Noninvasive determination of resting state diastole hemodynamic information

Abstract

To determine instantaneous wave-free ratio (IWFR) as a diastole-based hemodynamic index.SOLUTION: A diastole-based hemodynamic index may be calculated noninvasively for a patient by receiving image data respective of an anatomical region of the patient, creating an electronic model of the anatomical region, creating one or more boundary conditions model value sets representative of flow conditions during diastole, calculating one or more pressure drops at a location in the anatomical region, and determining, based on the calculated pressure drop (possibly drops) and based on a reference pressure, a hemodynamic index value, such as IWFR, for the location.SELECTED DRAWING: Figure 2

Description

[Technical field]

[0001] This disclosure generally relates to a method for obtaining patient hemodynamic information based on non-invasive imaging and computational fluid dynamics. Regarding the identification and display, the identification and display may include resting state diastolic-based hemodynamic information, e.g. This includes the identification and display of instantaneous wave-free ratio (IWFR). nothing.

[0002] [CROSS REFERENCE TO RELATED APPLICATIONS] This application is a continuation of U.S. Provisional Patent Application No. 62 / 788,914, filed January 6, 2019. The benefit of and priority to this U.S. provisional patent application is claimed, the entire contents of which are incorporated herein by reference. The entire disclosure is incorporated herein by reference. [Background technology]

[0003] Coronary heart disease (CHD) is the most common cause of death in the United States. CHD is a leading cause of death, with direct and indirect annual costs estimated at hundreds of billions of dollars. It is caused by atherosclerosis, which progresses This can lead to ischemia, angina, myocardial infarction and death. Depending on the severity and complexity of the condition, medical treatment, endovascular stents, and coronary artery bypass grafts may be used. The company offers patients a variety of treatment options, including coronary artery bypass graft (CABG) surgery. A typical diagnostic and treatment plan may include clinical evaluation, non-invasive stress testing, and for suitable patients, invasive coronary angiography and subsequent medical treatment and / or coronary angiography. Typically, patients undergoing medical treatment If symptoms remain unchanged or a significant defect in myocardial perfusion is found, medical personnel should would perform an invasive coronary angiogram on the patient. The decision to revascularize using a coronary stent or CABG surgery is based on angiography. Based on anatomical findings by and more recently, invasively measured fractional flow reserve (F The catheter is placed in the catheter catheter position, and the catheter is placed in the catheter position. Measuring FFR in the laboratory requires inserting pressure wires into the patient's coronary arteries. FFR values ​​below 0.8 are generally considered to indicate clinically significant obstructive disease. , revascularization would be permitted in appropriate clinical circumstances.

[0004] Instantaneous fractional flow reserve (IWFR) is more effective than FFR in identifying obstructive coronary lesions. It is a hemodynamic index that has been proven to have the same diagnostic accuracy as FFR. IWFR is measured invasively using a pressure wire. Like FFR, IWFR is is the intravascular pressure distal to the lesion(s) relative to the pressure in the aorta (Pa) The IWFR is defined as the ratio of the force (Pd) to the force (Pd) of the total blood flow. The IWFR differs from the FFR in several ways. First, FFR requires the induction of hyperemia when measuring the pressure ratio, whereas IWFR As a result, FFR is measured under resting conditions, just like IWFR. Second, FFR uses pressure averaged over the cardiac cycle. On the other hand, IWFR is used to measure the time during diastole when resistance to flow is approximately constant at a minimum. Pressure measurements averaged during the so-called wave-free period are utilized.

[0005] IWFR is not the only hemodynamic parameter measured under resting conditions during diastole. Other pressure ratio indices measured under resting conditions during diastole are The diastolic pressure ratio (dPR), which is the average of the standing ratios, and the diastolic Pressure ratio measured at the midpoint (dPR mid ), both of which are equivalent to the IWFR. It has been proven to have diagnostic accuracy such as Summary of the Invention

[0006] Disclosed herein is a non-invasive determination of resting state diastolic hemodynamic information. A first exemplary method for providing respective hemodynamic information includes imaging three-dimensional electrocardiograms of the patient's coronary arteries. obtaining a child model representing a diastolic period of a cardiac cycle of the patient when the patient is in a resting state; and obtaining a set of boundary condition model values. A three-dimensional computational fluid dynamics (CFD) simulation of the coronary artery model was performed based on the model set. performing a procedure for determining whether a first coronary artery is in a vascular graft according to the CFD simulation; and calculating a pressure drop between the first location and a second location in the coronary artery. The method may further include: and determining a hemodynamic index value indicative of the presence of a lesion at the location.

[0007] In one embodiment of the first exemplary method, the set of boundary condition model values ​​is represents the entire diastolic period of the cardiac cycle.

[0008] In one embodiment of the first exemplary method, the set of boundary condition model values ​​is represents the wave-free period of the diastolic phase of the cardiac cycle.

[0009] In one embodiment of the first exemplary method, the set of boundary condition model values ​​is represents the mid-diastolic point of the cardiac cycle.

[0010] In one embodiment of the first exemplary method, the method includes: Further comprising creating the model.

[0011] In one embodiment of the first exemplary method, the method comprises: receiving image data of each of the plurality of pixels; and and creating a child model.

[0012] In one embodiment of the first exemplary method, the set of boundary condition model values ​​is an inlet flow rate at the inlet of said coronary artery, representing a resting state of said inlet flow rate and flow division and two or more outlet flow rates calculated according to the model.

[0013] In one embodiment of the first exemplary method, the method includes: specifying the flow split model according to a shape of the model; and calculating the two or more outlet flow rates according to a split model.

[0014] An exemplary embodiment of a system for providing hemodynamic information for each of a patient includes instructions for recording the patient's hemodynamic status. a non-transitory computer readable memory for storing a coronary artery endothelial cell; obtaining a three-dimensional electronic model of a diastolic phase of a cardiac cycle of said patient while said patient is in a resting state; and obtaining a set of boundary condition model values ​​representative of the interval. and a processor for detecting the boundary condition model value. A three-dimensional computational fluid dynamics (CFD) simulation of the coronary artery model was performed based on the performing a first location of the coronary artery according to the CFD simulation; calculating a pressure drop between the coronary artery and a second location; and and based on the reference pressure, a hemodynamic index value indicative of the presence of a lesion at the location. The device can be configured to execute instructions to:

[0015] In one embodiment of the exemplary system, the set of boundary condition model values ​​is Represents the entire diastolic period of the cardiac cycle.

[0016] In one embodiment of the exemplary system, the set of boundary condition model values ​​is Represents the wave-free period of the diastolic phase of the cardiac cycle.

[0017] In one embodiment of the exemplary system, the set of boundary condition model values ​​is Represents the mid-diastolic point of the cardiac cycle.

[0018] In one embodiment of the exemplary system, the memory is causing the processor to generate the electronic model of the anatomical region. The instruction to execute the command is further stored.

[0019] In one embodiment of the exemplary system, the memory is Then, the processor receives image data for each of the anatomical regions of the patient. and creating the electronic model based on the received image data. The device further stores an instruction to synchronize the two.

[0020] In one embodiment of the exemplary system, the set of boundary condition model values ​​is an inlet flow rate at the inlet of the coronary artery, which represents a resting state; and two or more outlet flow rates calculated in accordance with the method.

[0021] In one embodiment of the exemplary system, the memory is Then, the processor calculates the flow distribution according to the shape of the three-dimensional model of the coronary artery. calculating a flow split model for the two or more outlets according to the inlet flow rate and the flow split model; and calculating a mouth flow rate.

[0022] A second exemplary method for providing hemodynamic information for each of a patient includes: and obtaining a boundary condition model representative of said patient's resting state. and determining a first time in the patient's cardiac cycle based on the three-dimensional model and the boundary condition model. calculating a first pressure drop across a portion of the anatomical region of the patient at a time point; The second exemplary method may include: at a second time point within the patient's cardiac cycle that is different from the first time point based on the calculating a second pressure drop across a portion of the anatomical region; and measuring the cardiac pressure of the patient. For a certain range of time in a cycle, the first pressure drop and the second pressure drop are calculating the respective pressure drops across the region; and indicating the presence of a lesion at said location based on the measured pressure drop and based on the baseline pressure. and determining a hemodynamic index value based on the determined hemodynamic status.

