CN116115208A - Method for predicting resting coronary microcirculation resistance based on physical driving - Google Patents
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Abstract
A method for predicting resting coronary microcirculation resistance based on physical driving belongs to the field of combined optimization algorithms. The method is based on CTA images of patients, and a personalized coronary artery three-dimensional vascular anatomical model is reconstructed; and by using a blood vessel scale rate based on a natural growth rule through an anatomical model, distributing coronary blood flow of a patient in an ideal state, and establishing a method for simulating microcirculation resistance in the ideal state; according to the coronary microcirculation resistance compensation mechanism, the microcirculation resistance value is iteratively and optimally adjusted by using a method based on physical driving, so that the inlet pressure of the coronary model is matched with the personalized aortic pressure value of a patient, and a high-fidelity resting state hemodynamics method conforming to a physiological mechanism is established. The invention realizes the simulation of the coronary artery resting state, constructs a method for accurately simulating the coronary artery microcirculation resistance in the resting state, and provides accurate personalized boundary conditions for realizing noninvasive calculation of the instantaneous wave-free amplitude ratio.
Description
Technical Field
The invention belongs to the field of combined optimization algorithms, and relates to a method for predicting coronary artery microcirculation compensation resistance based on physical driving.
Background
Recently, a new index for evaluating the severity of coronary artery stenosis in a resting state has been developed in the coronary physiology field: instantaneous wave-free ratio (instantaneous wave-free, iFR). It can shorten the operation time, reduce the medical cost and improve the measurement efficiency, and improve the comfort level of the patient. iFR is an index derived from studies of coronary flow, velocity and resistance. But the development of iFR is also limited to a certain extent because it is an invasive measurement.
Despite the rapid development of medical imaging equipment and fluid mechanics, noninvasive diagnosis of myocardial ischemia is enabled. However, little technical research has been done to calculate the resting index iFR noninvasively. The technical difficulty is that the change of coronary flow and resistance in the resting state needs to be simulated. In addition, a set of methods capable of accurately simulating the coronary microcirculation resistance in the resting state are not established in the current coronary physiology research, which is a key reason that the non-invasive calculation of the iFR cannot be performed. Therefore, in order to accurately simulate the resting state of the coronary artery and realize the noninvasive calculation of the iFR, the compensation mechanism of the micro-circulation resistance of the coronary artery must be considered, and a method for simulating the change of the micro-circulation resistance of the resting state of the coronary artery is established.
Clinical studies have shown that at stenosis rates below 85%, coronary resting flow is stable and does not decrease with increasing stenosis. It is thought that this is an autoregulation mechanism in which the resistance of the anterior arterioles and the arterioles gradually decreases in compensation to maintain stable coronary blood flow, i.e., a coronary microcirculation resistance compensation mechanism. When coronary artery gradually accumulates atherosclerotic plaque to form stenosis, regulated by endogenous adenosine release, arteriole smooth muscle cell relaxation, endothelial cell signaling and neurohumoral control, anterior arteriole and arteriole vasodilation reduce blood flow resistance for pressure gradient compensation. In short, coronary circulation counteracts the increase in coronary stenosis resistance by reducing microvascular flow resistance, thereby maintaining stable coronary flow until the diastolic reserve capacity of the anterior arterioles and arterioles is exhausted, as demonstrated by a number of clinical trials. This means that when the resting state model is built, it is necessary to consider the compensation mechanism of the microcirculation resistance, so that a method of high-fidelity resting state microcirculation resistance conforming to the physiological mechanism of the human body is built, and the noninvasive numerical calculation of the iFR can be realized.
