Characterization of the hemodynamic wall shear stresses in human umbilical vessels from normal and intrauterine growth restricted pregnancies

Significant reductions in blood flow and umbilical diameters were reported in pregnancies affected by intrauterine growth restriction (IUGR) from placental insufficiency. However, it is not known if IUGR umbilical blood vessels experience different hemodynamic wall shear stresses (WSS) compared to normal umbilical vessels. As WSS is known to influence vasoactivity and vascular growth and remodeling, which can regulate flow rates, it is important to study this parameter. In this study, we aim to characterize umbilical vascular WSS environment in normal and IUGR pregnancies, and evaluate correlation between WSS and vascular diameter, and gestational age. Twenty-two normal and 21 IUGR pregnancies were assessed via ultrasound between the 27th and 39th gestational week. IUGR was defined as estimated fetal weight and/or abdominal circumference below the 10th centile, with no improvement during the remainder of the pregnancy. Vascular diameter was determined by 3D ultrasound scans and image segmentation. Umbilical artery (UA) WSS was computed via computational flow simulations, while umbilical vein (UV) WSS was computed via the Poiseuille equation. Univariate multiple regression analysis was used to test for the differences between normal and IUGR cohort. UV volumetric flow rate, UA and UV diameters were significantly lower in IUGR fetuses, but flow velocities and WSS trends in UA and UV were very similar between normal and IUGR groups. In both groups, UV WSS showed a significant negative correlation with diameter, but UA WSS had no correlation with diameter, suggesting a constancy of WSS environment and the existence of WSS homeostasis in UA, but not in UV. Despite having reduced flow rate and vascular sizes, IUGR UAs had hemodynamic mechanical stress environments and trends that were similar to those in normal pregnancies. This suggested that endothelial dysfunction or abnormal mechanosensing was unlikely to be the cause of small vessels in IUGR umbilical cords.     

Influence of non-Newtonian properties of blood on the wall shear stress in human atherosclerotic right coronary arteries

The objective of this work is to investigate the effect of non-Newtonian properties of blood on the wall shear stress (WSS) in atherosclerotic coronary arteries using both Newtonian and non-Newtonian models. Numerical simulations were performed to examine how the spatial and temporal WSS distributions are influenced by the stenosis size, blood viscosity, and flow rate. The computational results demonstrated that blood viscosity properties had considerable effect on the magnitude of the WSS, especially where disturbed flow was observed. The WSS distribution is highly non-uniform both temporally and spatially, especially in the stenotic region. The maximum WSS occurred at the proximal side of the stenosis, near the outer wall in the curved artery with no stenosis. The lumen area near the inner wall distal to the stenosis region experienced a lower WSS during the entire cardiac cycle. Among the factors of stenosis size, blood viscosity, and flow rate, the size of the stenosis has the most significant effect on the spatial and temporal WSS distributions qualitatively and quantitatively.     

Volume flow and wall shear stress quantification in the human conjunctival capillaries and post-capillary venules in vivo

Understanding the mathematical relationships of volume blood flow and wall shear stress with respect to microvessel diameter is necessary for the study of vascular design. Here, for the first time, volume flow and wall shear stress were quantified from axial red blood cell velocity measurements in 104 conjunctival microvessels of 17 normal human volunteers. Measurements were taken with a slit lamp based imaging system from the post capillary side of the bulbar conjunctiva in microvessel diameters ranging from 4 to 24 micrometers. The variation of the velocity profile with diameter was taken into account by using a profile factor function. Volume flow ranged from 5 to 462 pl/s with a mean value of 102 pl/s and gave a second power law best fitting line (r=0.97) deviating significantly from the third power law relation with diameter. The estimated wall shear stress declined hyperbolically (r=0.93) from a maximum of 9.55 N/m(2) at the smallest capillaries, down to a minimum of 0.28 N/m(2) at the higher diameter post capillary venules. The mean wall shear stress value for all microvessels was 1.54 N/m(2).     