[0023] In one embodiment of the second exemplary method, the anatomical region is a blood vessel, and the analysis A portion of an anatomical region extends from an entrance to the blood vessel to a location within the artery.

[0024] In one embodiment of the second exemplary method, the anatomical region is a coronary artery.

[0025] In one embodiment of the second exemplary method, the method comprises: receiving image data of each of the plurality of pixels; and and creating a child model. [Brief description of the drawings]

[0026] [Figure 1] FIG. 1 illustrates an exemplary embodiment of an electronic system for determining hemodynamic information of a patient. [Diagram 2] 1 is a flow chart illustrating one exemplary embodiment of a method for determining patient hemodynamic information based on electronic patient data. [Diagram 3] 1 is a flow chart illustrating an exemplary embodiment of a method for determining hemodynamic information based on a single set of values ​​of a boundary condition model representing average flow conditions for a single point in time within a cardiac cycle or a portion of a cardiac cycle. [Figure 4] 1 is a flow chart illustrating an embodiment of a method for determining hemodynamic information based on two sets of boundary condition model values ​​representing two different cardiac cycle states. [Diagram 5] FIG. 1 illustrates an exemplary geometric model of an anatomical region of a patient that may be identified and find use in the methods of the present disclosure. [Figure 6]1 is a plot showing an example range of pressure drop for an example range of flow rates for a set of patients. [Figure 7] FIG. 1 illustrates an example embodiment of a user computing environment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0027] Given the diagnostic accuracy of invasive IWFR and other diastolic pressure ratio indices, noninvasive imaging and Methods to calculate these using numerical hemodynamics should advance invasive diagnostic angiography. Known hemodynamic indices may be useful as a tool in selecting patients who should or should not proceed. For example, FFR, dPR, and IWFR are measured invasively, and Approximately 50 percent of patients undergoing invasive testing are found not to have obstructive disease. To this end, non-invasive methods to identify IWFR and similar diastolic indices as screening tools are being developed. There is a clinical need for aggressive diagnostic methods.

[0028] Non-invasively captured image data, such as CT images and computational fluid dynamics (CFD), Within the range of anticipated blood flow requirements that a particular individual is likely to experience during daily activities. To rapidly calculate the hemodynamic relationship between pressure and coronary flow over a wide range of This relationship can be used to determine the relationship between IWFR and the flow rate caused by coronary artery disease. Specific indices of intra-arterial pressure loss, including diastolic pressure ratio and others that describe the degree of obstruction, can be non-invasively measured. It can be calculated automatically and in combination with other clinically derived information to support invasive diagnostic procedures. A judgement can be made as to whether a technique or intervention is advisable.

[0029] Current methods for calculating FFR assume hyperemic flow, which may be stochastic for a given individual. This requires the assumption of an increase in flow from the resting condition to the hyperemic condition. Depending on the pathophysiological state and depending on the individual, it can range from a factor of as large as 4 or 5 to slightly more than 1. Therefore, the assumed hyperemic flow (for FFR) Using an assumed rest flow (as required for IWFR) rather than The uncertainty in the assumed inflow conditions can be reduced, and therefore the CFD-based FF It can provide improved accuracy for R.

[0030] Individuals vary in resting fluid requirements depending on their physical condition and metabolic needs. Estimating resting flow for diseased populations can provide insight into underlying pathophysiology, e.g. Due to microvascular disease and other factors, there is more variability in estimating flow under hyperemic conditions. Calculations based on hyperemic flow conditions may be used to guide the decision to recommend an invasive diagnostic procedure. The basis may not be appropriate for the general population. A non-invasive computational technique to simulate the pressure drop during diastolic flow to provide diagnostic information to provide.

[0031] The present disclosure improves upon known CFD-based FFR measurements by considering patient-specific metabolic demands. In some embodiments, the method may further provide an improvement over computational methods. By incorporating information from the metabolic activity of the patient, a more accurate CFD-based This patient-specific metabolic workload information can be used to calculate the IWFR. This can be used to provide the flow rate utilized in the calculations.

[0032] IWFR and other hemodynamic indices can be calculated based on the flow field in the patient's vascular system. This can be based on the Navier-Stokes equations of fluid motion. The flow field within the fluid, e.g., in some forms as a function of time and three-dimensional (3D) space, and other formats, intravascular pressure within a region of interest (ROI) as a function of 3D space only, and The Navier-Stokes equations can be used to describe the velocities. For example, pressure drop, FFR, fractional flow reserve (IWFR), other diastolic pressure indices, blood Pressure fluctuations in the pipe and viscous shear stress (wall shear stress (WSS)) It is possible to calculate quantities of clinical interest, such as the forces on the arterial wall caused by CFD is used to solve the Bies-Stokes equations, which are This includes imposing boundary conditions, such as the inlet flow rate (e.g., at the selected inlet boundary) and the vessel Subjects with any combination of flow distributions in the branches (e.g., one or more outflow streams) The vessel lumen geometry (obtained from CT or other imaging) is also included in the CFD. The pressure field in I can be calculated as the deviation from a reference pressure and hence The absolute level of pressure, e.g., Pa, may not be necessary when calculating the pressure field. If a pressure (e.g., Pa) is specified, the deviation from the reference is calculated and the absolute value of the pressure inside the field is calculated. Counter pressure can be specified.

[0033] Many clinical applications of coronary flow, such as pressure drop, FFR and IWFR, are addressed by the navigation system. The Estoques equation is assumed to be time-independent (i.e., independent of the time dimension, For example, the time average of the pressure ratio Pd / Pa can be calculated as where Pd is the pressure within the ROI and Pa is the reference pressure. This is because the 3D CFD model is adequate to calculate these pressure exponents, and therefore However, it is faster than a four-dimensional model (i.e., a model that incorporates the three dimensions of space and time). This means that calculations become possible.

[0034] The pressure field within the ROI can be determined based on, for example, the flow rate within and around the ROI. For coronary flow and pressure, the flow rate and the proximal and distal locations within the region of interest are The relationship between the pressure gradient (ΔP) between the Therefore, a sufficient approximation can be achieved. ΔP=aQ+bQ 2 (Formula 1) Here, a and b depend on the vascular geometry and blood viscosity of the individual patient, and are determined by the method described below. is a constant that can be calculated for a given patient in Both have a mathematical basis. Physically, the aQ term is the pressure loss due directly to blood viscosity. while bQ 2 The term is the pressure resulting from flow separation and turbulence (if present). Related to losses. bQ 2 The term is, if the constriction is large enough to cause flow separation. , can be considered significant. Mathematically, this formula can be expressed as a polynomial for ΔP=fcn(Q) Equation (1) can be regarded as the first two terms in a series expansion. The pressure drop across a region of the vascular system of a test patient through which the flow field is identified is determined.