Disclosure of Invention
The invention provides a method for predicting coronary artery microcirculation compensation resistance based on physical driving, which firstly constructs a method for accurately simulating resting state coronary artery microcirculation resistance and provides accurate personalized boundary conditions for realizing noninvasive calculation of iFR. A method for predicting coronary microcirculation resistance compensation based on physical driving, comprising: reconstructing a personalized coronary artery three-dimensional (3D) vessel anatomical model using the patient CTA image; utilizing a blood vessel scale law based on a natural growth rule to distribute coronary blood flow of a patient in an ideal state, and establishing an ideal state coronary microcirculation resistance model; according to a coronary microcirculation resistance compensation mechanism, iteratively optimizing and adjusting a microcirculation resistance value based on a physical driving method, so that the inlet pressure of a coronary model is matched with the personalized aortic pressure value of a patient, and a high-fidelity resting state hemodynamic method which accords with a physiological mechanism is established;
in order to achieve the above purpose, the present invention is realized by the following technical scheme:
a method for predicting coronary microcirculation compensatory resistance based on physical driving, the method comprising the steps of:
a1, acquiring actual physiological waveform data of a human body, including the arterial pressure and the myocardial quality;
and step A2, reconstructing a personalized coronary artery structure by using the CTA image of the patient.
And step A3, measuring anatomical parameters of normal blood vessels and structural parameters of narrow blood vessels.
Step A4, allocating coronary blood flow of coronary artery of the patient under ideal state by using blood vessel scale rate based on natural growth rule, and establishing a method for simulating coronary microcirculation resistance under ideal state.
And step A5, iteratively optimizing and adjusting the microcirculation resistance value based on a physical driving method according to the microcirculation resistance compensation mechanism, outputting the microcirculation resistance value in the normal blood vessel and narrow blood vessel resting state, and establishing a high-fidelity resting state hemodynamic method conforming to a physiological mechanism.
As a further aspect of the present invention, the features in step A1 include collecting data of physiological waveforms of the human body, because the pressure waveforms cannot be obtained noninvasively clinically. However, the pressure waveform of the brachial artery of the upper arm at a position near the aortic root is easily collected, so that the pressure of the brachial artery can be used instead of the aortic pressure. The myocardial mass is obtained by non-invasive estimation in an ultrasonic measurement mode.
As a further technical scheme of the invention, the features in the step A2 are reconstructed to obtain an accurate coronary anatomy structure based on the coronary CTA image through three-dimensional reconstruction software such as mini 20.0 software, so as to prepare for realizing the step A3.
As a further aspect of the present invention, the characteristics described in step A3, anatomical parameters of a normal coronary vessel, such as vessel length, diameter, are measured. Stenotic vessel anatomical parameters such as inlet area, stenotic length, stenotic cross-sectional area are measured.
As a further technical scheme of the invention, the characteristic in the step A4 is that a method for simulating the coronary microcirculation resistance in an ideal state is established. The ideal state is a method established by calculating the microcirculation resistance of the coronary artery according to the personalized hemodynamic parameters of the patient under the condition that the coronary artery is not in the presence of stenosis. And respectively calculating the coronary inlet flow in the ideal state, the microcirculation resistance value in the ideal state and the pressure at each branch.
As a further technical scheme of the invention, the method for establishing the high-fidelity resting state hemodynamic method which accords with a physiological mechanism by using a microcirculation resistance compensation mechanism and iteratively optimizing and adjusting a microcirculation resistance value based on a physical driving method in the step A5 comprises the following steps of:
step B1, taking the coronary inlet flow calculated in the step A4 as an optimized initial parameter;
step B2, taking the microcirculation resistance calculated in the step A4 as an initial resistance boundary condition;
step B3, taking the outlet pressure calculated in the step A4 as the outlet boundary condition of the 3D model;
step B4, calculating the resting resistance pressure drop through the narrow geometric parameters measured in the step A3;
and B5, iteratively optimizing and adjusting the microcirculation resistance value of the outlet of the blood vessel at the downstream of the stenosis by using a method based on physical driving. And reducing the resistance value to be optimized within a set step range according to the comparison result. When the pressure of the inlet is matched with the personalized arterial pressure of the patient, the coronary microcirculation resistance average value of the downstream of the narrow branch outlet in the resting state can be obtained. And ending the optimization, otherwise, continuing the optimization. And outputting the microcirculation resistance values of the normal blood vessel and the narrow blood vessel, and finishing iterative calculation.
