What are the main CFD approaches, modeling strategies, and hemodynamic parameters used to study LCA bifurcation over the last decade, and how have these advanced the understanding of atherosclerosis progression?
Advanced computational fluid dynamics simulations, increasingly utilizing patient-specific models and AI, consistently link disturbed flow patterns and low wall shear stress to atherogenesis in the left main coronary bifurcation.
Computational fluid dynamics (CFD) simulations are essential for studying cardiovascular diseases, particularly atherosclerosis. The left coronary artery (LCA) and its bifurcations, which supply blood to a large portion of the myocardium, are recognized as high-risk sites for plaque formation. This systematic review addresses the question: “What are the main CFD approaches, modeling strategies, and hemodynamic parameters used to study LCA bifurcation over the last decade, and how have these advanced the understanding of atherosclerosis progression?” A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases. Following preferred reporting items for systematic reviews and meta-analyses guidelines, the search focused on original studies published within the last decade employing CFD to analyze LCA bifurcation hemodynamics. The review includes 108 CFD studies, mostly three-dimensional (3D) simulations (104 studies). Forty-seven used idealized 3D LCA models and 48 used patient-specific models focusing on bifurcation. Recent studies increasingly focus on hemodynamic parameters linked to atherosclerosis and the impact of stenosis and post-stenting restenosis on local blood flow. Simulations incorporating physiological features, such as fluid–structure interaction, cardiac motion, and blood rheology, are also included. Additionally, artificial intelligence is being integrated to efficiently predict hemodynamic parameters, reducing simulation time and cost. There is a clear trend toward using high-resolution imaging and advanced modeling for patient-specific CFD simulations. Despite methodological differences, disturbed flow patterns, low wall shear stress, and high oscillatory shear index are studied in the LCA bifurcation, supporting their role in atherogenesis. Standardizing protocols and integrating clinical data are essential for translating CFD findings into practice.
Quinteiro et al. (Thu,) studied this question.