[0035] To calculate a and b, we solve the three-dimensional Navier-Stokes equations for two values ​​of Q. For example, the first value Q1 may be a flow rate for the start of diastole (or another time point). The second value Q2 may represent the flow rate for the end of diastole (or another time point). In other embodiments, Q1 can represent a first physiological state, and Q 2 can represent different second physiological states. These calculations are done using Q1, Q2, ΔP Once 1 and ΔP2 are known, the following equations (2) and (3) can be solved for a and b. This gives two values ​​for ΔP so that ΔP1=aQ1+bQ1 2 (Formula 2) ΔP2=aQ2+bQ2 2 (Formula 3)

[0036] Once the coefficients a and b for a given patient are known, the flow rate can be calculated for a range of flow conditions (e.g., Further CFD is required for each flow condition within the range of physiologically relevant flow conditions It is possible to calculate ΔP over that range without

[0037] The clinical definition of IWFR is shown in equation (4) below. IWFR=Pd / Pa (Equation 4) where Pd and Pa are the distal coronary artery pressures averaged over the diastolic waveless period, respectively. Alternatively, the IWFR can be calculated by dividing the aortic pressure by the waveless period, as shown in the following equation (5): It can be defined using an intermediate value. IWFR=1-ΔP / Pa (Equation 5)

[0038] Equations (4) and (5) are the Pd and Pa (Equation (4)) at different parts or points of the cardiac cycle. Calculate other indices by calculating ΔP and Pa (if equation (5)) For example, the diastolic pressure ratio (dPR) is the pressure that is applied throughout the diastole. It can be calculated by performing the calculation on

[0039] (In the case of IWFR, ΔP is calculated at the beginning and end of the diastolic wave-free period. Q1 and Q2 are calculated for the start and end of the diastolic wave-free period, and Pa is calculated for the start and end of the diastolic wave-free period. Once the IWFR is calculated, the IWFR value can then be calculated. The pressure vs. flow curve for can be calculated and integrated and averaged to obtain the IWF The R-value can be calculated non-invasively.

[0040] As mentioned above, IWFR values ​​can be calculated under two different conditions (e.g., two different time periods within the cardiac cycle). Alternatively, in one embodiment, Based on a single representative Q value and a single representative Pa value for the diastolic waveless period, To non-invasively calculate IWFR in a patient with a pulmonary artery disease, a single calculation can be performed. The Q value can be calculated in some embodiments (as discussed below with respect to equation (9)) by The calculation can be performed according to the shape of the area of ​​biological interest.

[0041] As described above, one or more Pa values ​​may be used as the reference pressure for IWFR calculation. In one embodiment, to estimate this mean diastolic pressure, brachial cuff pressure measurements are used. The cuff pressure is the peak systolic pressure (SP) and the maximum Provides low diastolic pressure (DP) during wave free period Resting mean aortic diastolic pressure (Pa dmean or dPa) (this is for IWFR calculation) (which can be used for this purpose) is, in some embodiments, described in Formula 6 below: It can be estimated from the SP and DP cuff values ​​according to a transfer function. Pa dmean =(SP+3DP) / 4 (Equation 6) In other embodiments, other transfer functions may be used to relate the cuff pressure value to the reference pressure. can be done.

[0042] In another embodiment, the mean aortic diastolic pressure at rest (Pa) dmean or dPa) is It can be calculated from the cuff pressure as shown in Equation 7 below. dPa=Pc+offset (Equation 7) where Pc is the resting upper arm cuff pressure given by Equation 8 below. Pc=dPc+FF*PP (Equation 8) where dPc is the diastolic cuff pressure, FF is the scalar form factor, and PP is the cuff pulse pressure (e.g., the systolic (SP) cuff pressure and the diastolic (DP) cuff pressure of a patient at rest). ) the difference between the cuff pressure and the scalar form factor FF, which is a value between 0.15 and 0.45. For example, heart rate, age, height, systolic pressure, and / or amplification index (AUGM In some embodiments, the patient-specific characteristics may be dependent on the patient's own characteristics, including the patient's entation index. In some cases, FF can be approximately 0.2, 0.25, or 0.33. In an embodiment, the offset value in Equation 7 may be between about 0 mmHg and -10 mmHg. In one embodiment, the offset value in Equation 7 may be approximately -7 mmHg. The value of the SET may, in some embodiments, be the value of the form factor FF, the desired hemodynamic index, (and therefore the portion of the cardiac cycle under examination) and the physiological state of the patient. Cut.

[0043] In another embodiment, the mean aortic diastolic pressure relates the cuff pressure to the aortic pressure during diastole. For example, the diastolic Pa value can be estimated using a transfer function that is based on the invasively measured The formula was fitted to a data set containing the cuff pressures and central diastolic resting pressures of the patient population. By finding the value of the FF and / or offset value, the cuff pressure of the test patient can be Once this function is known, it can be determined from the non-invasively measured This can be used to obtain an estimate of diastolic resting pressure from the measured cuff pressure.

[0044] In another embodiment, the mean aortic diastolic pressure is measured using an optical finger device or other wearable device. Combination of radial pressure measurement device (e.g. radial tonometry device) and upper arm cuff pressure device For example, the Fourier analysis of the optical finger device output can be used to estimate the This can be performed and mathematically combined with the upper arm cuff pressure to determine a value in Pa.

[0045] Referring to the drawings, in which like reference numbers refer to the same or similar features in the various drawings, FIG. FIG. 1 is a diagram of an exemplary embodiment of an electronic system 10 for determining hemodynamic information. The system 10 includes a patient image source 12, a user input device 14, and a hemodynamic information computer. The system may include a computing system 16 and a display 18. As will be described in detail, the system 10 collects electronic patient data (e.g., patient area of ​​interest data) and stores the patient's Calculating and / or determining hemodynamic information of a patient based on the patient's blood flow (images and other data) Based on the hemodynamic information obtained, the patient may be recommended for further testing (e.g., further noninvasive evaluation or may find use in making recommendations regarding interventional evaluation and / or interventional treatment. can.

[0046] In one embodiment, one or more aspects of the system 10 may be deployed in a clinical environment. For example, in some embodiments, a patient image source 12, a user input device 1 4. The hemodynamic information computing system 16 and the display 18 are used in hospitals, etc. In some embodiments, the system The 10 components are a laptop or desktop computer or workstation. In some embodiments, some of the systems 10 may be implemented in a The components of the system, such as the hemodynamic information computing system 16, may be remotely located from the clinical setting. and may be remote, for example in a cloud computing based implementation. do.

[0047] A patient image source 12 is configured to acquire one or more medical images of the vasculature of a subject patient. For example, the patient image source 12 may include a medical image acquisition device configured to In some embodiments, the patient image source may be a non-invasive image acquisition device. The 12 is, among other things, a computed tomography (CT) acquisition device, an intravascular ultrasound (IVUS) acquisition device, VUS), biplane angiography, optical coherence tomography (OCT), magnetic resonance imaging (MRI), or It may include, but is not limited to, combinations thereof.

[0048] Additionally or alternatively, the patient image source 12 may include a store of existing image data of the patient under test. In some embodiments, the patient image source 12 may include a medical image storage device. A device, such as a database or other local electronic data storage device, or a medical imaging device. a remote storage device (e.g., a cloud-based storage device) configured to store the image. It can include.

[0049] User input device 14 may include one or more input devices for input to the computing system. devices, e.g. mouse, touchpad, touchscreen, keyboard, microphone The input device may be or may include a smartphone, camera, or other input device. Cut.

[0050] The hemodynamic information computing system 16 includes a processor 20 and data and instructions. and a non-transitory computer readable memory 22 configured to store In one embodiment, the memory 22 is capable of storing images from a patient under test, and thus The processor 20 may function as the patient image source 12, or an aspect thereof. 2, a memory 22 for executing one or more of the steps, methods, algorithms, etc. of the present disclosure. In particular, the memory 22 may be configured to execute instructions stored in a shape-specific A determination module 24, a boundary condition determination module 26, a flow field determination module 28, and a pressure determination module Various functions in the form of instructions, including a module 30 and a hemodynamic information identification module 32 The module can be configured to store

[0051] The various modules 24, 26, 28, 30, 32 in the memory 22 will now be described individually. However, such individualization is clearly merely for the purposes of argumentation. It should be understood that the instructions implemented by the various modules may be stored in common files, memory, and / or other storage. The modules described herein may be included in any of the devices, etc. One or more of these may be individualized into multiple individual files, storage devices, and the like.

[0052] The shape identification module 24 identifies an anatomical region of interest ( The method may be configured to generate an electronic geometric representation (e.g., a model) of the ROI. In some embodiments, the ROI is a portion of the cardiovascular system of a subject patient, e.g., one or more arteries. One or more arterial segments may be one or more arteries and their associated It may include portions of one or more branches extending therefrom.