Compared with the prior art, the invention has the beneficial effects that:
the invention provides a method for predicting the coronary microcirculation compensation resistance based on physical driving, which can accurately simulate the compensation mechanism of the microcirculation resistance under the coronary resting state. Has important significance for realizing noninvasive calculation of the rest index iFR. Has certain application value for assisting in evaluating the severity of coronary stenosis in a resting state.
Drawings
FIG. 1 is a schematic view of a segmented coronary structure and left ventricular structure of the present invention;
FIG. 2 is a schematic diagram of coronary stenosis parameter measurement in accordance with the present invention;
FIG. 3 is a schematic diagram of ideal coronary conditions and resting conditions according to the present invention;
FIG. 4 is a flow chart of an iterative implementation of the present invention based on physically driven resting state coronary microcirculation resistance values;
FIG. 5 is a graph showing the results of the calculation of the resting state microcirculatory resistance of an individual according to the present invention;
Detailed Description
The present invention will be described in detail with reference to specific embodiments and drawings.
A1, acquiring actual physiological waveform data of a human body, including the arterial pressure and the myocardial quality;
and step A2, reconstructing a personalized coronary artery structure by using the CTA image of the patient.
And step A3, measuring anatomical parameters of normal blood vessels and structural parameters of narrow blood vessels.
And step A4, distributing coronary blood flow of the coronary artery of the patient in an ideal state by utilizing a blood vessel scale rate based on a natural growth rule, and establishing a method for simulating the coronary microcirculation resistance in the ideal state.
And step A5, iteratively optimizing and adjusting the microcirculation resistance value based on a physical driving method according to the microcirculation resistance compensation mechanism, and establishing a high-fidelity resting state hemodynamic method conforming to a physiological mechanism.
As a further technical solution of the present invention, the features in step A1 include collecting physiological waveform data of a human body, wherein an aortic pressure waveform is replaced by a brachial artery pressure waveform pressure of an upper arm, and myocardial mass is obtained by coronary CTA image reconstruction, and coronary flow is estimated by myocardial mass.
As a further aspect of the invention, the features described in step A2 include the use of software to reconstruct CTA images, such as ITK-SNAP humanity0.1.1, materialise Mimics Innovation Suite 20.0.0 Research, the coronary structure of the patient is obtained by reconstruction of CTA images by more than two years radiologists, the coronary diameter is less than 1mm without subdivision until a personalized coronary structure is segmented, as shown in fig. 1. Preparation is made for implementing steps A3, A4.
As a further aspect of the present invention, the features described in step A3, including the coronary anatomy obtained by the clinician in step A2, are measured for the length and diameter of a normal vessel using a measuring tool such as Materialise Mimics Innovation Suite 20.0.20.0 Research, and a stenosed vessel is required to measure six parameters, namely, an inlet area, a stenosed inlet length, a stenosed outlet length, a minimum stenosed length, and a stenosed rate; as shown in fig. 2. The measured vascular parameters are measured simultaneously by two radiologists by a standard measurement procedure, and when the measurement result error exceeds 3%, a third radiologist is required to intervene in the measurement and determine the measurement result. The data measured in step A3 is used as a basis for implementing steps A4 and A5.
