Computational Fluid Dynamics: From Lab to Bedside · 2012. 7. 17. · Computational Fluid Dynamics:...

Computational Fluid Dynamics:From Lab to Bedside

Δημοσθένης Γ. Κατρίτσης, MD, PhD (London), FRCP

Athens Euroclinic, Athens Greece

St Thomas’ Hospital, London UK

City University, London UK

• Coronary artery disease (CAD) is the single most common cause of death in the developed world, responsible for about 1 in every 5 deaths. In 2002, out of 57 million deaths worldwide, approximately 16.7 million were due to cardiovascular disease (as compared with

approximately 5 million due to tuberculosis, human immunodeficiency virus, and malaria combined).

• Mortality from cardiovascular disease is estimated to reach 23.4 million in 2030. Coronary artery disease (including acute MI) is responsible for about half of these cardiovascular deaths.

Computational Fluid Dynamics: From Lab to Bedside

One death every two sec

Atherosclerosis in Ancient Egyptian MummiesAllam AH et al. The Horus Study J Am Coll Cardiol Img 2011;4:315–27

Coronary atherosclerosis in patients

Computational Fluid Dynamics: From Lab to BedsideLAD stable stenosis

RAO Cranial

Determinants of thrombosis in coronary atherosclerotic plaques.



Stenotic lesions have smaller lipid cores, more fibrosis, and calcification;

thick fibrous caps; and less compensatory enlargement (positive remodeling).

Nonstenotic lesions have large lipid cores and thin,

fibrous caps susceptible to rupture and thrombosis.

Computational Fluid Dynamics: From Lab to Bedside PCI vs MEDICAL THERAPY In Stable CAD

Katritsis and Ioannidis. Circulation 2005; 111:2906-2912.

PCI not recommended in stable IHD in recent GLs

Update of Meta-Analysis of PCI, as Compared with Medical Treatment,for Stable Coronary Artery Disease

PCI vs MEDICAL THERAPY In Stable CADKatritsis and Ioannidis. New Engl J Med 2007;357:414-5 .

Intervention is indicated as soon as possible in ACSKatritsis DG, et al. Optimal timing of coronary angiography and potential intervention in non-ST-elevation

acute coronary syndromes. Eur Heart J. 2011;32:32-40.

MIs often occur at sites of mild-to-moderate stenosesAmbrose et al. J Am Coll Cardiol. 1988;12:56-62

Little et al. Circulation. 1988;78:1157-1166

Ruptured plaques leading to acute coronary syndrome

more likely occur within the segment of significant

stenosesFalk E. B Heart J. 1983;50:127-134

Richardson et al. Lancet. 1989;2:941-944

Qia et al. J Am Coll Cardiol. 1991;17:1138-1142


Computational Fluid Dynamics: From Lab to BedsideKaski JC, Chen L, Chester M, Katritsis D. Circulation 1995;92:2058-2065

Characteristics of Stenosis Progressing to Total Occlusion

Computational Fluid Dynamics: From Lab to BedsideAnatomy and Haemodynamics May Affect Plaque Rupture

el Fawal MA, et al. Sudden coronary death in Glasgow:

nature and frequency of acute coronary lesions. Br Heart J 1987;57:329-335.

Fox B, et al. Atherosclerosis 1982;41:337-347.

Gibson CM, et al. J Thromb Thrombolysis 2003;15:189-196.

Hochman JS, et al. Am Heart J 1988;116:1217-1222.

Vieweg WV, et al. Cathet Cardiovasc Diagn 1979;5:319-330.

LAD LCx RCA

Computational Fluid Dynamics: From Lab to Bedside Anatomy and Haemodynamics May Affect Plaque Rupture

Wang, J. C. et al. Circulation 2004;110:278-284

RAO 28.5 CAUD 18

RAO 12.3 CRAN 35.3

Computational Fluid Dynamics: From Lab to Bedside3-D coronary reconstruction

RAO 28 CAUD 0

LAO 47 CRAN

0

Computational Fluid Dynamics: From Lab to Bedside3-D coronary reconstruction

3D

reconstruction2D acquisition

Coronary geometry is acquired by two 2-D images of the coronary tree from different projection angles

Using the concept of epipolar geometry 3-D reconstruction is performed by identifying identical points at the two projections

Andriotis A, Zifan A, Gavaises M, Liatsis P, Pantos I, Theodorakakos A, Efstathopoulos EP, Katritsis D.