[0053] In some embodiments, the one or more arterial segments include one or more coronary artery segments. The one or more coronary artery segments may include one or more coronary artery segments emanating from the aorta of the subject. One or more coronary arteries and one or more branches extending therefrom. The above coronary artery segments are the left coronary artery (LCA) and / or It may include one or more parts of the right coronary artery (RCA). , but not limited to, one or more coronary artery segments of the left coronary artery (LCA) In particular, the left main coronary artery (LM), the left anterior descending artery (LAD), and the left the circumflex artery (also called the "circumflex branch"), or a combination thereof, Not limited to these.

[0054] This disclosure will refer to coronary artery segments. However, more than one artery The segments are not limited to the coronary artery segments discussed, but may be, among other things, other coronary artery segments. The present invention may include a segment of an artery, other types of arterial segments, or a combination thereof. For example, one or more arterial segments may be a cerebral artery segment (multiple femoral artery segment(s), iliac artery segment(s) (multiple), popliteal artery segments (multiple), carotid artery segments (multiple) The renal artery segment(s) may include one or more renal artery segments, etc.

[0055] In some embodiments, the shape representation generated by shape identification module 24 may include: The model may be a three-dimensional (3D) electronic model of the spatial volume of one or more arterial segments. For example, the geometric representation of one or more artery segments may be represented as a three-dimensional volumetric mesh, e.g., a polyhedron ( In some embodiments, the shape representation can be discretized into a set of discrete points (e.g., tetrahedrons). It may include a surface mesh representing the luminal boundary of the arterial segment.

[0056] In some embodiments, the boundary condition identification module 26 may identify boundary conditions for each artery segment. A "boundary" refers to a cross-section of a representation of an arterial segment. In particular, the inflow boundary corresponds to the cross section through which blood flows, One or more cross sections corresponding to cross sections located downstream or distal from the inflow boundary, which are directed outwardly from the inflow boundary. Outflow boundary on one or more of the vessel walls, corresponding to the interface between the inner surface of the arterial wall and the flowing blood These may include, but are not limited to, a boundary, a perimeter ...

[0057] In some embodiments, one or more of the outflow boundaries may be at a junction (e.g., a bifurcated, trifurcated, etc. , and combinations thereof) In some embodiments, the one or more outflow boundaries may be located in the left circumflex artery. In some embodiments, the outflow boundary may be located at or adjacent to the outflow boundary. The at least one outflow boundary is a first outflow boundary and is located between the inflow boundary and the first outflow boundary. In some embodiments, the first outgoing boundary may include a second outgoing boundary. corresponding to the distal boundary of the ment (i.e., the cross section located downstream or distal from the inflow boundary). In some embodiments, for example, if the shape representation includes the left coronary artery, The second outflow boundary can correspond to the circumflex artery. In some embodiments, the first outflow The boundary and the second outflow boundary may be connected to one or more further outflow boundaries, e.g., at least a third outflow boundary. The third outflow boundary corresponds to a junction such as a branch or bifurcation. It may be located at or adjacent to the

[0058] In some embodiments, the boundary condition identification module 26 may include a step of: and configuring the shape representation generated by the method to identify shape data for each boundary. In some embodiments, the shape data may include, among other things, the radius, diameter, The measurements may include the circumference, length, area, volume of the epicardial coronary arteries, or a combination thereof. But not limited to these.

[0059] In some embodiments, the boundary condition identification module 26 may identify boundary conditions for each artery segment. For example, the boundary conditions for each segment can be specified. The boundary conditions may include, among others, an inflow boundary condition, an outflow boundary condition, one or more vessel wall boundary conditions, or The inflow boundary conditions may include velocity, flow rate, pressure or other specific Each outflow boundary condition can be a value, or a range of values, of the property of the flow rate. It may be a percentage of a condition, or a value or range of values ​​of other characteristics. Boundary conditions can be values ​​or ranges of values ​​for velocity, flow, pressure, or a combination of these or other properties. It can be said that:

[0060] In some embodiments, the identification of the inflow boundary condition and / or the outflow boundary condition may include, among other things: Patient information, relevant physiological state (e.g., resting state, hyperemic state), type of segment ( For example, the identification can be based on LCA or RCA, or a combination of these. In some embodiments, the inflow boundary condition is determined based on the expected patient activity level (e.g., In some embodiments, the method may be identified according to the information provided by In, the inflow boundary conditions can be stored values ​​and / or can be user specified.

[0061] In some embodiments, the inflow boundary condition depends on the shape of the anatomical ROI, e.g., the vascular portion According to the radius, diameter, length, or volume (e.g., the volume of an epicardial coronary artery) of For example, the flow rate can be calculated based on the lumen volume of the region of interest, as shown in Equation 9 below: It can be calculated according to the model. Q in = αV β (Formula 9) Here, Q in is the flow rate at the inlet of the anatomical model, and V is the flow rate of the luminal body of the region of interest. where α is a coefficient that depends on the physiological state of the patient, β is the vascular tree structure, and In some embodiments, the resolution of the images used to generate the 3D model of the anatomical region This is a coefficient that depends on the image resolution.

[0062] In an embodiment in which the region of interest is the coronary artery tree, V is segmented from its proximal origin. The luminal volume of the LCA or RCA is defined as the area up to which the diameter of the vessel is a specific diameter. The particular diameter may be used to create a model of the patient's anatomy. For example, the position may depend on the resolution of the image being captured. , can be defined as the diameter of three or four voxels in the image dataset. In examples, the location may be where the lumen has a diameter of 1 mm or 1.5 mm.

[0063] In some embodiments, the parameters α and β are constant across all patients. Both non-invasive and invasive data can be used to verify the values ​​of α and β. The data can be obtained from an exemplary data set having:

[0064] In some embodiments, the outflow boundary conditions may be identified using an outflow distribution model. The outflow distribution model can be calculated using the geometric data and / or the stored hemodynamic data. The stored hemodynamic data can be used to determine the shape of the outflow boundary (e.g., radius, One can define empirical relationships between the diameter, length, volume, etc. and the respective flow rates, The stored hemodynamic data can also be used to define this. For example, The boundary condition generation module generates a boundary condition based on the stored hemodynamic data and the first outflow of the segment. Specify runoff distribution model using radius, diameter, length, volume etc. of boundary and secondary runoff boundary In another example, the boundary condition generation module may generate shape data, e.g., the radius, diameter, length of the first outflow boundary (distal boundary) of the cerebrospinal fluid or the portion of the vessel proximal to the boundary; A runoff distribution model can be specified using only the volume, etc. Used to identify the outflow (e.g., velocity, flow rate, percentage of inflow) for each outflow boundary. can be used to specify each outflow boundary condition.

[0065] By way of example, the boundary conditions identified by the boundary condition identification module 26 may be determined based on the flow field (e.g., Identify blood flow, wall shear stress, and hemodynamic information (e.g., FFR, IWFR, etc.) It can be used for steady and / or unsteady flow calculations to determine the boundary conditions. Joule also uses optimization techniques to define the flow partitioning of arterial segments. Thus, the boundary condition generation module 26 provides versatility, accuracy, and efficiency in identifying boundary conditions. It is possible to provide efficiency.

[0066] The flow field characterization module 28 is configured to convert the shape representations identified by the shape characterization module 24 into One or more boundary conditions identified by the boundary condition identification module 26 and each of the patient The pressure data is then used to determine the flow field for each arterial segment. The pressure data can be, for example, the cuff pressure of the patient in a resting state. In some embodiments, the flow field may be, among others, a pressure field, a velocity field, a wall shear stress field, an axial pressure field, a flow field, a flow rate ... The following examples may include, but are not limited to, pressure, lark stress, or combinations thereof.

[0067] In some embodiments, flow field parameters (e.g., pressure field, velocity, etc.) are calculated using geometric data. In this way, the flow field characterization module can be based only on the parameters and boundary conditions. It is configured to identify flow fields based solely on spatial position (i.e., independent of time). It is possible.

