Analysis of Fluid Mechanics Flows and Phenomena in Coronary Arteries Using a New Diagnostic Angiography Technique Based on an Acoustic Map.

Background: The precise mechanisms that initiate atherosclerosis and regulate plaque progression are not fully understood. Could fluid mechanics (FM) help address this cardiovascular (CV) challenge?

Method: The CV system was modeled as an integrated network of pumps and pipes. This study explored the FM principles governing arterial flows and phenomena, arising from the complex interactions between the left ventricle, aorta, and coronary arteries. A novel diagnostic angiographic technique was employed to image arterial flows and phenomena associated with presence of lesions.

Results: Three key FM flows and phenomena were observed in arteries: (1) laminar antegrade and retrograde flows, with vortex formation from collisions that degraded into disorganized flows, (2) recirculating flow at coronary bifurcation outer curves, where thickened boundary layers damaged the intima and late lesion formation, (3) vibratory effects from rapid cyclic acceleration and deceleration of blood flow and (4) retrograde pressure wave phenomenon caused by water hammer effects. To enhance diagnostic precision, artificial intelligence and machine learning algorithms were developed and tested, improving detection of arterial flows and phenomena. Conclusions: Conceptualizing the CV system as a network of pumps and pipes enabled a novel angiographic technique to detect abnormal FM flow patterns and phenomena which may contribute to intimal injury, triggering and sustaining the atherosclerotic process.