A new method of three-dimensional coronary artery reconstruction from X-ray angiography: validation against

a virtual phantom and multislice computed tomography. Catheter Cardiovasc Interv. 2008;71:28-43.



Visual representation of the method used for determining the vessel diameterAndriotis A, Zifan A, Gavaises M, Liatsis P, Pantos I, Theodorakakos A, Efstathopoulos EP, Katritsis D.



The reconstruction algorithm has been validated against multislice detector CT coronary angiography which is considered now days the most accurate non-invasive means to visualize and

characterize the epicardial coronary arteries

Andriotis A, Zifan A, Gavaises M, Liatsis P, Pantos I, Theodorakakos A, Efstathopoulos EP, Katritsis D.




Computational Fluid Dynamics: From Lab to Bedside Andriotis A, Zifan A, Gavaises M, Liatsis P, Pantos I, Theodorakakos A, Efstathopoulos EP, Katritsis D.



Katritsis DG, et al. Three-dimensional analysis of the left anteriordescending coronary artery: comparison with

conventional coronary angiograms. Coronary Artery Disease 2008, 19:265–270

Conventional coronary angiography cannot provide accurate estimates of

anatomical parameters, such as distance of a coronary stenosis from the ostium of

the vessel, coronary artery curvature at the site of stenosis, axial deformity and

bending because of ventricular contraction.

Distance of lesion from LAD ostium 14.6mm and vessel curvature at lesion

14.6 mm and 137.20 on 2-D, whereas on 3-D 21.9mm and 1600, respectively


145 patients were identified with

a LAD lesion, 54 patients with a LCx lesion, and 76

patients with a RCA lesion responsible for the clinical

presentation.

Katritsis et al. Anatomic Characteristics of Culprit Sites in Acute Coronary Syndromes. J Interven

Cardiol 2008;21:140–150

The presence of angulation on the lesion increased the risk of an ACS 1.92

times (95% confidence interval [CI] 1.9–3.07)

The presence of bifurcation after the lesion increased the risk 1.65 times (95%

CI1.04–2.62)

Angulated lesions located within the first 40 mm from the ostium and before a

bifurcation presented an 11-fold increased risk for an ACS.


RAO CranialRAO Caudal


RAO Cranial LAO Caudal


Diastole Systole


Katritsis DG et al. Three-dimensional analysis of vulnerable segments in the left

anterior descending artery. Coron Artery Dis. 2009;20:199-206.

Coronary angiograms of 76 consecutive patients with an

anterior STEMI and a recanalized LAD were reconstructed

in the three-dimensional space, and compared with

angiograms of 76 patients with stable coronary artery

disease (SCAD) and significant LAD stenosis.


Dominant anatomic models of STEMI and stable coronary artery disease




Hemodynamic and mechanical forces acting on

vulnerable plaque:1. Wall shear stress

2. Circumferential wall stress and shear failure

3. Mechanical shear failure

4. Arterial wall collapse

5. Circumferential bending

6. Longitudinal flexion

7. Vasospasm

8. Fatigue failure


The hemodynamic factor that has been

most extensively studied and associated

with the localization, generation and

growth of atherosclerotic lesions is wall

(or endothelial) shear stress (WSS), ie

the tangential force exerted on the vessel

wall by blood flow due to the viscous

properties of blood (μ).

Illustration of the WSS acting on the

vascular endothelium

dr

duWSS

Computational Fluid Dynamics: From Lab to BedsideFlow Must Have a Role

Katritsis DG, Kaiktsis L, Chaniotis A, Pantos J, Efstathopoulos EP, Marmarelis V.

Wall shear stress: theoretical considerations and methods of measurement. Prog Cardiovasc Dis. 2007;49:307-29.

Circumferential Wall Stress

The circumferential wall stress is a tensile stress which is induced on the vessel wall by the transmural blood pressure and it is several orders of magnitude stronger than the wall shear stress

. For a given intraluminal pressure, the circumferential stress on a 50% stenosis is five times greater than on a 90% stenosis.Consequently, mildly or moderately stenotic plaques are generally stressed more than severely stenotic plaques and could therefore be more prone to rupture

Circumferential Stress Failure




Mechanical Shear Failure

Mechanical shear stress is the shearing stress that is exerted between adjacent layers of the vessel induced by the circumferential elongation due to circumferential stresses

Mechanical shear failure of the vessel occurs when vessel layers separate and slide relative to one another and when the extracellular matrix, which functions as the glue holding these layers together, cannot withstand the shear stress

Shear Failure




Arterial Wall CollapseAccording to the Bernoulli principle, at sites of artery stenosis, blood flow causes a

drop in static pressure within the throat of the stenosis.

