Statistical analysis of the association between rheological properties of blood and atherosclerosis

Document Type : Research Article


1 Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran

2 Department of Mechanical Engineering, Khajeh Nasir University of Technology

3 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia; ANZAC Research Institute, The University of Sydney, Sydney, NSW 2139, Australia


The aim of this study is to investigate the effects of non-Newtonian blood rheology models on the wall shear stress (WSS) distribution in a cohort of patients-specific coronary arteries. Twenty patients with diseased left anterior descending (LAD) coronary arteries (with varying degrees of stenosis severity from mild to severe) who underwent angiography and in-vivo pressure measurements were selected to perform computational fluid dynamics (CFD) simulations. Three-dimensional (3D) patient-specific geometries were reconstructed from 3D quantitative coronary angiography. To compare the effects of rheological properties of blood on WSS along the arteries, each artery was divided into 3 segments; proximal (pre-stenosis), stenosis and distal (post-stenosis). Blood was modelled as a Newtonian and non-Newtonian (Carreau-Yasuda, Casson and Power-law) fluid. Our findings showed that the WSS distributions over proximal and stenosis segments were significantly affected by the non-Newtonian properties of blood whereas the effect was negligible over distal segment. On the other hand, the type of non-Newtonian model is important to achieve accurate results over proximal and stenosis regions, but over distal region, it does not matter what model is used. Therefore, to simplify the simulation, the Newtonian model can be acceptable in finding the wall shear stress distribution over the distal region regardless of severity of stenosis.


dor 20.1001.1.25882953.2019.

