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BackgroundPersonalized hemodynamic models can accurately compute fractional flow reserve (FFR) from coronary angiograms and clinical measurements (FFR ${}_{\mathrm{baseline}}$), but obtaining patient-specific data could be challenging and sometimes not feasible. Understanding which measurements need to be patient-tuned vs. patient-generalized would inform models with minimal inputs that could expedite data collection and simulation pipelines. AimsTo determine the minimum set of patient-specific inputs to compute FFR using invasive measurement of FFR (FFR ${}_{\mathrm{invasive}}$) as gold standard. Materials and MethodsPersonalized coronary geometries ( $N=50$) were derived from patient coronary angiograms. A computational fluid dynamics framework, FFR ${}_{\mathrm{baseline}}$, was parameterized with patient-specific inputs: coronary geometry, stenosis geometry, mean arterial pressure, cardiac output, heart rate, hematocrit, and distal pressure location. FFR ${}_{\mathrm{baseline}}$was validated against FFR ${}_{\mathrm{invasive}}$and used as the baseline to elucidate the impact of uncertainty on personalized inputs through global uncertainty analysis. FFR ${}_{\mathrm{streamlined}}$was created by only incorporating the most sensitive inputs and FFR ${}_{\text{semi-streamlined}}$additionally included patient-specific distal location. ResultsFFR ${}_{\mathrm{baseline}}$was validated against FFR ${}_{\mathrm{invasive}}$via correlation ( $r=0.714$, $p<0.001$), agreement (mean difference: $0.01\pm 0.09$), and diagnostic performance (sensitivity: 89.5%, specificity: 93.6%, PPV: 89.5%, NPV: 93.6%, AUC: 0.95). FFR ${}_{\text{semi-streamlined}}$provided identical diagnostic performance with FFR ${}_{\mathrm{baseline}}$. Compared to FFR ${}_{\mathrm{baseline}}$vs. FFR ${}_{\mathrm{invasive}}$, FFR ${}_{\mathrm{streamlined}}$vs. FFR ${}_{\mathrm{invasive}}$had decreased correlation ( $r=0.64$, $p<0.001$), improved agreement (mean difference: $0.01\pm 0.08$), and comparable diagnostic performance (sensitivity: 79.0%, specificity: 90.3%, PPV: 83.3%, NPV: 87.5%, AUC: 0.90). ConclusionStreamlined models could match the diagnostic performance of the baseline with a full gamut of patient-specific measurements. Capturing coronary hemodynamics depended most on accurate geometry reconstruction and cardiac output measurement. 

Background and objective:Coronary artery disease (CAD) is highly prevalent and associated with adverse events. Challenges have emerged in the treatment of intermediate coronary artery stenoses. These lesions are often interrogated with fractional flow reserve (FFR) testing to determine if a stenosis is likely to be causative for ischemia in a cardiac territory. This invasive test requires insertion of a pressure wire into a coronary vessel. Recently computational fluid dynamics (CFD) has been used to noninvasively assess fractional flow reserve in vessels reconstructed from medical imaging data. However, many of these simulations are unable to provide additional information about intravascular hemodynamics, including velocity, endothelial shear stress (ESS), and vorticity. We hypothesized that vorticity, which has demonstrated utility in the assessment of ventricular and aortic diseases, would also be an important hemodynamic factor in CAD. Methods:Three-dimensional (3D), patient-specific coronary artery geometries that included all vessels >1 mm in diameter were created from angiography data obtained from 10 patients who underwent diagnostic angiography and FFR testing (n = 9). A massively parallel CFD solver (HARVEY) was used to calculate coronary hemodynamic parameters including pressure, velocity, ESS, and vorticity. These simulations were validated by comparing velocity flow fields from simulation to both velocities derived fromin vitroparticle image velocimetry and to invasively acquired pressure wire-based data from clinical testing. Results:There was strong agreement between findings from CFD simulations and particle image velocimetry experimental testing (p< 0.01). CFD-FFR was also highly correlated with invasively measured FFR (ρ= 0.77,p= 0.01) with an average error of 5.9 ± 0.1%. CFD-FFR also had a strong inverse correlation with the vorticity (ρ= -0.86,p= 0.001). Simulations to determine the effect of the coronary stenosis on intravascular hemodynamics demonstrated significant differences in velocity and vorticity (bothp< 0.05). Further evaluation of an angiographically normal appearing non-FFR coronary vessel in patients with CAD also demonstrated differences in vorticity when compared with FFR vessels (p< 0.05). Conclusion:The use of highly accurate 3D CFD-derived intravascular hemodynamics provides additional information beyond pressure measurements that can be used to calculate FFR. Vorticity is one parameter that is modified by a coronary stenosis and appears to be abnormal in angiographically normal vessels in patients with CAD, highlighting a possible use-case in preventative screening for early coronary disease.