The collapse of arteries may produce highly compressive stresses which arteries cannot withstand since they are typically constructed for tension only. Compressive stress is particularly determinant in that it may induce a crack or cavity

Experimental study of wall

collapse using a latex tube model

with induced stenosis

Stenosis





Chatzizisis YS, et al. J Am Coll Cardiol. 2007;49:2379-93

The endothelial cytoskeleton transmits the shear forces to the focal adhesions located at

the basal endothelial surface, where a downstream intracellular signaling cascade starts.


Davies KA, et al Annu Rev Physiol 19977; 59:527–549

Low endothelial shear stress promoting atherogenesis, atherosclerotic plaque formation

and progression, and vascular remodeling.

Computational Fluid Dynamics: From Lab to BedsideLow SS promotes atherogenesis

Chatzizisis YS, et al. J Am Coll Cardiol. 2007;49:2379-93

WSS is an important determinant of endothelial function and phenotype. High WSS induces endothelial

quiescence and an atheroprotective gene expression profile while low WSS stimulates an atherogenic

phenotype.

Low shear– mediated recruitment and activation of monocytes, increased

vasoconstriction and paracrine growth stimulation of the vessel wall constituents,

increased oxidant state, and increased apoptosis and cellular turnover.

Illustration of the arterial phenotype switch from atheroprotective (left) to atherogenic (rightl) induced by low WSS

conditions

Malek et al. Jama.1999;282:2035-2042


The complex three-dimensional vascular geometry, the blood molecular viscosity and the

flow pulsation constitute the major determinants of intravascular blood flow patterns and

shear stress.

In relatively straight vessel segments WSS is

pulsatile and unidirectional and yields a positive

time-averaged value over the cardiac cycle

In geometrically irregular regions, pulsatile

flow generates low or oscillatory WSS

Low and oscillatory WSS

-Direction: bidirectional

-Magnitude: low time-

averaged

Normal and

pulsatile WSS

-Direction:

uniderectional

-Magnitude:

physiologic time-

averaged

Ku DN et al. Arteriosclerosis. 1985;5: 293-302


Atherogenesis preferentially involves the outer

walls of vessel bifurcations, the inner walls of

arterial curvature and points of blood flow

recirculation and stasis. In these geometrically

predisposed locations, WSS is significantly lower

in magnitude than adjacent regions.

Asakura T, Karino T. Circ Res. 1990;66:1045-1066


Atherosclerotic lesions co-localize with regions of low and oscillatory WSS

Chatzizisis et al. Journal of the American College of Cardiology; 2007, 49:2379-

2393.

•In susceptible to atherosclerosis regions

(e.g. branches, arterial curvatures) where

WSS is low, an early fibroatheroma is

formed

•The vascular response (compensatory

expansive, constrictive or excessive

expansive remodelling) to that early

fibroatheroma likely determines the

subsequent natural history of the plaque

•% reported are based on IVUS studies

Computational Fluid Dynamics: From Lab to BedsideTHE EVOLUTION OF CORONARY PLAQUES


High SS is associated with plaque erosion and rupture

and causes platelet activation

Bluestein D, et al. Annals of biomedical engineering. 1999;27:763-773

Nesbitt WS, et al. Journal of molecular medicine (Berlin, Germany). 2006;84:989-995

Computational Fluid Dynamics: From Lab to BedsideKoskinas KC, Chatzizisis YS, Antoniadis AP, Giannoglou GD. Role of endothelial shear stress in stent

restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation.

J Am Coll Cardiol. 2012;59:1337-49.

Specific anatomic conditions identified at sites of coronary occlusions, such as the presence of bifurcation branches, create zones of vortices and flow recirculation.

These flow disturbances promote atherosclerosis and plaque development as well as thrombus formation and may affect the clinical outcome of coronary plaque rupture and potentially the incidence of MI.

Identification of such coronary segments may indicate targets of preventive intervention (plaque passivation?).

Computational Fluid Dynamics: From Lab to Bedside It is the flow stupid…..

Computational Fluid Dynamics: From Lab to BedsideThe Navier Stokes Equations

0uρt

ρ

0uuρt

uρ

S

TuuμIuμ3

2PS

Mass conservation equation:

where ρ is the density, t the time,u the velocity vector.