[0068] The pressure determination module 30 uses the flow field determined by the flow field determination module 28 to determine the pressure. The method may be configured to determine blood pressure at one or more points within a patient's anatomy using a blood pressure sensor. In some embodiments, the pressure data can be, among other things, calculated flow fields / pressures. Non-invasive determination of the patient's mean blood pressure as determined by a force field, e.g., a blood pressure cuff, or It can be determined from the combination.

[0069] The pressure determination module 30 determines the pressure of a particular location within the patient's anatomy by a user (e.g., and configuring the pressure sensor to identify a particular pressure at the particular location in response to the selection. The user can then select a geometric model of the patient's region of interest (e.g., an artery) on the display 18. In response to the display, the user can input the selection using the user input device 14. In an embodiment, the pressure determination module is configured to determine a pressure drop at a user selected location. The pressure sensor can be configured to determine the pressure upstream and / or downstream from a user-selected location, such as Cut.

[0070] The hemodynamic information computing system 32 receives one or more hemodynamic information of each of the patients. The device may be configured to calculate a state parameter, such as IWFR or dPR. Calculating the IWFR of a patient may, in some embodiments, involve, for example, calculating the IWFR for a range of flow rates. Calculate the range of pressure drop for one or more points in the patient's anatomy In other embodiments, the patient's IWFR, dPR, or other diastolic index may be measured. Calculating the number of times the mean for part or all of the diastole (e.g., the diastolic wave-free period) can be calculated. The method may include calculating a single pressure drop using an average flow rate. Based on the calculated IWFR value, the system 16 or a clinician may select further diagnostic procedures and / or It can be determined whether an interventional procedure should be performed.

[0071] FIG. 2 is a flow diagram illustrating an exemplary embodiment of a method 40 for determining hemodynamic information about a patient. Method 40, or one or more aspects of method 40, may, in embodiments, include: This can be performed by the hemodynamic information computing system 16 of FIG.

[0072] The method 40 may include, at block 42, receiving patient data. The patient data includes, for example, basic information about the patient, such as the patient's age, sex, upper arm cuff blood pressure, etc. The patient data may include, in an embodiment, the patient's metabolic data, e.g., the user's typical activity level (e.g., sedentary) or active, the amount of exercise per week, the amount of a particular activity per week, e.g. The patient data may further include the amount of exercise time, the amount of exercise, the amount of walking and running, etc. In some embodiments, the patient data may further include patient data from one or more diagnostic tests, such as a cardiac ultrasound. This can be done.

[0073] The method 40 further comprises receiving an image of the patient's anatomy at block 44. In an embodiment, the received patient images may include CT images, MRI images, or other non-invasively obtained images. The images may be of an anatomical region of interest of the patient. In one embodiment, for example, the received images may include one or more coronary arteries. or other vasculature of interest. The images may be taken from a patient image source, e.g., an imaging device. The information may be received from a device or a database or other computer memory.

[0074] The method 40 continues at block 46 by: The method may further include creating an anatomical model of each of the patient regions of interest. In an embodiment, the anatomical model is generated by extracting the anatomy of interest from the images received in block 44. The anatomical structure of interest can be created by segmenting the anatomical structure of interest. For example, one or more coronary arteries. FIG. 5 shows an exemplary anatomical diagram of a coronary artery. The anatomical model is shown in FIG. In some embodiments, the anatomical model can be created by a computer. a computing system (e.g., hemodynamic information computing system 16) It can be obtained by a computer or created by a computing system. The model may be obtained by receiving a pre-existing model of the patient under test. do.

[0075] The method 40 includes, at block 48, generating one or more diastolic-based boundary condition model value sets. The one or more boundary condition value sets may further include identifying a set of boundary condition values. can be a set of values ​​for each of the same boundary conditions model (e.g. , the same set of condition values ​​for inflow boundary, outflow boundary, wall boundary, etc.). Block 48 is In some embodiments, sub-portions 48a and 48b may be included. Thus, The method 40 may include, at block 48a, obtaining an inlet flow rate. The amount may in some embodiments be the flow rate at the inlet of the patient's anatomical ROI. In other embodiments, the blood flow may be the flow in another portion of the ROI.

[0076] The inflow flow rate obtained in block 48a may represent a particular physiological condition of the patient. For example, in some embodiments, the inlet flow rate obtained in block 48a can be calculated as: It can represent the patient's resting state.

[0077] The inflow flow rate obtained in block 48a may, in some embodiments, be a function of the patient's cardiac cycle. For example, in some embodiments, block 4 The inflow flow rate obtained in 8a represents the average flow rate over the entire diastolic waveless period of the patient. In another embodiment, the inflow flow rate may represent the overall average flow rate during the patient's diastole. In other embodiments, the inflow rate can be measured at a particular point in the diastole, e.g. The midpoint can be represented.

[0078] In some embodiments, obtaining the inlet flow rate at block 48a may be performed using the above formula ( Calculate the inflow flow rate according to the shape of the patient's anatomical model as discussed in relation to 9) In one embodiment, the value of α selected for the inflow rate is determined based on the pericardial Specific periods or points within a phase (e.g., start of diastole, end of diastole, end of diastole waveless period) The time intervals can represent the beginning of diastolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic systolic dias ...

[0079] In another embodiment, instead of calculating the inlet flow rate according to Equation 9 above, block 48a obtaining the blood flow rate in the The inlet flow rate may be determined via manual user input (e.g., via a user input device 11 of the system 10). 4) in one embodiment, the inlet flow rate in block 48a. The specific It can be determined.

[0080] Block 48 calculates the inflow flow rate obtained in block 48a in block 48b. and in accordance with a flow splitting model. The flow segmentation model is calculated or modeled according to the geometry of a 3D electronic model of the patient's anatomical region. You can specify it differently, or you can do this already. The flow split model is In some embodiments, the relative radius, diameter, circumference, length, volume, etc. of blood vessels are measured in the electronic model. , and / or according to surface area.

[0081] In relation to the flow rate obtained in block 48a, a flow rate The outlet flow rate may include a boundary condition model of the patient's anatomical region. Therefore, the patient's particular physiological state (e.g., resting state) and the patient's cardiac cycle A specific portion or point (e.g., the entire diastole, the waveless portion of the diastole, a point in time within the diastole, etc.) It can be represented.

[0082] In an embodiment where the anatomical region is a coronary artery of a patient, the The inflow flow rate can be the inlet flow rate of the coronary artery, and the flow partitioning model is The flow partitioning model can be calculated according to the shape of the coronary artery portion downstream of the inlet. , according to the relative radius, diameter, circumference, length, surface area, or volume of the coronary artery portion downstream of the inlet In some embodiments, the flow partitioning model can be calculated as follows: It can be calculated according to the volume of the membranous coronary artery.

[0083] The method 40 includes, in block 50, providing an anatomical model (e.g., model 58), one or more Based on the above boundary condition model value set and, in some embodiments, the patient data, calculating one or more hydrodynamic flow fields of blood flow through the subject's anatomy. Block 50 is the process of creating the anatomical model, the boundary conditions, and the respective pressure data of the patient. Using data (e.g., aortic pressure data) to identify the flow field for each arterial segment In some embodiments, the pressure data may include, for example, The cuff pressure can be obtained and / or can be a stored value. In some embodiments, the flow field may include, among other things, a pressure field, a velocity field, or a combination thereof. The fluid dynamics can be, but are not limited to, the flow field specific module of FIG. This can be calculated by the module 28.