Ultrasonic transit-time measurement of blood flow in the umbilical arteries and veins in the bovine fetus during stage II of labor

The vitality of the bovine fetus during parturition depends on an intact umbilical circulation to supply adequate amounts of oxygen and nutrients to the fetus. The goal of the present study was to measure the blood flow in the umbilical vessels during stage II of labor and to determine when blood flow ceases in the umbilical cord. In 20 cows, ultrasonographic transducers were placed on one umbilical vein and one umbilical artery after rupture of the allantochorionic sac, and the blood flow volume per unit time was measured. At the same time, a pressure transducer was placed into the uterus to measure uterine pressure. Parturition was spontaneous in all 20 cows. In 20 live calves born, pH, base excess and lactate concentration were measured in the blood immediately after birth. During the last 90 min before birth the mean total umbilical blood flow (artery and vein combined) was 1.186+/-0.028 L/min. Calves with a blood pH> or =7.2 (n=13) had a higher mean total blood flow than calves with a pH<7.2 (n=7; 1.243+/-0.038 versus 1.095+/-0.038 L/min). In calves with a blood pH<7.2, the mean total blood flow decreased from 1.178+/-0.134 at 20 min before birth to 0.959+/-0.126 L/min at the end of stage II of labor. During this time period, the arterial blood flow did not differ between calves with a blood pH> or =7.2 and<7.2, but venous blood flow decreased significantly in calves with a blood pH<7.2. During uterine contractions, the total umbilical blood flow decreased significantly by 0.22 L/min. The blood flow in the umbilical artery and vein ceased before the calves were completely born.     

Maximal wall shear stress in arterial stenoses: application to the internal carotid arteries

Maximal wall shear stress (MWSS) in the convergent part of a stenosis is calculated by the interactive boundary-layer theory. A dimensional analysis of the problem shows that MWSS depends only on a few measurable parameters. A simple relationship between MWSS and these parameters is obtained, validated, and used to calculate the magnitude of MWSS in a carotid stenosis, as a function of the patency of the circle of Willis and the stenotic pattern. This demonstrates the huge effect of collateral pathways. Elevated MWSS are observed even in moderate stenoses, provided they are associated with a contralateral occlusion, a large anterior, and narrow posterior communicating arteries, suggesting a potential risk of embolus release in this configuration.     

Effects of elastic compression stockings on wall shear stress in deep and superficial veins of the calf

The purpose of this study was to estimate wall shear stress (WSS) in individual vessels of the venous circulation of the calf and quantify the effects of elastic compression based on change of vessel geometry and velocity waveform. The great saphenous vein and either a peroneal or posterior tibial vein have been imaged in four healthy subjects using magnetic resonance imaging, with and without the presence of a grade 1 medical stocking. Flow through image-based reconstructed geometries was numerically simulated for both a range of steady flow rates and ultrasound-derived transient velocity waveforms, scaled to give a standardized time averaged flow rate. For steady flow, the stocking produced an average percentage increase in mean WSS of approximately 100% in the great saphenous vein across a range of 0.125-1.25 ml/s. The percentage increase in the peroneal/posterior tibial veins varied from 490 to 650% across a range of 0.5-5 ml/s. In addition, application of the stocking eliminated periods of very low or zero flow from the transient waveforms. The average minimum value of WSS in all vessels without the stocking was <0.1 Pa. With the stocking, this was increased to 0.7 Pa in the great saphenous and 0.9 Pa in the peroneal/posterior tibial veins. The pathophysiological effects of these changes are discussed. In conclusion, the flight stocking was effective in raising venous WSS levels in prone subjects, and this effect was much more pronounced in the deep vessels. The stocking also tended to prevent cessation of flow during periods of increased downstream pressure produced by respiration.     

Flow patterns and wall shear stress distribution in human internal carotid arteries: the geometric effect on the risk for stenoses

It has been widely observed that atherosclerotic stenosis occurs at sites with complex hemodynamics, such as arteries with high curvature or bifurcations. These regions usually have very low or highly oscillatory wall shear stress (WSS). In the present study, 3D sinusoidally pulsatile blood flow through the models of internal carotid artery (ICA) with different geometries was investigated with computational simulation. Three preferred sites of stenoses were found along the carotid siphon with low and highly oscillatory WSS. The risk for stenoses at these sites was scaled with the values of time-averaged WSS and oscillating shear index (OSI). The local risk for stenoses at every preferred site of stenoses was found different between 3 types of ICA, indicating that the geometry of the blood vessel plays significant roles in the atherogenesis. Specifically, the large curvature and planarity of the vessel were found to increase the risk for stenoses, because they tend to lower WSS and elevate OSI. Therefore, the geometric study makes it possible to estimate the stenosis location in the ICA siphon as long as the shape of ICA was measured.     

