Title |
Non-invasive Stenotic Renal Artery Haemodynamics by in silico Medicine
|
---|---|
Published in |
Frontiers in Physiology, August 2018
|
DOI | 10.3389/fphys.2018.01106 |
Pubmed ID | |
Authors |
Aikaterini Mandaltsi, Andrii Grytsan, Aghogho Odudu, Jacek Kadziela, Paul D. Morris, Adam Witkowski, Timothy Ellam, Philip Kalra, Alberto Marzo |
Abstract |
Background: Measuring the extent to which renal artery stenosis (RAS) alters renal haemodynamics may permit precision medicine by physiologically guided revascularization. This currently requires invasive intra-arterial pressure measurement with associated risks and is rarely performed. The present proof-of-concept study investigates an in silico approach that uses computational fluid dynamic (CFD) modeling to non-invasively estimate renal artery haemodynamics from routine anatomical computed tomography (CT) imaging of RAS. Methods: We evaluated 10 patients with RAS by CT angiography. Intra-arterial renal haemodynamics were invasively measured by a transducing catheter under resting and hyperaemic conditions, calculating the translesional ratio of distal to proximal pressure (Pd/Pa). The diagnostic and quantitative accuracy of the CFD-derived virtual Pd/Pa ratio (vPd/Pa) was evaluated against the invasively measured Pd/Pa ratio (mPd/Pa). Results: Hyperaemic haemodynamics was infeasible and CT angiography in 4 patients had insufficient image resolution. Resting flow data is thus reported for 7 stenosed arteries from 6 patients (one patient had bilateral RAS). The comparison showed a mean difference of 0.015 (95% confidence intervals of ± 0.08), mean absolute error of 0.064, and a Pearson correlation coefficient of 0.6, with diagnostic accuracy for a physiologically significant Pd/Pa of ≤ 0.9 at 86%. Conclusion: We describe the first in silico estimation of renal artery haemodynamics from CT angiography in patients with RAS, showing it is feasible and diagnostically accurate. This provides a methodological framework for larger prospective studies to ultimately develop non-invasive precision medicine approaches for studies and interventions of RAS and resistant hypertension. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
Switzerland | 1 | 100% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 20 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 8 | 40% |
Unspecified | 2 | 10% |
Lecturer | 2 | 10% |
Researcher | 2 | 10% |
Student > Master | 2 | 10% |
Other | 1 | 5% |
Unknown | 3 | 15% |
Readers by discipline | Count | As % |
---|---|---|
Engineering | 6 | 30% |
Medicine and Dentistry | 3 | 15% |
Unspecified | 2 | 10% |
Environmental Science | 1 | 5% |
Psychology | 1 | 5% |
Other | 3 | 15% |
Unknown | 4 | 20% |