Influence of Coronary Flow and Left Ventricular Outflow Tract Velocity on LDL Accumulation and Calcification in Aortic Valve Leaflets.

Abstract

Background/objectives: Calcific aortic valve disease (CAVD) is a progressive condition marked by thickening and calcification of the valve leaflets, leading to impaired cardiac function and increased cardiovascular risk. As disease progression is strongly influenced by hemodynamics and lipid accumulation, computational modeling provides a powerful tool for understanding the biomechanical drivers of calcification.

Methods: This study investigates the effects of coronary artery flow and varying left ventricular outflow tract (LVOT) velocity profiles on low density lipoprotein (LDL) accumulation and associated aortic valve calcification using a partitioned fluid-structure interaction framework coupled with scalar transport modeling, with a focus on understanding the differential behaviors of the three valve leaflets: the non-coronary cusp (NCC), right coronary cusp (RCC), and left coronary cusp (LCC). Four distinct LVOT flow velocity profiles (anterior, lateral, posterior, and medial) and coronary flow are simulated to determine their effects on the distribution of LDL accumulation and associated calcification across the valve leaflets.

Results/conclusions: Our results indicate that the RCC experiences greatest excursion and lowest calcification. The LCC shows lowest excursion and slightly higher susceptibility for calcification. Finally, the NCC experiences intermediate excursion, but is most prone to calcification.