As a further aspect of the present invention, the features described in step A4 include a method adapted to establish a simulated ideal state microcirculatory resistance. The ideal state model refers to calculating the coronary microcirculation resistance value according to the personalized hemodynamic parameters of the patient under the condition that the coronary artery is not in the presence of stenosis. Based on the CTA image of the coronary stenosis patient, a personalized coronary artery 3D vessel anatomical model is reconstructed. The total coronary flow can be estimated to be 4% of cardiac output, with a 6:4 flow ratio for the left and right crowns. It is assumed that in an ideal situation, all coronary vessels are not stenosed. The flow of each branch of the coronary artery can be calculated by utilizing the blood vessel scale law through the total flow of the coronary artery. Taking the ideal left crown model shown in fig. 3a as an example, for bifurcated vessels, according to the rule of scale, the blood flow is proportional to the vessel diameter:
q in lad : is left anterior descending branch vascular flow;
Q lcx : left coronary branch vessel flow;
D lad : the diameter of the left anterior descending branch vessel;
D lcx : left coronary branch vessel diameter;
n: scale law coefficients.
According to the coronary 3D model, a personalized arterial pressure inlet pressure boundary condition P is given in The outlet is the flow Q of each branch distributed according to the blood vessel scale law out-k Calculating the differential pressure DeltaP of the normal blood vessel section k The pressure difference at this time is generated by the on-way resistance. The resistance to microcirculation downstream of each outlet can be calculated. For example, for an ideal state of a vessel segment (without stenosis) at an original stenosis location, a differential pressure ΔP of an ideal state of a stenosed vessel is calculated s-ideal The pressure at the downstream branch k outlet and the total resistance of the microcirculation downstream of the branch k outlet in the ideal state can be calculated:
P out-k-ideal ＝P in -ΔP s-ideal -ΔP k (2)
p in the formula out-k-ideal : the outlet pressure of the vessel branch k in the ideal state;
P in : aortic inlet pressure;
ΔP s-ideal : the pressure difference generated by the blood vessel in the ideal state of the narrow blood vessel;
ΔP k : the pressure differential created by branch k of the normal vessel segment;
R m-k-ideal : the total resistance of the microcirculation downstream of the outlet of the branch k in an ideal state;
Q out-k : the distributed vascular branch k outlet flow;
n: total number of vessel outlet branches.
Based on the method, a method for simulating the coronary microcirculation resistance under ideal conditions can be obtained.
As a further aspect of the present invention, the features described in step A4 include a method adapted to establish a simulated resting state coronary microcirculation resistance.
In the resting state, due to stenosis of coronary artery, the anterior arterioles and arterioles in the coronary microcirculation vessel gradually adaptively dilate and regulate to reduce self resistance to maintain the blood flow constant in the resting state (stenosis rate<85%). According to the reconstructed personalized coronary 3D model, taking the left anterior descending stenosis of FIG. 3b as an example, the inlet flow boundary condition Q is given Left side (the total coronary flow is the same as that of the ideal state, Q total ＝4％·CO，Q Left side :Q Right side =6:4), the outlet gives an ideal state of microcirculation resistance, and the microcirculation resistance value of the outlet of the narrow downstream blood vessel is adjusted by iterative optimization based on a physical driving method:
R m-k-rest ′＝R m-k-rest -s (4)
wherein R is m-k-rest : dynamically adjusting the coronary microcirculation resistance value before;
R m-k-rest ': dynamically adjusting the coronary microcirculation resistance value;
s: the step length is adjusted to be 1.
When the inlet pressure is matched with the personalized arterial pressure of the patient, namely the formula (5) is satisfied, the coronary microcirculation resistance average value at the downstream of the narrow branch outlet in the resting state can be obtained.
P in -P in ′≤ε (5)
P in '＝P out-k-rest +ΔP k +ΔP s-rest (6)
P in the formula in ': the calculated inlet pressure after the microcirculation resistance value is adjusted;
P out-k-rest : the calculated coronary outlet pressure in the resting state;
ΔP k : pressure drop caused by the resistance along the outlet vessel branch K;
ΔP s-rest : pressure drop generated by the blood vessel in the resting state of the narrow blood vessel;
epsilon: and (5) converging the residual error, wherein the value is 0.0001.
For blood vessels without stenosis, the microcirculation resistance value in ideal state is directly used. The flow of the iterative optimization algorithm of the microcirculation resistance is shown in figure 4.