Momentum conservation equation:

-20

0

20

40

60

80

100

120

0.0 0.2 0.4 0.6 0.8

Time (s)

Flo

w R

ate

(m

l/m

in)

Steady -state

-20

0

20

40

60

80

100

120

0.0 0.2 0.4 0.6 0.8

Time (s)

Flo

w R

ate

(m

l/m

in)

Steady -state

0.0 0.25 0.5 0.75

Non Dimensional Time

1.0

Computational Fluid Dynamics: From Lab to BedsideComputer Models

Computational Fluid Dynamics: From Lab to BedsideComputational Fluid Dynamics (CFD) is a powerful tool

which can mathematically access important hemodynamic features such as local velocity, shear stress and flow patterns (vortices, recirculation)

Katritsis D et al. Prog Cardiovasc Dis. 2007;49:307-29.



Wall Shear Stress Distribution

Vortex Formation and Recirculation

Blood Flow Streamlines





Real-time Flow Real-time Shear stress

Myocardial infarctionPlaque rupture AND Thrombosis

IVUS studies have suggested that plaque rupture itself

may not necessarily lead to clinical events.

A high incidence of multiple plaque ruptures remote

from the culprit lesion in ACS patients has been reported,

and plaque ruptures have also been identified in patients

with stable angina or asymptomatic ischemia.

Rioufol G et al.. Circulation. 2002;106:804-808

Hong et al. Circulation. 2004;110:928-933

Maehara et al. J Am Coll Cardiol. 2002;40:904-910

Maehara et al. J Am Coll Cardiol. 2002;40:904


Effect of Flow on Potential Thrombosis?

Computational Fluid Dynamics: From Lab to BedsideFrom plaque rupture to thrombosis

Coronary angiograms of 186 consecutive patients (original sample) with an

anterior ST elevation myocardial infarction (STEMI) and a recanalized LAD

were reconstructed in the three-dimensional space. Culprit lesions were

compared with 293 stable LAD coronary stenoses on the same patients.

Katritsis DG, Efstathopoulos EP, Pantos I, Tzanalaridou E, De Waha A, Siontis GC, Toutouzas K, Redwood S, Kastrati A,

Stefanadis C. Ruptured versus stable plaques in human coronary arteries. Coron Artery Dis. 2011;22:345-51.


Anatomic parametersStable lesions

N=293

Culprit

lesions

N=186

P

Lesion reference diameter (mm) 2.8 ± 0.7 3.1 ± 0.6

• The majority of culprit lesions occurred between 20 and 40 mm from the LAD ostium while the majority of stable lesions were found

in distance >60 mm (p

Points

Lesion length

15 mm

0

1.5

Curvature on systole

>165o

Figure 1. General model of the

LAD and side branches

Model of stenosis

associated with MI. The

stenosis involves two side

branches, one upstream

and one downstream the

most stenotic site.

Model of stenosis

associated with MI. The

stenosis involves one side

branch downstream the

most stenotic site.

Model of stenosis

associated stable CAD.

The stenosis does not

involve any side branch.

Derived dominant models of vulnerable and stable coronary lesions

Katritsis DG, Efstathopoulos EP, Pantos I, Tzanalaridou E, De Waha A, Siontis GC, Toutouzas K, Redwood S, Kastrati A,

Stefanadis C. Ruptured versus stable plaques in human coronary arteries. Coron Artery Dis. 2011;22:345-51.


• Vulnerable plaque

– Characteristic histology

• Vulnerable blood

– Platelet hyperactivity, procoagulant states

• Vulnerable patient

– Prominent risk factors for IHD

• Vulnerable coronary segment


Scope:

To study intracoronary hemodynamics and particularly the formation of zones of flow recirculation and stagnation

Facts:

o The relationship of hemodynamic factors and thrombus formation due to platelet deposition has been previously investigated in various experimental and computational studies

o These studies showed that the flow condition at the stenosis promote platelet activation and aggregation

o If recirculation zones are present downstream the stenosis, the aggregation of platelets is further promoted and the motion of the platelets bring them into contact with the arterial wall

Based on the analysis of the anatomical characteristics of 152 coronary angiograms of

vulnerable and stable coronary lesions, the following three dominant models were derived

3D geometries were consequently generated incorporating a lesion with varying diameter

% stenosis

Computational Fluid Dynamics: From Lab to BedsideKatritsis DG, Theodorakakos A, Pantos I, Andriotis A, Efstathopoulos EP, Siontis G, Karcanias N, Redwood S, Gavaises M.

