Refining Our Understanding of the Flow Through Coronary Artery Branches; Revisiting Murray’s Law in Human Epicardial Coronary Arteries

Author:

Taylor Daniel J.,Feher Jeroen,Halliday Ian,Hose D. Rodney,Gosling Rebecca,Aubiniere-Robb Louise,van ‘t Veer Marcel,Keulards Danielle,Tonino Pim A. L.,Rochette Michel,Gunn Julian,Morris Paul D.

Abstract

Background: Quantification of coronary blood flow is used to evaluate coronary artery disease, but our understanding of flow through branched systems is poor. Murray’s law defines coronary morphometric scaling, the relationship between flow (Q) and vessel diameter (D) and is the basis for minimum lumen area targets when intervening on bifurcation lesions. Murray’s original law (Q α DP) dictates that the exponent (P) is 3.0, whilst constant blood velocity throughout the system would suggest an exponent of 2.0. In human coronary arteries, the value of Murray’s exponent remains unknown.Aim: To establish the exponent in Murray’s power law relationship that best reproduces coronary blood flows (Q) and microvascular resistances (Rmicro) in a bifurcating coronary tree.Methods and Results: We screened 48 cases, and were able to evaluate inlet Q and Rmicro in 27 branched coronary arteries, taken from 20 patients, using a novel computational fluid dynamics (CFD) model which reconstructs 3D coronary anatomy from angiography and uses pressure-wire measurements to compute Q and Rmicro distribution in the main- and side-branches. Outputs were validated against invasive measurements using a Rayflow™ catheter. A Murray’s power law exponent of 2.15 produced the strongest correlation and closest agreement with inlet Q (zero bias, r = 0.47, p = 0.006) and an exponent of 2.38 produced the strongest correlation and closest agreement with Rmicro (zero bias, r = 0.66, p = 0.0001).Conclusions: The optimal power law exponents for Q and Rmicro were not 3.0, as dictated by Murray’s Law, but 2.15 and 2.38 respectively. These data will be useful in assessing patient-specific coronary physiology and tailoring revascularisation decisions.

Funder

Wellcome Trust

National Institute for Health Research

Publisher

Frontiers Media SA

Subject

Physiology (medical),Physiology

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1. Letter to the editor;Medical Engineering & Physics;2024-08

2. Systematic review and meta-analysis of Murray’s law in the coronary arterial circulation;American Journal of Physiology-Heart and Circulatory Physiology;2024-07-01

3. Evaluation of models of sequestration flow in coronary arteries—Physiology versus anatomy?;Computers in Biology and Medicine;2024-05

4. Plant-Based Decellularization: A Novel Approach for Perfusion-Compatible Tissue Engineering Structures;Journal of Microbiology and Biotechnology;2024-02-29

5. Towards effects from stent implantation into coronary bifurcation stenosis: experiment and simulation;Сибирский научный медицинский журнал;2024-02-27

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