[0084] In some embodiments, the velocity field and / or pressure field are calculated without regard to time and without regard to boundaries. and can be specified based on boundary conditions only. For example, the velocity and / or pressure fields can be specified based on , the velocity and pressure variables are functions of spatial position only (i.e., time is not taken into account). The steady-flow Navier-Stokes equations can be used to determine the pressure. and speed, near real-time to enable point-of-care analysis by clinicians. The system can accurately and efficiently identify

[0085] Based on the patient data and the calculated fluid dynamics, the method 40 at block 52 includes: The method may further include calculating diastolic-based hemodynamic information for each of the patients. The behavioral information, in one embodiment, may be a diastolic based index, e.g., IWFR; Calculating the IWFR may include determining whether one or more blood vessels in the patient's vascular system are in a blood vessel or a blood vessel wall. The method may include calculating one or more pressure drops for the above positions. The set can be analyzed for aortic pressure during diastole to obtain hemodynamic index values. can.

[0086] Block 52 includes, in block 52a, displaying one or more clinical images on an anatomical model of a patient. The method may include receiving a user designation of a distal point associated with the target. For example, the user may using a user input device to input one or more distal points on an anatomical model of the patient's vasculature. Annotations can be entered, whereby the hemodynamic information computing system , one or more annotations may be received from a user. The indicated points may be, for example, coronary arteries The location of the suspected stenosis may be one or more locations distal to the location of the suspected stenosis in the esophagus.

[0087] Block 52 includes, in block 52b, a user-specified point for the first cardiac cycle state. The method may further include calculating a respective pressure drop in each of the first The state may be, for example, the onset of diastole. The pressure drop may be determined by one or more user-specified The flow field can be calculated based on the flow field calculated for the first cardiac cycle at the point. The remaining aspects of method 80, in one embodiment, include determining whether the indicated point has a clinically significant stenosis. A test can be run for each point to determine whether it is likely or not.

[0088] The method 60 includes, at block 54, displaying flow rate, pressure, and / or hemodynamic information. The display may further include, for example, overlaying the display on a geometric model of the patient's anatomy. flow velocity at one or more locations in the patient's vasculature that is adjacent to or adjacent to the model; It may include one or more indicators of pressure and / or hemodynamic information.

[0089] The method 40, at block 56, determines a therapeutic target for the patient based on the calculated hemodynamic information. For example, the hemodynamic information may include recommending a further procedure. If the blood flow is below the threshold value indicating the presence of a stenosis in the ductal system, the patient is not referred for further diagnostic procedures. techniques, such as invasive angiography and pressure measurements at the site of suspected stenosis, may be recommended. Additionally or alternatively, to address the stenosis, a corrective procedure, e.g. Placement of stents or the like in suspected locations may be recommended.

[0090] Figure 3 shows a boundary condition model that represents the average flow conditions at a single time point in the cardiac cycle or at a portion of the cardiac cycle. FIG. 1 shows an exemplary embodiment of a method 60 for determining hemodynamic information based on a single value set of a 6 is a flowchart illustrating the method 60, or one or more aspects of the method 60, in an embodiment. and can be executed by the hemodynamic information computing system 16 of FIG. Method 60 may be considered an embodiment of blocks 48, 50, and 52 of method 40. Cut.

[0091] The method 60 begins at block 62 with a boundary condition model representing the average flow conditions during diastole. For example, in one embodiment, block 6 2 is to identify a set of boundary condition model values ​​that represent the average flow throughout the diastole. In another embodiment, block 62 may include a boundary line representing a diastolic wave-free period. The boundary condition model may include specifying a set of boundary condition model values. In an embodiment, this may be determined as discussed with respect to block 48 of method 40 .

[0092] The method 60 begins at block 64 by determining a single point in diastole, e.g., a midpoint in diastole. The method may further include identifying a boundary condition model value set. In some embodiments, the target is identified as discussed with respect to block 48 of method 40. It is possible.

[0093] In some embodiments, one or both of blocks 62 and 64 may be used for calculations. The calculation of the IWFR can be performed according to the desired hemodynamic index desired for the purpose of the present invention. If desired, block 62 can be performed for the diastolic waveless period, dP If an R calculation is desired, block 62 may be performed for the entire diastole, d PR mid If a calculation is desired, block 64 may be performed for the midpoint of diastole. can.

[0094] The method 60 may, at block 66, generate a single set of boundary condition model values ​​(e.g., Calculating flow rate and pressure based on the measured value of the flow rate (either 62 or 64). The flow velocities can be calculated in block 66 in a single time-independent CFD simulation. For example, the velocity field and / or pressure field can be calculated using the velocity and pressure variables is a function of spatial position only (i.e., time is not taken into account) The flow rate and pressure can be determined, for example, using the equations in the system 10 of FIG. The flow field can be identified by the flow field identification module 28. Multiple instances of the 66 may be implemented, each of which may be a separate Hemodynamic index calculations can be provided.

[0095] The method 60 may further include, at block 68, calculating a baseline pressure. The reference pressure may be, in some embodiments, the aortic pressure. As disclosed herein, one or more aortic pressures are determined based on the respective cuff pressures of the patient. The aortic pressure may be, in one embodiment, measured at the beginning, end, and / or mid-diastole. The basis calculated in block 68 may be the aortic pressure for the diastole. The pseudo pressure is the boundary condition model value set used as the basis for the calculation in block 66. A point in the cardiac cycle may represent the same point or portion of the cardiac cycle.

[0096] The method 60, in block 70, comprises: The method may further include calculating hemodynamic information based on the baseline pressure of the blood pressure gauge 68. The dynamic information may be or may include a hemodynamic index value. In one embodiment, the hemodynamic index value may be an IWFR value. can be the average ratio of local pressure to aortic pressure over diastole, where The local pressure is determined by the calculated pressure field at a location of interest, such as a location distal to the stenosis. It is determined.

[0097] Figure 4 shows the hemodynamics of the blood flow based on two sets of boundary condition model values ​​representing two different cardiac cycle states. 1 is a flow chart illustrating an embodiment of a method 80 for determining activity information. One or more aspects of the method 80 may, in embodiments, be implemented using the hemodynamic information computing system of FIG. The method 80 may be performed by the operating system 16. 50 and 52.

[0098] The method 80 includes, at block 82, obtaining an inflow flow rate for a first cardiac cycle state of the patient. The first blood flow may include, for example, measuring the blood flow rate of the patient at the beginning of diastole. The flow rate in block 62 may be a user manual control of the flow rate. Receiving via input (e.g., using user input device 14 of system 10) In one embodiment, the flow rate in block 62 can be determined by a The therapeutic effect of the present invention can be determined based on metabolic needs and the patient's condition (by the stem).

[0099] The method 80 includes, at block 84, measuring flow in a region of interest during a first cardiac cycle state of the patient. The first cardiac cycle state may further include calculating a diastolic velocity and a pressure. In some embodiments, the velocity field and / or the pressure field may be related Based on the defined boundaries and boundary conditions of each of the central regions (which in turn The flow rate may be determined based on the flow rate received at block 82.

[0100] The method 80 may, at block 86, include determining whether or not the first cardiac cycle state (e.g., one or more and calculating a first pressure drop (at the user-specified point and / or at other points). The pressure drop can be measured from the vessel inlet to a relevant point (e.g., user-specified or otherwise). The first state may be, for example, the beginning of diastole. The pressure drop is calculated based on the flow field calculated for the first cardiac cycle state. It is possible.

[0101] The method 80 includes, at block 88, determining a second cardiac cycle state of the patient that is different from the first cardiac cycle state. The second inflow rate may further include obtaining an inflow rate at a first state. , may be the expected flow rate for the patient at the end of diastole. Block 8 The flow rate at 8 may be determined via a user manual input of the flow rate (e.g., a user input of the system 10). In one embodiment, the device 14 may receive the The inflow rate is determined (e.g., by the clinician or by an electronic system) based on metabolic demand and patient condition. It can be identified based on the

[0102] The method 80 includes, at block 90, determining a flow velocity in the region of interest during a second cardiac cycle state of the patient. and pressure. The flow rate and pressure are substantially 84, except that the second blood flow rate is calculated as described above. Therefore, the specified boundary conditions are used.

