Modelling The Hemodynamics of Coronary Ischemia

Acting upon clinical patient data, acquired in the pathway of percutaneous intervention, we deploy hierarchical, multi-stage, data-handling protocols and interacting low- and high-order mathematical models (chamber elastance, state-space system and CFD models), to establish and then validate a framework to quantify the burden of ischaemia. Our core tool is a compartmental, zero-dimensional model of the coupled circulation with four heart chambers, systemic and pulmonary circulations and an optimally adapted windkessel model of the coronary arteries that reflects the diastolic dominance of coronary flow. We guide the parallel development of protocols and models by appealing to foundational physiological principles of cardiac energetics and a parameterisation (stenotic Bernoulli resistance and micro-vascular resistance) of patients' coronary flow. We validate our process first with results which substantiate our protocols and, second, we demonstrate good correspondence between model operation and patient data. We conclude that our core model is capable of representing (patho)physiological states and discuss how it can potentially be deployed, on clinical data, to provide a quantitative assessment of the impact, on the individual, of coronary artery disease.

Automated summary

Based on clinical patient data, we have developed a framework using hierarchical, multi-stage data handling protocols and mathematical models to quantify the burden of ischaemia. Our core tool is a compartmental, zero-dimensional model of the circulation system, which includes heart chambers, circulations, and coronary arteries. By validating with patient data, we have demonstrated the capability of our model to represent physiological states and assess the impact of coronary artery disease on individuals.