The results of calculation of resting microcirculation resistance for one individual in clinical practice are shown in FIG. 5.
Claims (6)
1. A method for predicting resting coronary microcirculation resistance based on physical driving, the method comprising the steps of:
a1, acquiring actual physiological waveform data of a human body, including the arterial pressure and the myocardial quality;
a2, reconstructing a personalized coronary artery structure by using the CTA image of the patient;
a3, measuring anatomical parameters of normal blood vessels and structural parameters of narrow blood vessels;
a4, distributing coronary blood flow of coronary arteries of a patient in an ideal state by utilizing a blood vessel scale rate based on a natural growth rule, and establishing a method for simulating coronary microcirculation resistance in the ideal state;
and step A5, iteratively optimizing and adjusting the microcirculation resistance value based on a physical driving method according to the microcirculation resistance compensation mechanism, outputting the microcirculation resistance value in the normal blood vessel and narrow blood vessel resting state, and establishing a high-fidelity resting state hemodynamic method which simulates a physiological mechanism of a human body.
2. The method for predicting resting coronary microcirculation resistance based on physical driving according to claim 1, wherein in step A1, the actual physiological waveform data of human body including arterial pressure and myocardial mass is acquired; the aortic pressure is replaced by the pressure of the brachial artery; myocardial mass is obtained by CTA image reconstruction.
3. A method for predicting resting coronary microcirculation resistance based on physical drive according to claim 1 wherein step A2 is reconstructing a personalized coronary artery structure using the patient CTA image; comprising the use of software to reconstruct CTA images, obtained by a patient's coronary structure radiologist, without subdivision of the coronary diameter to less than 1mm, until a personalized coronary structure is segmented.
4. A method for predicting resting coronary microcirculation resistance based on physical drive according to claim 1, characterized by the step A3 of measuring the anatomical parameters of normal blood vessels and the structural parameters of stenosed blood vessels; the clinician measures the length and the diameter of a normal blood vessel through the coronary anatomy structure obtained in the step A2, and a narrow blood vessel is required to measure six parameters of an inlet area, a narrow inlet length, a narrow outlet length, a minimum narrow length and a narrow rate; the measured vascular parameters are measured simultaneously by two radiologists by a standard measurement procedure, and when the measurement result error exceeds 3%, a third radiologist is required to intervene in the measurement and determine the measurement result.
5. A method for predicting resting coronary microcirculation resistance based on physical drive according to claim 1, wherein step A4 is a method for allocating coronary blood flow of a patient's coronary artery in an ideal state using a blood vessel scale rate based on a natural growth rule and establishing a simulated ideal state coronary microcirculation resistance; the ideal state model is a method which is established by calculating the microcirculation resistance of the coronary artery according to the personalized hemodynamic parameters of the patient under the condition that the coronary artery is not in stenosis; calculating coronary inlet flow in an ideal state, microcirculation resistance value in the ideal state and pressure at each branch respectively;
the ideal state model is a model which is established by calculating the coronary microcirculation resistance value according to the personalized hemodynamic parameters of a patient under the condition that the coronary artery is not in a narrow state; reconstructing a personalized three-dimensional vascular anatomical model of the coronary artery based on the CTA image of the coronary stenosis patient; according to clinical studies, the total coronary flow is 4% of cardiac output, wherein the flow ratio of the left and right crowns is 6:4; assuming that in an ideal situation, all coronary vessels are not stenosed; the flow of each branch of the coronary artery can be calculated by utilizing the blood vessel scale law through the total flow of the coronary artery; in the ideal coronary condition, for bifurcated vessels, according to the rule of scale, the blood flow is proportional to the vessel diameter:
q in lad : is left anterior descending branch vascular flow;
Q lcx : left coronary branch vessel flow;
D lad : the diameter of the left anterior descending branch vessel;
D lcx : left coronary branch vessel diameter;
n: scaling law coefficients;
according to the coronary 3D model, a personalized arterial pressure inlet pressure boundary condition P is given in The outlet is the flow Q of each branch distributed according to the blood vessel scale law out-k Calculating the differential pressure DeltaP of each blood vessel segment k The micro-circulation resistance at the downstream of each expenditure opening can be calculated; for example, for an ideal state blood vessel segment at an original narrow position, an ideal state differential pressure DeltaP is calculated s-ideal The pressure at the downstream branch k outlet and the total resistance of the microcirculation downstream of the branch k outlet in the ideal state can be calculated:
P out-k-ideal ＝P in -ΔP s-ideal -ΔP k (2)
p in the formula out-k-ideal : the outlet pressure of the vessel branch k in the ideal state;
P in : aortic inlet pressure;
ΔP s-ideal : the pressure difference generated by the blood vessel in the ideal state of the narrow blood vessel;
ΔP k : the pressure differential created by branch k of the normal vessel segment;
R m-k-ideal : the total resistance of the microcirculation downstream of the outlet of the branch k in an ideal state;
Q out-k : the distributed vascular branch k outlet flow;
n: total number of vessel outlet branches.