[0103] The method 80 includes, at block 92, determining the time at one or more points for a second cardiac cycle state. The second cardiac cycle state may further include calculating a second pressure drop resulting from the second cardiac cycle state, for example. , the end of diastole. The pressure drop may be a second drop at one or more user-specified points. The flow field can be calculated based on the flow fields calculated for the cardiac cycle state.

[0104] The method 94 determines a range of cardiac cycle states based on the first pressure drop and the second pressure drop. and further calculating the range of pressure drops at relevant (e.g., user-specified) points. The pressure drop range can include a central pressure drop from Q1 to Q2 (or the range). A range of cycle states can be calculated, where Q1 is the first cardiac cycle state, Q1 is the inflow rate at the second cardiac cycle state, and Q2 is the inflow rate at the second cardiac cycle state. The pressure drop in the suction chamber is expressed in this disclosure as equation (1) and is a quadratic equation repeated below: It can be calculated according to the formula: ΔP=aQ+bQ 2 where Q is the flow rate at a given cardiac cycle state, and a and b are patient-specific constants. As explained above, to calculate a and b, the three-dimensional Navier-Stokes equation The formula can be expanded to include two values ​​of Q ( For example, the flow rate at a first cardiac cycle state and a second cardiac cycle state can be solved for Once the coefficients a and b are known, they can be calculated without the need for CFD at each time point within diastole: ΔP over diastole can be calculated. Then, that range of ΔP is It can be used to calculate average values ​​to determine hemodynamic indices such as IWFR. can.

[0105] FIG. 6 shows an example graph of pressure drop for an example range of activity levels for a set of patients. 6 is a plot 100 showing a range of pressure drops (mm on the horizontal axis (units Hg / 100), and flow rate (units ml / sec). The six plot lines 102, 104, 106, 108, 110, 112, and Horizontal threshold lines 114, 116 are shown. The first threshold line 114 is generally The second threshold line 116 may indicate a clinically significant pressure drop for the flow. Ultimately, it can demonstrate a clinically significant pressure drop for resting flow.

[0106] As a result of the method 80, one or more vasculature samples of the patient are obtained for one or more locations in the patient's vasculature. Calculate (and, in an embodiment, display) flow and / or pressure fields for the cardiac cycle state. For example, in one embodiment, the flow field and pressure field can be output as a spreading The start and end of the tonic phase can be calculated and output. Each hemodynamic value, such as IWFR or other diastolic-based hemodynamic value, This can be used to determine

[0107] The method 80, at block 96, identifies a reference pressure, e.g., one or more aortic pressures. The aortic pressure may further include measuring the aortic pressure of the patient as described herein. The aortic pressure can be determined based on the respective cuff pressure. The aortic pressure may be for end, mid-diastole, and / or for mid-diastole. In this embodiment, the reference pressure calculated in block 96 is the same as that calculated in blocks 82, 84, 86, and 88. , 90, 92 representing a portion of a cardiac cycle spanning a first cardiac cycle state and a second cardiac cycle state. can be done.

[0108] The method 80 determines, at block 98, a blood flow rate based on the range of pressure drop and the baseline pressure. In one embodiment, the hemodynamic index value is determined by the I The index value may be a WFR value. In one embodiment, the index value is a function of the local pressure over diastole. The ratio of the local pressure to the aortic pressure distal to the stenosis can be calculated as follows: In one embodiment, the pressure field is determined by a calculated pressure field at a location of interest, such as a pressure point. The pressure vs. flow curve for the diastole (e.g., as shown in FIG. 6) is integrated and averaged to obtain I The WFR value can be calculated. For example, referring to FIG. 6, for a given plot line (e.g. For example, plot line 104) represents the IWFR for the patient associated with plot line 104. To calculate the value, it can be integrated and averaged.

[0109] FIG. 7 illustrates a general-purpose computing system environment 190, such as a desktop computer. computer, laptop, smartphone, tablet, or non-transitory computer readable medium Any other such device capable of executing instructions, such as instructions stored within the body. FIG. 1 is a diagram of an exemplary embodiment of a user computing environment including a single computer. Although described and illustrated in the context of a computing system 190, those skilled in the art will recognize that For example, various tasks described hereinafter may be performed by a number of computing systems 190. and associating executable instructions with one or more of the plurality of computing systems 190. and / or may be implemented by a local or wide area network. It will also be understood that the present invention may be practiced in a distributed environment, with the systems linked via a network. In some embodiments, the computing environment 190, or a portion thereof, may be the system of FIG. It may include 10.

[0110] In its most basic configuration, the computing system environment 190 typically comprises comprises at least one processing unit 192 and at least one memory 194; These may be linked by a bus 196. Depending on the exact configuration and type of environment, memory 194 may be volatile (such as RAM 200), non-volatile (such as RAM 200), or non-volatile (such as RAM 200). Volatile (ROM198, Flash memory, etc.), or some combination of the two The computing system environment 190 may also include additional features and / or functionality. For example, the computing system environment 190 may include limited No, but magnetic or optical disks, tape drives and / or flash drives It may also include additional storage (removable and / or non-removable) including Such additional memory devices may be implemented, for example, by a hard disk drive interface 20. 2. Magnetic disk drive interface 204 and / or optical disk drive interface accessible to the computing system environment 190 via the interface 206 It will be appreciated that these may be linked to the system bus 196. The devices are capable of reading and writing data from and removing data from the hard disk 208. Read or write to a removable magnetic disk 210 and / or a removable optical disk A disk 212, e.g., a CD / DVD ROM or other optical media for reading or writing. The drive interfaces and their associated computer readable media are Computer-readable instructions, data structures, program modules and computing systems 1 and 2. The system environment 190 may also include a non-volatile storage of other data. Other types of computer readable media capable of storing data may be used for this same purpose. It will be further understood that the media device may be used in a variety of applications. Magnetic cassettes, flash memory cards, digital video disks, Bernoulli cars Bernoulli cartridge, random access memory, nanodrive, memory tick, other read / write and / or read-only memory and / or computer Other devices for storing information such as readable instructions, data structures, program modules or other data. Any such computer-aided method or technique may be used, but is not limited to such a method or technique. The computer storage media may be part of the computing system environment 190 .

[0111] Storing multiple program modules in one or more of the memories / media devices For example, during startup or otherwise, communication between elements within the computing system environment 190 may occur. A basic input / output system (BIOS) 214 that contains basic routines that aid in the transfer of information between the , ROM 198. Similarly, RAM 200, hard drive 208 2, and / or the peripheral memory device may include an operating system 216, one or more applications Application program 218 (e.g., modules 24, 26, 28, 30, 31 of FIG. 1) 2) a component including other program modules 220 and / or program data 222; The present invention can be used to store computer executable instructions. The executable instructions may be transmitted to a computing device, for example, via a network connection, as needed. The software can be downloaded to the database environment 190.

[0112] An end user, e.g., a clinician, may use a keyboard 224 and / or a pointing device. A command is input to the computing system environment 190 through an input device such as a keyboard 226. Although not shown, other input devices can be used to input information. These may include smartphones, joysticks, game pads, scanners, etc. These and other input devices are typically connected to a peripherals interface 228. The peripheral interface 228 is connected to the processing unit 192 via the bus 196. The input device can be, for example, a parallel port, a game port, a firewire re or Universal Serial Bus (USB) or other interface with the processor 1 92. The computing system environment 190 a monitor 230 or other type of display device for viewing information from A video adapter 232 or other interface may also be connected to the bus 196. In addition to the monitor 230, the computing system environment 190 may also include speakers and Other peripheral output devices (not shown), such as printers, may also be provided.

[0113] The computing system environment 190 may include one or more computing system A logical connection may also be used for the computing system environment 190. Communication between remote computing system environments is performed through network routing. The data may be exchanged via a further processing device, such as a network router 242. Communication using the network router 242 requires a network interface configuration. Therefore, in such a network connection environment, For example, the Internet, the World Wide Web, a LAN, or other similar types of wired or in a wireless network, a computing system environment 190 is illustrated. The program modules or portions thereof may be implemented in the computing system environment 190. It will be appreciated that the method may be stored in a memory storage device or devices. Wax.