Velocity and wall shear stress patterns in the human right coronary artery.

Blood flow dynamics in the human right coronary artery have not been adequately quantified despite the clinical significance of coronary atherosclerosis. In this study, a technique was developed to construct a rigid flow model from a cast of a human right coronary artery. A laser photochromic method was used to characterize the velocity and wall shear stress patterns. The flow conditions include steady flow at Reynolds numbers of 500 and 1000 as well as unsteady flow with Womersley parameter and peak Reynolds number of 1.82 and 750, respectively. Characterization of the three-dimensional geometry of the artery revealed that the largest spatial variation in curvature occurred within the almost branch-free proximal region, with the greatest curvature existing along the acute margin of the heart. In the proximal segment, high shear stresses were observed on the outer wall and lower, but not negative, stresses along the inner wall. Low shear stress on the inner wall may be related to the preferential localization of atherosclerosis in the proximal segment of the right coronary artery. However, it is possible that the large difference between the outer and inner wall shear stresses may also be involved.     

Twenty-fold difference in hemodynamic wall shear stress between murine and human aortas

Endothelial cells regulate vascular tone and mural remodelling in a shear-dependent manner that is commonly assumed to keep wall shear stress constant across arteries and species. Allometric arguments show that aortic flow velocity is constant across species, a deduction that is consistent with much experimental data, but the same arguments also show that the shear stress experienced by aortic endothelium will depend inversely on body mass to the 3/8th power, and hence will be 20-fold higher in mice than in men. This conclusion is robust and has important implications for the study of shear-dependent vascular biology and pathology.     

Correlation between quantitative analysis of wall shear stress and intima-media thickness in atherosclerosis development in carotid arteries

Background

This paper presents quantitative analysis of blood flow shear stress by measuring the carotid arterial wall shear stress (WSS) and the intima-media thickness (IMT) of experimental rabbits fed with high-fat feedstuff on a weekly basis in order to cause atherosclerosis.

Methods

This study is based on establishing an atherosclerosis model of high-fat rabbits, and measuring the rabbits’ common carotid arterial WSS of the experimental group and control group on a weekly basis. Detailed analysis was performed by using WSS quantification.

Results

We have demonstrated small significant difference of rabbit carotid artery WSS between the experimental group and the control group (P<0.01) from the 1st week onwards, while the IMT of experimental group had larger differences from 5th week compared with the control group (P<0.05). Next, we have shown that with increasing blood lipids, the rabbit carotid artery shear stress decreases and the rabbit carotid artery IMT goes up. The decrease of shear stress appears before the start of IMT growth. Furthermore, our receiver operator characteristic (ROC) curve analysis showed that when the mean value of shear stress is 1.198 dyne/cm², the rabbit common carotid atherosclerosis fatty streaks sensitivity is 89.8%, and the specificity is 81.3%. The area under the ROC curve is 0.9283.

Conclusions

All these data goes to show that WSS decreasing to 1.198 dyne/cm² can be used as an indicator that rabbit common carotid artery comes into the period of fibrous plaques. In conclusion, our study is able to find and confirm that the decrease of the arterial WSS can predict the occurrence of atherosclerosis earlier, and offer help for positive clinical intervention.

     

Strain distribution over plaques in human coronary arteries relates to shear stress

Once plaques intrude into the lumen, the shear stress they are exposed to alters with hitherto unknown consequences for plaque composition. We investigated the relationship between shear stress and strain, a marker for plaque composition, in human coronary arteries. We imaged 31 plaques in coronary arteries with angiography and intravascular ultrasound. Computational fluid dynamics was used to obtain shear stress. Palpography was applied to measure strain. Each plaque was divided into four regions: upstream, throat, shoulder, and downstream. Average shear stress and strain were determined in each region. Shear stress in the upstream, shoulder, throat, and downstream region was 2.55+/-0.89, 2.07+/-0.98, 2.32+/-1.11, and 0.67+/-0.35 Pa, respectively. Shear stress in the downstream region was significantly lower. Strain in the downstream region was also significantly lower than the values in the other regions (0.23+/-0.08% vs. 0.48+/-0.15%, 0.43+/-0.17%, and 0.47+/-0.12%, for the upstream, shoulder, and throat regions, respectively). Pooling all regions, dividing shear stress per plaque into tertiles, and computing average strain showed a positive correlation; for low, medium, and high shear stress, strain was 0.23+/-0.10%, 0.40+/-0.15%, and 0.60+/-0.18%, respectively. Low strain colocalizes with low shear stress downstream of plaques. Higher strain can be found in all other plaque regions, with the highest strain found in regions exposed to the highest shear stresses. This indicates that high shear stress might destabilize plaques, which could lead to plaque rupture.     

