Abstract 11177: Uncontrolled Systolic Hypertension Exaggerates the Effect of Water Hammer Shock from a Retrograde Direction While Diastolic Hypertension Aggravates the Injury from an Antegrade Direction: New Mechanism of Coronary Artery Disease by Angiographic and Machine Learning Investigation

• Published in: Circulation (New York, N.Y.) N.Y.), 2021-11, Vol.144 (Suppl_1), p.A11177-A11177
• Main Authors: Nguyen, Thach N, Truong, Duc T, Le, Thoa, Anh, Le M, Nguyen, Thu Q, Minh, Le H, Tran, Nghi, Le, Chuong, Vu, Loc, Pham, Hung N, Ho, Dung, Rigatelli, Gianluca, Cao, Thinh, Zuin, Marco, Talarico, Ernest, Nguyen Thuong, Nghia T
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.144.suppl_1.11177

IntroductionHypertension (HTN) is a strong risk factor of coronary artery disease. HypothesisBased on the damages induced by flow abnormalities in pipes, our research is built on the hypothesis that flow disturbances start the atherosclerotic process. Our strategy is to use today’s practice of fluid mechanics to unlock the mechanism of HTN on coronary plaques. MethodsAll patients with uncontrolled HTN and unstable angina underwent coronary angiography and were selected if they had 1 or 2 moderate lesions. At first. contrast was injected until the index artery was completely opacified. As the injection stopped, the blood moved in and displaced the contrast. The movements and interactions of the blood flow in white color above a black background could be clearly analyzed. At the same time, Artificial Intelligence (Machine Learning (ML algorithms) program had 2 models built on Python. Model 1 was based on U-net and Densenet-121 for vessel segmentation. Model 2 was used for classification and movement of flow. Model 2 was trained based on the convolutional neural network. The main measurements were the types, durations and directions of flows. Results20 patients were enrolled. 80% of lesions happened at the mid right coronary artery, near the bifurcation of the left anterior descending artery and diagonal, and of the circumflex artery and obtuse marginal. At the locations of lesions, 100% patients had turbulence caused by collision of the antegrade against the retrograde flow (water hammer shock). If there was excessive diastolic HTN >100mmHg, the duration of retrograde flow was short ( 0.30 sec) and 80% turbulence happened PROXIMAL to the collision/bifurcation site due to higher gradient from distal to proximal. ConclusionsUncontrolled diastolic HTN exaggerated the strength of antegrade flow and turbulence DISTAL to the collision/bifurcation site while uncontrolled systolic HTN intensified the retrograde flow and turbulence PROXIMAL to the collision/bifurcation site. Both inflicted damage on the intima and started the atheroslerotic process.