Main Subjects

[1] S. Barquera, A. Pedroza-Tobías, C. Medina, L. Hernández-Barrera, K. Bibbins-Domingo, R. Lozano, A.E. Moran, Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease, Archives of Medical Research, 46(5) (2015) 328-338.
[2] A. Javadzadegan, A. Moshfegh, H.H. Afrouzi, M. Omidi, Magnetohydrodynamic blood flow in patients with coronary artery disease, Computer Methods and Programs in Biomedicine, 163 (2018) 111-122.
[3] A. Javadzadegan, A. Moshfegh, M. Behnia, Effect of magnetic field on haemodynamic perturbations in atherosclerotic coronary arteries, Journal of medical engineering & technology, 42(2) (2018) 148-156.
[4] S. Glagov, C. Zarins, D. Giddens, D. Ku, Hemodynamics and Atherosclerosis, Insights and perspectives gained from studies of human arteries, Archieves of Pathology and Laboratory Medicine 112 (1988) 1018–1031, C1016 References C1021 Author addresses, 1.
[5] L. Zhong, J.-M. Zhang, B. Su, R. San Tan, J.C. Allen, G.S. Kassab, Application of patient-specific computational fluid dynamics in coronary and intra-cardiac flow simulations: Challenges and opportunities, Frontiers in physiology, 9 (2018).
[6] R.A. Malinauskas, P. Hariharan, S.W. Day, L.H. Herbertson, M. Buesen, U. Steinseifer, K.I. Aycock, B.C. Good, S. Deutsch, K.B. Manning, FDA benchmark medical device flow models for CFD validation, ASAIO Journal, 63(2) (2017) 150-160.
[7] P.D. Morris, A. Narracott, H. von Tengg-Kobligk, D.A. Silva Soto, S. Hsiao, A. Lungu, P. Evans, N.W. Bressloff, P.V. Lawford, D.R. Hose, J.P. Gunn, Computational fluid dynamics modelling in cardiovascular medicine, Heart, 102(1) (2016) 18-28.
[8] S.A. Berger, L.-D. Jou, Flows in Stenotic Vessels, Annual Review of Fluid Mechanics, 32(1) (2000) 347-382.
[9] K. Perktold, M. Resch, H. Florian, Pulsatile Non-Newtonian Flow Characteristics in a Three-Dimensional Human Carotid Bifurcation Model, Journal of Biomechanical Engineering, 113(4) (1991) 464-475.
[10] D. Kumar, R. Vinoth, V.S. Raviraj Adhikari, Non-Newtonian and Newtonian blood flow in human aorta: a transient analysis,  (2017).
[11] T.J. Pedley, The Fluid Mechanics of Large Blood Vessels, Cambridge University Press, 2008.
[12] F.J.H. Gijsen, F.N. van de Vosse, J.D. Janssen, The influence of the non-Newtonian properties of blood on the flow in large arteries: steady flow in a carotid bifurcation model, Journal of Biomechanics, 32(6) (1999) 601-608.
[13] D.S. Sankar, K. Hemalatha, A non-Newtonian fluid flow model for blood flow through a catheterized artery—Steady flow, Applied Mathematical Modelling, 31(9) (2007) 1847-1864.
[14] L. Goubergrits, E. Wellnhofer, U. Kertzscher, Choice and Impact of a Non-Newtonian Blood Model for Wall Shear Stress Profiling of Coronary Arteries, in, Springer Berlin Heidelberg, Berlin, Heidelberg, 2008, pp. 111-114.
[15] B.M. Johnston, P.R. Johnston, S. Corney, D. Kilpatrick, Non-Newtonian blood flow in human right coronary arteries: Transient simulations, Journal of Biomechanics, 39(6) (2006) 1116-1128.
[16] B. Liu, D. Tang, Influence of non-Newtonian properties of blood on the wall shear stress in human atherosclerotic right coronary arteries, Molecular & cellular biomechanics : MCB, 8(1) (2011) 73-90.
[17] Y. Jiang, J. Zhang, W. Zhao, Effects of the inlet conditions and blood models on accurate prediction of hemodynamics in the stented coronary arteries, AIP Advances, 5(5) (2015) 057109.
[18] K.R. Kensey, Y.I. Cho, M. Chang, Effects of Whole Blood Viscosity on Atherogenesis, The Journal of invasive cardiology, 9(1) (1997) 17-24.
[19] W.L. Siauw, E.Y.K. Ng, J. Mazumdar, Unsteady stenosis flow prediction: a comparative study of non-Newtonian models with operator splitting scheme, Medical Engineering & Physics, 22(4) (2000) 265-277.
[20] J. Suo, Y. Yan, J. Oshinski, A. Tannenbaum, J. Gruden, D. Giddens, Flow Patterns and Wall Shear Stress Distributions at Atherosclerotic-Prone Sites in a Human Left Coronary Artery - An Exploration Using Combined Methods of CT and Computational Fluid Dynamics, in:  The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2004, pp. 3789-3791.
[21] J. Jung, A. Hassanein, R.W. Lyczkowski, Hemodynamic Computation Using Multiphase Flow Dynamics in a Right Coronary Artery, Annals of Biomedical Engineering, 34(3) (2006) 393.
[22] Y.H. Kim, P.J. VandeVord, J.S. Lee, Multiphase non-Newtonian effects on pulsatile hemodynamics in a coronary artery, International Journal for Numerical Methods in Fluids, 58(7) (2008) 803-825.
[23] V.A. Nosovitsky, O.J. Ilegbusi, J. Jiang, P.H. Stone, C.L. Feldman, Effects of Curvature and Stenosis-Like Narrowing on Wall Shear Stress in a Coronary Artery Model with Phasic Flow, Computers and Biomedical Research, 30(1) (1997) 61-82.
[24] Abdulrajak Buradi, A. Mahalingam, Numerical Simulation Of Pulsatile Blood Flow In An Idealized Curved Section Of A Human Coronary Artery, International Journal of Mechanical and Production Engineering (IJMPE), (Special Issue 2016) (2016) 15-19.
[25] W.-d. Qin, S.-h. Mi, C. Li, G.-x. Wang, J.-n. Zhang, H. Wang, F. Zhang, Y. Ma, D.-w. Wu, M. Zhang, Low shear stress induced HMGB1 translocation and release via PECAM-1/PARP-1 pathway to induce inflammation response, PLoS One, 10(3) (2015) e0120586.
[26] F. Gijsen, A. van der Giessen, A. van der Steen, J. Wentzel, Shear stress and advanced atherosclerosis in human coronary arteries, Journal of biomechanics, 46(2) (2013) 240-247.
[27] A.C. Guyton, J.E. Hall, Textbook of Medical Physiology, Elsevier Saunders, 2006.
[28] D.A. Cooley, G.W. He, Arterial Grafting for Coronary Artery Bypass Surgery, Springer Berlin Heidelberg, 2006.
[29] B.M. Johnston, P.R. Johnston, S. Corney, D. Kilpatrick, Non-Newtonian blood flow in human right coronary arteries: steady state simulations, Journal of Biomechanics, 37(5) (2004) 709-720.
[30] J. Soulis, G. Giannoglou, Y. Chatzizisis, T. M Farmakis, G. Giannakoulas, G. E Parcharidis, G. Louridas, Spatial and phasic oscillation of non-Newtonian wall shear stress in human left coronary artery bifurcation: An insight to atherogenesis, 2006.
[31] J.V. Soulis, G.D. Giannoglou, Y.S. Chatzizisis, K.V. Seralidou, G.E. Parcharidis, G.E. Louridas, Non-Newtonian models for molecular viscosity and wall shear stress in a 3D reconstructed human left coronary artery, Medical Engineering & Physics, 30(1) (2008) 9-19.
[32] R. Torii, N.B. Wood, N. Hadjiloizou, A.W. Dowsey, A.R. Wright, A.D. Hughes, J. Davies, D.P. Francis, J. Mayet, G.-Z. Yang, S.A.M. Thom, X.Y. Xu, Fluid–structure interaction analysis of a patient-specific right coronary artery with physiological velocity and pressure waveforms, Communications in Numerical Methods in Engineering, 25(5) (2009) 565-580.
[33] A. Santamarina, E. Weydahl, J.M. Siegel, J.E. Moore, Computational Analysis of Flow in a Curved Tube Model of the Coronary Arteries: Effects of Time-varying Curvature, Annals of Biomedical Engineering, 26(6) (1998) 944-954.