颈动脉血管壁切应力的分析

动脉中管壁的脉动低切应力在动脉粥样硬化形成中起始动和主要的决定作用。本文比较了几种计算血管壁切应力的方法,认为采用有约束的弹性管模型计算获得的动脉壁切应力更适合于临床应用。根据检测得到的正常人和动脉硬化性脑血管病患者的颈动脉血流速度、血管管径等数据,计算两者的颈动脉壁面切应力。研究发现动脉硬化性脑血管病患者的壁面切应力比正常人显著减小。这表明,颈动脉的壁面切应力可以作为动脉硬化性脑血管疾病的早期诊断的重要参考指标。     

Proteoglycans of human umbilical cord arteries

Proteoglycans (PGs) were dissociatively extracted from human umbilical cord arteries (UCAs) with 4 M guanidine hydrochloride containing Triton X-100 and protease inhibitors, purified by Q-Sepharose anion exchange chromatography and lyophilized. They were analysed by gel filtration, SDS/PAGE and agarose gel electrophoresis before and after treatment with chondroitinase ABC. It was found that the PG preparation was especially enriched in chondroitin/dermatan sulphate PGs. The predominant PG fraction included small PGs that emerged from Sepharose CL-2B with Kav = 0.74. Their molecular mass, estimated by SDS/PAGE, was 160-200 kDa and 90-150 kDa, i.e. it was typical for biglycan and decorin, respectively. Treatment with chondroitinase ABC yielded the core proteins of 45 and 47 kDa, characteristic for both small PGs. Remarkable amounts of the 45 kDa protein were detected in non-treated PG samples, suggesting the presence of free core proteins of biglycan and decorin. Large PGs were present in lower amounts. In intact form they were eluted from Sepharose CL-2B with Kav = 0.17 and 0.43. Digestion with chondroitinase ABC yielded the core proteins with a molecular mass within the range of 180-360 kDa but predominant were the bands of 200, 250 and 360 kDa. The large PGs probably represent various forms of versican or perlecan bearing chondroitin sulphate chains.     

Zero-stress states of human pulmonary arteries and veins

The zero-stressstates of the pulmonary arteries and veins fromorder3 toorder9 were determined in six normal humanlungs within 15 h postmortem. The zero-stress state of each vessel was obtained by cutting the vessel transversely into a series of short rings, then cutting each ring radially, which caused the ring to springopen into a sector. Each sector was characterized by its opening angle.The mean opening angle varied between 92 and 163° in the arterialtree and between 89 and 128° in the venous tree. There was atendency for opening angles to increase as the sizes of the arteriesand veins increased. We computed the residual strains based on theexperimental measurements and estimated the residual stresses accordingto Hooke's law. We found that the inner wall of a vessel at the statein which the internal pressure, external pressure, and longitudinalstress are all zero was under compression and the outer wall was intension, and that the magnitude of compressive stress was greater thanthe magnitude of tensile stress.

     

Alterations in wall shear stress predict sites of neointimal hyperplasia after stent implantation in rabbit iliac arteries

Restenosis resulting from neointimal hyperplasia (NH) limits the effectiveness of intravascular stents. Rates of restenosis vary with stent geometry, but whether stents affect spatial and temporal distributions of wall shear stress (WSS) in vivo is unknown. We tested the hypothesis that alterations in spatial WSS after stent implantation predict sites of NH in rabbit iliac arteries. Antegrade iliac artery stent implantation was performed under angiography, and blood flow was measured before casting 14 or 21 days after implantation. Iliac artery blood flow domains were obtained from three-dimensional microfocal X-ray computed tomography imaging and reconstruction of the arterial casts. Indexes of WSS were determined using three-dimensional computational fluid dynamics. Vascular histology was unchanged proximal and distal to the stent. Time-dependent NH was localized within the stented region and was greatest in regions exposed to low WSS and acute elevations in spatial WSS gradients. The lowest values of WSS spatially localized to the stented area of a theoretical artery progressively increased after 14 and 21 days as NH occurred within these regions. This NH abolished spatial disparity in distributions of WSS. The results suggest that stents may introduce spatial alterations in WSS that modulate NH in vivo.     

