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Toward translating near-infrared spectroscopy oxygen saturation data for the non-invasive prediction of spatial and temporal hemodynamics during exercise

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Abstract

Image-based computational fluid dynamics (CFD) studies conducted at rest have shown that atherosclerotic plaque in the thoracic aorta (TA) correlates with adverse wall shear stress (WSS), but there is a paucity of such data under elevated flow conditions. We developed a pedaling exercise protocol to obtain phase contrast magnetic resonance imaging (PC-MRI) blood flow measurements in the TA and brachiocephalic arteries during three-tiered supine pedaling at 130, 150, and 170 % of resting heart rate (HR), and relate these measurements to non-invasive tissue oxygen saturation \((\hbox {StO}_{2})\) acquired by near-infrared spectroscopy (NIRS) while conducting the same protocol. Local quantification of WSS indices by CFD revealed low time-averaged WSS on the outer curvature of the ascending aorta and the inner curvature of the descending aorta (dAo) that progressively increased with exercise, but that remained low on the anterior surface of brachiocephalic arteries. High oscillatory WSS observed on the inner curvature of the aorta persisted during exercise as well. Results suggest locally continuous exposure to potentially deleterious indices of WSS despite benefits of exercise. Linear relationships between flow distributions and tissue oxygen extraction calculated from \(\hbox {StO}_{2}\) were found between the left common carotid versus cerebral tissue \((r^{2}=0.96)\) and the dAo versus leg tissue \((r^{2}=0.87)\). A resulting six-step procedure is presented to use NIRS data as a surrogate for exercise PC-MRI when setting boundary conditions for future CFD studies of the TA under simulated exercise conditions. Relationships and ensemble-averaged PC-MRI inflow waveforms are provided in an online repository for this purpose.

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Abbreviations

AAo:

Ascending aorta

BF:

Blood flow

BP:

Blood pressure

BSA:

Body surface area

\(\hbox {CexO}_{2}\) :

Oxygen extraction

\(\hbox {CaO}_{2}\), \(\hbox {CtO}_{2}\), \(\hbox {CvO}_{2}\) :

Arterial, tissue and venous oxygen concentration/content, respectively

CFD:

Computational fluid dynamics

CHD:

Congenital heart disease

CI:

Cardiac index

CPET:

Cardiopulmonary exercise testing

CO:

Cardiac output

dAo:

Descending aorta

FD:

Flow distribution

HR:

Heart rate

IA:

Innominate artery

LCCA:

Left common carotid artery

LSA:

Left subclavian artery

MRI:

Magnetic resonance imaging

NMF:

Normalized mean flow

NIRS:

Near-infrared spectroscopy

PC:

Phase contrast

\(\hbox {SaO}_{2}, \hbox {StO}_{2}\), \(\hbox {SvO}_{2}\) :

Arterial, tissue and venous oxygen saturation, respectively

TA:

Thoracic aorta

TAWSS:

Time-averaged wall shear stress

WSS:

Wall shear stress

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Acknowledgments

This work was supported by an American Heart Association Postdoctoral Fellowship, 10POST4210030 (to LE) and a National Institutes of Health Award R15HL096096-01 (to JFL). We also gratefully acknowledge the guidance and contributions of Mary Krolikowski RN, MSN, Kristen Andersen, Sheila Moore MD FACR, Robert Prost PhD, Barbara Hilker, Marjorie Bissette, Jim Joers PhD, David Wendell PhD, Brett Arand MS, Timothy Gundert MS, Nutta-On Promjunyakul PhD, and Atefeh Razavi MS.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Marquette University, 1515 West Wisconsin Ave, Milwaukee, WI, 53233, USA

    Laura Ellwein, Margaret M. Samyn & John F. LaDisa Jr.

  2. Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, 1015 Floyd Ave, Richmond, VA, 23284, USA

    Laura Ellwein

  3. Department of Pediatrics, Herma Heart Center, Children’s Hospital of Wisconsin, and the Medical College of Wisconsin, 9000 W Wisconsin Ave, Wauwatosa, WI, 53266, USA

    Margaret M. Samyn

  4. Department of Radiology, Children’s Hospital of Wisconsin, 9000 W Wisconsin Ave, Wauwatosa, WI, 53266, USA

    Stacy Liebham

  5. Department of Exercise Science, Marquette University, 604 N. 16th St, Milwaukee, WI, 53233, USA

    Michael Danduran

  6. Department of Physical Therapy, Marquette University, 604 N. 16th St, Milwaukee, WI, 53233, USA

    Sheila Schindler-Ivens

  7. Division of Cardiovascular Medicine, Departments of Medicine and Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    John F. LaDisa Jr.

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  1. Laura Ellwein
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Correspondence to Laura Ellwein.

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Appendix

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Table 4 Preprocess and 3D segmentation parameters used in ITK-Snap to reconstruct geometrically representative computer models of the thoracic aorta and its head and neck branches
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Ellwein, L., Samyn, M.M., Danduran, M. et al. Toward translating near-infrared spectroscopy oxygen saturation data for the non-invasive prediction of spatial and temporal hemodynamics during exercise. Biomech Model Mechanobiol 16, 75–96 (2017). https://doi.org/10.1007/s10237-016-0803-4

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