6. The method for predicting resting coronary microcirculation resistance based on physical driving according to claim 1, wherein the step A5 comprises the following steps:
step B1, taking the coronary inlet flow calculated in the step A4 as an optimized initial parameter;
step B2, taking the microcirculation resistance calculated in the step A4 as an initial resistance boundary condition;
step B3, taking the outlet pressure calculated in the step A4 as the outlet boundary condition of the 3D model;
step B4, calculating the resting resistance pressure drop through the narrow geometric parameters measured in the step A3;
step B5, iteratively optimizing and adjusting the microcirculation resistance value of the outlet of the blood vessel at the downstream of the stenosis by using a method based on physical driving; reducing the resistance value to be optimized within a set step range according to the comparison result; when the pressure of the inlet is matched with the personalized arterial pressure of the patient, the coronary microcirculation resistance average value of the downstream of the narrow branch outlet in the resting state can be obtained; ending the optimization, otherwise, continuing the optimization; outputting the microcirculation resistance values of the normal blood vessel and the narrow blood vessel, and finishing iterative calculation;
in the resting state, due to stenosis of coronary artery, anterior arterioles and arterioles in coronary microcirculation blood vessels can gradually adaptively dilate, regulate and reduce self resistance so as to maintain constant blood flow in the resting state; according to the reconstructed personalized coronary 3D model, taking the left anterior descending stenosis of FIG. 3b as an example, the inlet flow boundary condition Q is given Left side I.e. the total coronary flow is the same as that of the ideal state, Q total ＝4％·CO，Q Left side :Q Right side Outlet given ideal state microcirculation resistance, based on thing =6:4And iteratively optimizing and adjusting the microcirculation resistance value of the outlet of the blood vessel at the downstream of the stenosis by using a rational driving method:
R m-k-rest ′＝R m-k-rest -s (4)
wherein R is m-k-rest : dynamically adjusting the coronary microcirculation resistance value before;
R m-k-rest ': dynamically adjusting the coronary microcirculation resistance value;
s: adjusting the step length; the step length is 1;
when the inlet pressure is matched with the personalized arterial pressure of the patient, namely the formula (5) is satisfied, the coronary microcirculation resistance average value at the downstream of the narrow branch outlet in the resting state can be obtained;
P in -P in ′≤ε (5)
P in '＝P out-k-rest +ΔP k +ΔP s-rest (6)
p in the formula in ': the calculated inlet pressure after the microcirculation resistance value is adjusted;
P out-k-rest : the calculated coronary outlet pressure in the resting state;
ΔP k : pressure drop caused by resistance along the outlet vessel branch;
ΔP s-rest : pressure drop across the stenosis;
epsilon: converging residual error, wherein the value is 0.0001;
for vessels where no stenosis is present, the ideal state of the microcirculation resistance value is used.
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