Computational Fluid Dynamics of Coronary Artery Disease

Ischemic heart disease (IHD), caused by coronary artery disease (CAD), limits coronary blood flow to the heart. IHD is a major cause of morbidity and mortality in the world, and CAD is the leading cause of death in the USA with over 800,000 deaths per year (Benjamin et al. 2019). Although coronary blood flow and perfusion (flow/myocardial mass) can be measured with medical imaging, the resulting stresses on the coronary endothelium (e.g., shear stresses) cannot be directly measured, but only computed through mathematical models (e.g., computational fluid dynamics). In engineering terms, blood flow and blood pressure represent the loading on the blood vessel wall, while shear stresses (on the endothelium) and intramural stresses (inside the vessel wall, i.e., media and adventitia) represent the resultant stresses. Basic and clinical research has shown that the stresses on the coronary endothelium are responsible for atherogenesis and plaque progression. The use of validated computational fluid dynamics allows the use of patient-specific coronary anatomy and geometry through imaging to determine the endothelial stresses and other important hemodynamic parameters. Computational fluid dynamics (CFD) also allows integration of the structural/mechanical/biochemical determinants of coronary flow for better understanding of coronary physiology/pathophysiology as well as to provide strategies for diagnosis and therapy of IHD.