE = 0.000587, RMSE = 0.001626; OSI: R2 = 0.961977, MAE = 0.022264, RMSE = 0.041411) offering rapid and reliable assessments of hemodynamic conditions in the LCA bifurcation. Integration of ML algorithms with comprehensive CFD simulations provides a promising approach to enhance the non-invasive prediction of complex hemodynamics in the LCA bifurcation. The ability to efficiently predict hemodynamic parameters could significantly aid medical practitioners in time-sensitive clinical settings, offering valuable insights for coronary artery disease management. Further research is warranted to evaluate the effectiveness of deep learning models and address challenges in patient-specific applications.

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          Most cited references42

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          Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis.

          Coronary computed tomography angiography (CTA) has emerged as a noninvasive method for direct visualization of coronary artery disease, with previous studies demonstrating high diagnostic performance of CTA compared with invasive coronary angiography. However, CTA assessment of coronary stenoses tends toward overestimation, and even among CTA-identified severe stenosis confirmed at the time of invasive coronary angiography, only a minority are found to be ischemia causing. Recent advances in computational fluid dynamics and image-based modeling now permit determination of rest and hyperemic coronary flow and pressure from CTA scans, without the need for additional imaging, modification of acquisition protocols, or administration of medications. These techniques have been used to noninvasively compute fractional flow reserve (FFR), which is the ratio of maximal coronary blood flow through a stenotic artery to the blood flow in the hypothetical case that the artery was normal, using CTA images. In the recently reported prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study and the DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography) trial, FFR derived from CTA was demonstrated as superior to measures of CTA stenosis severity for determination of lesion-specific ischemia. Given the significant interest in this novel method for determining the physiological significance of coronary artery disease, we herein present a review on the scientific principles that underlie this technology. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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            Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress.

            Fluid velocities were measured by laser Doppler velocimetry under conditions of pulsatile flow in a scale model of the human carotid bifurcation. Flow velocity and wall shear stress at five axial and four circumferential positions were compared with intimal plaque thickness at corresponding locations in carotid bifurcations obtained from cadavers. Velocities and wall shear stresses during diastole were similar to those found previously under steady flow conditions, but these quantities oscillated in both magnitude and direction during the systolic phase. At the inner wall of the internal carotid sinus, in the region of the flow divider, wall shear stress was highest (systole = 41 dynes/cm2, diastole = 10 dynes/cm2, mean = 17 dynes/cm2) and remained unidirectional during systole. Intimal thickening in this location was minimal. At the outer wall of the carotid sinus where intimal plaques were thickest, mean shear stress was low (-0.5 dynes/cm2) but the instantaneous shear stress oscillated between -7 and +4 dynes/cm2. Along the side walls of the sinus, intimal plaque thickness was greater than in the region of the flow divider and circumferential oscillations of shear stress were prominent. With all 20 axial and circumferential measurement locations considered, strong correlations were found between intimal thickness and the reciprocal of maximum shear stress (r = 0.90, p less than 0.0005) or the reciprocal of mean shear stress (r = 0.82, p less than 0.001). An index which takes into account oscillations of wall shear also correlated strongly with intimal thickness (r = 0.82, p less than 0.001). When only the inner wall and outer wall positions were taken into account, correlations of lesion thickness with the inverse of maximum wall shear and mean wall shear were 0.94 (p less than 0.001) and 0.95 (p less than 0.001), respectively, and with the oscillatory shear index, 0.93 (p less than 0.001). These studies confirm earlier findings under steady flow conditions that plaques tend to form in areas of low, rather than high, shear stress, but indicate in addition that marked oscillations in the direction of wall shear may enhance atherogenesis.
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              A machine-learning approach for computation of fractional flow reserve from coronary computed tomography

              Fractional flow reserve (FFR) is a functional index quantifying the severity of coronary artery lesions and is clinically obtained using an invasive, catheter-based measurement. Recently, physics-based models have shown great promise in being able to noninvasively estimate FFR from patient-specific anatomical information, e.g., obtained from computed tomography scans of the heart and the coronary arteries. However, these models have high computational demand, limiting their clinical adoption. In this paper, we present a machine-learning-based model for predicting FFR as an alternative to physics-based approaches. The model is trained on a large database of synthetically generated coronary anatomies, where the target values are computed using the physics-based model. The trained model predicts FFR at each point along the centerline of the coronary tree, and its performance was assessed by comparing the predictions against physics-based computations and against invasively measured FFR for 87 patients and 125 lesions in total. Correlation between machine-learning and physics-based predictions was excellent (0.9994, P < 0.001), and no systematic bias was found in Bland-Altman analysis: mean difference was -0.00081 ± 0.0039. Invasive FFR ≤ 0.80 was found in 38 lesions out of 125 and was predicted by the machine-learning algorithm with a sensitivity of 81.6%, a specificity of 83.9%, and an accuracy of 83.2%. The correlation was 0.729 (P < 0.001). Compared with the physics-based computation, average execution time was reduced by more than 80 times, leading to near real-time assessment of FFR. Average execution time went down from 196.3 ± 78.5 s for the CFD model to ∼2.4 ± 0.44 s for the machine-learning model on a workstation with 3.4-GHz Intel i7 8-core processor.
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                Author and article information

                Contributors
                Journal
                Heliyon
                Heliyon
                Heliyon
                Elsevier
                2405-8440
                16 January 2025
                30 January 2025
                16 January 2025
                : 11
                : 2
                : e41973
                Affiliations
                [1]Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, 19991-43344, Iran
                Author notes
                [* ]Corresponding author. m.sharbatdar@ 123456kntu.ac.ir
                Article
                S2405-8440(25)00353-6 e41973
                10.1016/j.heliyon.2025.e41973
                11791239
                39906857
                2c12b8f6-0968-4a3b-b3ec-3435b68ff7c8
                © 2025 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 4 September 2024
                : 7 December 2024
                : 14 January 2025
                Categories
                Research Article

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