Hemodynamics analysis for advancing risk assessment of coronary artery aneurysm caused by Kawasaki disease using patient-specific cardiovascular simulation*

Kawasaki disease (KD) is a systemic vasculitis primarily affecting children, which can lead to coronary artery aneurysms (CAA). Large CAA can cause thrombosis, coronary artery stenosis, occlusion, and even sudden death. However, the current KD guidelines primarily focus on the size of the aneurysm, without considering hemodynamics associated with the thrombus formation. Previous small-scale pilot studies have shown evidence of associations between thrombus formation and hemodynamic metrics derived from computational fluid dynamics in KD patients with CAA. This study aimed to investigate the risk assessment capability of hemodynamic metrics using a large number of patient cohort. We conducted a retrospective analysis of 45 computed tomography scans from 30 patients diagnosed with KD and CAA with the thrombosis group comprising 9 patients. CAAs were divided into two groups based on the presence of thrombosis, and the hemodynamic factors were compared between the groups. The Wilcox Rank test revealed significant differences in hemodynamic parameters between the two groups of vessels with and without thrombus formation, specifically Residence time (RT) and Time-averaged wall shear stress. The Receiver-Operating-Characteristics analysis demonstrated the superior predictive performance of hemodynamic parameters over geometry-based metrics in identifying thrombus formation.