Vortex formation and recirculation zones in left anterior descending artery stenoses: computational fluid dynamics analysis.

Phys Med Biol. 2010;55:1395-411.

STEMI 1

50% stenosis

50% stenosis

SCS

50% stenosis

STEMI 2

Computational Fluid Dynamics: From Lab to BedsideEffect of % stenosis on flow

Katritsis DG, Theodorakakos A, Pantos I, Andriotis A, Efstathopoulos EP, Siontis G, Karcanias N, Redwood S, Gavaises M.


Phys Med Biol. 2010;55:1395-411.

For the 50% stenosis there is flow recirculation at

the ostium of the side branch in both STEMI

geometries (blue arrows), whereas no recirculation

is seen in the SCS model

No recirculation zones are noted at STEMI for

0% and 20% stenosis



Phys Med Biol. 2010;55:1395-411.



Phys Med Biol. 2010;55:1395-411.

No recirculation zones are noted at STEMI for 0% and 20% stenosis



Phys Med Biol. 2010;55:1395-411.

No recirculation zones are noted at SCAD for 50% stenosis

For the 50% stenosis there is flow recirculation at the ostium of the side branch in both STEMI geometries



Phys Med Biol. 2010;55:1395-411.



Phys Med Biol. 2010;55:1395-411.

For the 50% stenosis there is flow recirculation at the ostium of the side branch in both STEMI geometries

For the 50% stenosis, in STEMI 2 geometry the recirculation vortex virtually blocks the

entry into the side branch



Phys Med Biol. 2010;55:1395-411.

For the 90% stenosis, flow recirculation

occurs in both main (red arrow) and side

branch (blue arrow) after the stenosis.

In the SCS geometry, recirculation is also

seen in the post-stenotic lumen of the main

branch (red arrow) despite the absence of

bifurcation




Phys Med Biol. 2010;55:1395-411.

For the 90% stenosis, flow recirculation occurs in both main and side branch after the

stenosis.




Phys Med Biol. 2010;55:1395-411.

In the SCS geometry, recirculation is also seen in the post-stenotic lumen of the main branch

despite the absence of bifurcation




Phys Med Biol. 2010;55:1395-411.

BIFURCATION STENTINGClassifications

Chen-Gao

BIFURCATION STENTINGTreatment Modes

T-stenting

Y-stenting

Culotte

Crush

Reverse Crush

Kissing Stents

Main branch stenting

Main branch stenting with kissing

balloons

CulotteSKSCrush

BIFURCATION STENTINGTreatment Modes

Computational Fluid Dynamics: From Lab to BedsideDouble Stenting in Bifurcations

Katritsis DG, Siontis GC, Ioannidis JP. Double versus single stenting for coronary bifurcation lesions: a meta-

analysis. Circ Cardiovasc Interv. 2009;2:409-15.

Considered bifurcation model

Considered single (left panel) and double

(right panel) bifurcation stenting techniques

Considered coronary DES

Computational Fluid Dynamics: From Lab to BedsideKatritsis DG, Theodorakakos A, Pantos I, Gavaises M, Karcanias N,. Efstathopoulos EP. Flow Patterns at

Stented Coronary Bifurcations: Computational Fluid Dynamics Analysis. Circulation AE (In press)

High TAWSS values, low OSI values, and low tr values are considered hemodynamically favorable

Katritsis DG, Theodorakakos A, Pantos I, Gavaises M, Karcanias N,. Efstathopoulos EP. Flow Patterns at



Streamlines WSS distribution


Main branch stentingKatritsis DG, Theodorakakos A, Pantos I, Gavaises M, Karcanias N,. Efstathopoulos EP. Flow Patterns at





Main branch stenting

BIFURCATION STENTINGFate of side branches

- Dissected or even occluded side branches are usually clinically silent

- Probably do not affect long-term clinical event-free survival

- The majority of side branches (up to 90%) reappear at follow-up

Alfonso et al. J Am Coll Cardiol. 2000;36:1549-1556.

Tanabe et al. Am J Cardiol. 2002;90:937-941

Pan et al. Am Heart J. 2004;148:857-864.


