Perspective on CFD studies of coronary artery disease lesions and hemodynamics: A review

Coronary artery disease (CAD) is the most common cardiovascular disease. Early diagnosis of CAD's physiological significance is of utmost importance for guiding individualized risk-tailored treatment strategies. In this paper, we first review the state-of-the-art clinical diagnostic indices to quantify the severity of CAD and the associated invasive and noninvasive imaging technologies in order to quantify the anatomical parameters of diameter stenosis, area stenosis, and hemodynamic indices of coronary flow reserve and fractional flow reserve. With the development of computational technologies and CFD methods, tremendous progress has been made in applying image-based CFD simulation techniques to elucidate the effects of hemodynamics in vascular pathophysiology toward the initialization and progression of CAD. So then, we review the advancements of CFD technologies in patient-specific modeling, involving the development of geometry reconstruction, boundary conditions, and fluid-structure interaction. Next, we review the applications of CFD to stenotic sites, in order to compute their hemodynamic parameters and study the relationship between the hemodynamic conditions and the clinical indices, to thereby assess the amount of viable myocardium and candidacy for percutaneous coronary intervention. Finally, we review the strengths and limitations of current researches of applying CFD to CAD studies.