[0114] The computing system environment 190 is Location determination hardware 186 for determining location may also be provided. Location hardware 246 may include, by way of example only, a GPS antenna, an RFID chip, or or identify the location of the reader, WiFi antenna, or computing system environment 190. Other devices that can be used to capture or transmit signals that can be used to determine It may include computing hardware.

[0115] Although this disclosure has described certain embodiments, the claims are intended to cover the scope of the present invention. Except as expressly recited herein, the present invention is not intended to be limited to these embodiments. To the contrary, it will be understood that the present disclosure does not include, within the spirit and scope of the present disclosure, It is intended to cover all alternatives, modifications, and equivalents which may be included in the present invention. In the detailed description of the present disclosure, numerous references are made to the present invention in order to provide a thorough understanding of the disclosed embodiments. Many specific details are described. However, systems and methods consistent with this disclosure However, it will be apparent to one skilled in the art that the present invention may be practiced without these specific details. In other instances, known methods, procedures, components, and circuits may be adapted to practice various aspects of the present disclosure. In order to avoid any ambiguity, the details are not explained.

[0116] Some portions of the detailed description of this disclosure are presented as procedures, logic blocks, processes, and computer programs. In terms of other symbolic representations of operations on data bits in a digital system memory These descriptions and representations have been presented in a manner that is easily understood by those skilled in the data processing arts. The means used to most effectively convey the substance of their work to others skilled in the art. Procedures, logic blocks, processes, etc. are referred to herein and generally as methods for performing a desired result. A step is assumed to be a self-consistent sequence of steps or instructions that result in , which require physical manipulations of physical quantities. Usually, but not necessarily, these The logical operations are carried out in a computer system or similar electronic computing device. Electrical or magnetic data capable of being stored, transferred, combined, compared, and otherwise manipulated For reasons of convenience, and in accordance with common usage, such data will be referred to herein as With reference to the various embodiments disclosed herein, bits, values, elements, symbols, characters, , terms, numbers, etc.

[0117] However, these terms should be construed to refer to physical operations and quantities and are within the skill of the art. Convenient labels that should be further interpreted in the light of terms commonly used in the field Unless specifically stated otherwise, As is apparent from the discussion in the present embodiment, the term "identifying / determining" is used throughout the discussion of the present embodiment. / request / determining" or "output" or "transmit" or "record" "or" "arrange" or "store" or "display" or "receive" or "recognize" "Use" or "Generate" or "Provide" or "Access" or "T Statements using terms such as "check" or "notify" or "communicate" are An application that manipulates and transforms data in a computer system or similar electronic computing device. It is understood that data refers to transactions and processes in a computer system. The memory of a computer system is expressed as a physical (electronic) quantity in the memory and or register, or as described herein or otherwise understood by one of ordinary skill in the art. as physical quantities within other such information storage, transmission, or display devices, is converted to other data that is similarly represented.

Claims

1. 1. A method for providing hemodynamic information for a respective patient, comprising: obtaining a three-dimensional electronic model of the patient's coronary arteries; a set of boundary condition model values ​​representing a diastolic period of the patient's cardiac cycle when the patient is in a resting state; and 3. A three-dimensional computational fluid dynamics (CFD) analysis of the coronary artery model based on the boundary condition model. Running a simulation; and According to the CFD simulation, a first location of the coronary artery and a first location of the coronary artery are determined. calculating the pressure drop between the two locations; determining whether a lesion is present at the location based on the calculated pressure drop and based on a reference pressure; determining a hemodynamic index value indicative of the presence of A method comprising:

2. 2. The method of claim 1, wherein the boundary condition model value set represents an entire diastolic period of the patient's cardiac cycle. The method according to

3. the set of boundary condition model values ​​represents a waveless period during a diastolic phase of the patient's cardiac cycle.

1. The method according to claim 1.

4. 2. The method of claim 1, wherein the set of boundary condition model values ​​represents a mid-diastolic point in the patient's cardiac cycle. Method of posting.

5. The method of claim 1 , further comprising creating the electronic model of an anatomical region.

6. receiving image data of the anatomical region of each of the patients; generating the electronic model based on the received image data; and The method of claim 5 further comprising:

7. The boundary condition model value set is an inlet flow rate at the inlet of the coronary artery, the inlet flow rate representing the patient's resting state; two or more outlet flow rates calculated according to the inlet flow rate and flow splitting model; The method of claim 1 , comprising:

8. determining the flow partitioning model according to a shape of the three-dimensional model of the coronary artery; 、 calculating the two or more outlet flow rates according to the inlet flow rate and the flow splitting model; and, The method of claim 7 further comprising:

9. 1. A system for providing hemodynamic information for a respective patient, comprising: a non-transitory computer readable memory storing instructions; 1. A processor comprising: obtaining a three-dimensional electronic model of the patient's coronary arteries; A boundary condition model value set representing the diastolic period of the patient's cardiac cycle when the patient is in a resting state. and 3D computational fluid dynamics (CFD) of the coronary artery model based on the boundary condition model Running a simulation; and According to the CFD simulation, a first location of the coronary artery and calculating a pressure drop between the first position and the second position; Based on the calculated pressure drop and based on a reference pressure, a disease state at the location is detected. determining hemodynamic index values ​​indicative of the presence of abnormalities; A processor configured to execute instructions to perform A system comprising:

10. 10. The method of claim 9, wherein the boundary condition model value set represents an entire diastolic period of the patient's cardiac cycle. The system described in

11. the set of boundary condition model values ​​represents a waveless period during a diastolic phase of the patient's cardiac cycle.

9. The system described in

12. 10. The method of claim 9, wherein the set of boundary condition model values ​​represents a mid-diastolic point in the patient's cardiac cycle. The system is as follows:

13. The memory, when executed by the processor, causes the processor to 10. The system of claim 9, further comprising instructions for creating the electronic model of Tem.

14. The memory, when executed by the processor, causes the processor to: receiving image data for each of the anatomical regions of the patient; generating the electronic model based on the received image data; and 14. The system of claim 13, further storing instructions to:

15. The boundary condition model value set is an inlet flow rate at the inlet of the coronary artery, the inlet flow rate representing the patient's resting state; two or more outlet flow rates calculated according to the inlet flow rate and flow splitting model; The system of claim 9 , comprising:

16. The memory, when executed by the processor, causes the processor to: determining the flow partitioning model according to a shape of the three-dimensional model of the coronary artery; 、 calculating the two or more outlet flow rates according to the inlet flow rate and the flow splitting model; and, 20. The system of claim 15, further storing instructions to:

17. 1. A method for providing hemodynamic information for a respective patient, comprising: obtaining a three-dimensional electronic model of the patient's anatomical region; obtaining a boundary condition model representative of the patient's resting state; A first time point in the patient's cardiac cycle is determined based on the three-dimensional model and the boundary condition model. calculating a first pressure drop across a portion of the patient's anatomical region at a point; Based on the three-dimensional model and the boundary condition model, a previous time point different from the first time point is A second pressure across the portion of the anatomical region at a second time point within the patient's cardiac cycle. Calculating the descent; The first pressure drop and the second pressure drop are measured for a range of points in time in the cardiac cycle of the patient. calculating a respective pressure drop across said regions according to the pressure drop; Based on the calculated pressure drop for the range of time points and based on a reference pressure determining a hemodynamic index value indicative of the presence of a lesion at the location; A method comprising:

18. the anatomical region is a blood vessel; The portion of the anatomical region extends from an entrance of the blood vessel to a location within the artery. Item 18. The method according to item 17.

19. 20. The method of claim 18, wherein the anatomical region is a coronary artery.

20. receiving image data for each of the anatomical regions of the patient; generating the electronic model based on the received image data; and 20. The method of claim 17, further comprising:

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