Culotte - Stenting




T - StentingKatritsis DG, Theodorakakos A, Pantos I, Gavaises M, Karcanias N,. Efstathopoulos EP. Flow Patterns at





Crush Stenting




Results:

Single stenting of the main branch with our without balloon angioplasty of the

side branch offers hemodynamic advantages over double stenting.

When double stenting is considered, the crush technique with the use of a thin

strut stent results in improved hemodynamics compared to culotte or T stenting.

Computational Fluid Dynamics: From Lab to BedsideKoskinas KC, Chatzizisis YS, Antoniadis AP, Giannoglou GD. Role of endothelial shear stress in stent

restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation.

J Am Coll Cardiol. 2012;59:1337-49.

Role of endothelial shear stress

in stent restenosis and thrombosis

1. Non-newtonian fluid (proteins, blood cells, paltelets, fibrinogen…).

1. Pulsatile flow

3. Cardiac motion has minimal impact on CFD-assessed flowTheodorakakos A, Gavaises M, Andriotis A, Zifan A, Liatsis P, Pantos I, Efstathopoulos EP, Katritsis D.

Simulation of cardiac motion on non-Newtonian, pulsating flow development in the human left anterior

descending coronary artery. Phys Med Biol. 2008;53:4875-92.

Computational Fluid Dynamics: From Lab to BedsideExperimental Conditions

Left: superimposed centerlines at coronary angiography at diastole, systole and one intermediate time

and Right: layout of the moving geometry simulated for 5 time steps as seen from two different views

Theodorakakos A, Gavaises M, Andriotis A, Zifan A, Liatsis P, Pantos I, Efstathopoulos EP, Katritsis D. Simulation of cardiac

motion on non-Newtonian, pulsating flow development in the human left anterior descending coronary artery. Phys Med Biol.

2008;53:4875-92.


Flow streamlines colored with the velocity magnitude in the location downstream of the

atheromatous stenosis during the heart cycle; the recirculation zones induced at the

trifurcation point just downstream of the stenosis due to the pulsating flow are observed

Systole

Diastole

Computational Fluid Dynamics: From Lab to BedsideTheodorakakos A, Gavaises M, Andriotis A, Zifan A, Liatsis P, Pantos I, Efstathopoulos EP, Katritsis D. Simulation of cardiac


2008;53:4875-92.

Shear stress distribution at systole and diastole as seen from two different views for the

moving and non-moving arterial tree

Systole

Diastole

Non-moving Non-movingMoving Moving



2008;53:4875-92.

The spatial distribution of WSS at the area of the stenosis is very similar

between the stationary and the moving coronary trees. However, the absolute

values of WSS differ in the two cases.

Predictions indicate that myocardial motion has only a minor effect on flow

distribution within the arterial tree relative to the effect of the blood pressure

pulse



2008;53:4875-92.

PIV study - laser sheet and two high resolutiondigital cameras view the intersection of the vessel with the laser beam

(a) Scanning electron microscopy image of fibrin mesh (blue) with trapped platelets (purple)

and red blood cells (red) and

(b) b) Multi-scale model of thrombus development

(a) (b)

1 - Computational 2 - Experimental

The Future: Computational vs Experimental

Flow Analysis

Blood flow and WSS (3 methodologies) throughout the cardiac cycle for a specific patient

WSS measurements based on the maximum blood velocity show large deviations with respect to the measurements that use the mean blood volume flow or the mean blood velocity.

Therefore, in-vivo WSS measurements require careful selection of the applied methodology

The Future: MRI vs CFD

Coronary Flow Research Unit, Athens Euroclinic (D. Katritsis, J. Pantos)

Dept of Radiology, Attikon Hosp, Athens Univ Med School (E. Efstathopoulos)

Fluid Research Co. Athens (A. Theodorakakos)

The City University, London, UK (M. Gavaises, N. Karcanias, D. Katritsis)

St Thomas’ Hospital, London, UK (S. Redwood, D. Katritsis)

Cardiology Dept, Munich University, Germany ( A. Kastrati)

University of Athens Medical School, Greece (C. Stefanadis)

Computational Fluid Dynamics: From Lab to BedsideThe Team

Computational Fluid Dynamics: From Lab to BedsideConclusions

Myocardial infarction, the leading cause of death in the developed world has not been studied from the perspective of coronary flow.

CFD and MRI allow studying of coronary flow.

Novel techniques and models that allow simulation of physiologic conditions are necessary for this purpose.

A new era has begun….

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