The relationship between wall shear stress distributions and intimal thickening in the human abdominal aorta

Purpose

The goal of this work was to determine wall shear stress (WSS) patterns in the human abdominal aorta and to compare these patterns to measurements of intimal thickness (IT) from autopsy samples.

Methods

The WSS was experimentally measured using the laser photochromic dye tracer technique in an anatomically faithful in vitro model based on CT scans of the abdominal aorta in a healthy 35-year-old subject. IT was quantified as a function of circumferential and axial position using light microscopy in ten human autopsy specimens.

Results

The histomorphometric analysis suggests that IT increases with age and that the distribution of intimal thickening changes with age. The lowest WSS in the flow model was found on the posterior wall inferior to the inferior mesenteric artery, and coincided with the region of most prominent IT in the autopsy samples. Local geometrical features in the flow model, such as the expansion at the inferior mesenteric artery (common in younger individuals), strongly influenced WSS patterns. The WSS was found to correlate negatively with IT (r² = 0.3099; P = 0.0047).

Conclusion

Low WSS in the abdominal aorta is co-localized with IT and may be related to atherogenesis. Also, rates of IT in the abdominal aorta are possibly influenced by age-related geometrical changes.

     

An assessment of intra-patient variability on observed relationships between wall shear stress and plaque progression in coronary arteries

Background

Wall shear stress (WSS) has been associated with sites of plaque localization and with changes in plaque composition in human coronary arteries. Different values have been suggested for categorizing WSS as low, physiologic or high; however, uncertainties in flow rates, both across subjects and within a given individual, can affect the classification of WSS and thus influence the observed relationships between local hemodynamics and plaque changes over time. This study examines the effects of uncertainties in flow rate boundary conditions upon WSS values and investigates the influence of this variability on the observed associations of WSS with changes in VH-IVUS derived plaque components.

Methods

Three patients with coronary artery disease underwent baseline and 12 month follow-up angiography and virtual histology-intravascular ultrasound (VH-IVUS) measurements. Coronary artery models were reconstructed from the data and models with and without side-branches were created. Patient-specific Doppler ultrasound (DUS) data were employed as inflow boundary conditions and computational fluid dynamics was used to calculate the WSS in each model. Further, the influence of representative coronary artery flow waveforms upon WSS values was investigated and the concept of treating WSS using relative, rather than actual, values was explored.

Results

Models that included side-branch outflows and subject-specific DUS velocities were considered to be the reference cases. Hemodynamic differences were caused by the exclusion of side-branches and by imposing alternative velocity waveforms. One patient with fewer side-branches and a scaled generic waveform had little deviation from the reference case, while another patient with several side-branches excluded showed much larger departures from the reference situation. Differences between models and the respective reference cases were reduced when data were analyzed using relative, rather than actual, WSS.

Conclusions

When considering individual subjects, large variations in patient-specific flow rates and exclusion of multiple side-branches in computational models can cause significant differences in observed associations between plaque evolution and ranges of computed WSS. These differences may contribute to the large variability typically found among subjects in pooled populations. Relative WSS may be more useful than actual WSS as a correlative variable when there is a large degree of uncertainty in flow rate data.

     

Some fibrinolytic properties of the human arteries and veins walls

The plasminogen activator of normal and atherosclerotic different arteries was studied with the histochemical method of Todd. An increase of plasminogen activator in atherosclerotic arteries of adventitia was found. The inhibition of plasmin fibrinolysis of intima-media and adventitia of normal and atherosclerotic different arteries was studied by means of the slide sandwich technique according to Noordhoek Hegt. In atherosclerotic arteries there was an increase of plasmin inhibitory activity of the intima-media layer in comparison with normal arteries. The mean plasmin inhibitory activity was higher in the vein wall of lower part of the body than in the higher one.