The Anatomy of Coronary Risk: How Arterial Geometry Shapes Coronary Artery Disease Through Blood Flow Haemodynamics – Latest Methods, Insights and Clinical Implications

Abstract Despite tremendous advances in cardiovascular medicine, significant opportunities remain to improve coronary artery disease (CAD) prevention and treatment strategies. The key limitation lies in the understanding of disease formation and progression mechanisms. The coronary anatomy plays an important role in local haemodynamics, governing endothelial health and, thus, pathophysiological responses. The significant variation of the coronary anatomy among patients, with significant trends across different populations, increases the complexity of understanding the details of disease progression. This review covers different aspects of the current status and understanding of the blood flow investigation in coronary arteries. We summarised the current knowledge of the haemodynamic effect of coronary anatomy and its evaluation and analysis methods. We discussed recent progress across medical imaging techniques and computational haemodynamic analysis. Based on the reviewed papers, we identified the persisting knowledge gaps and challenges in the field. We then elaborated on future directions and opportunities to increase understanding of the fundamental mechanism of CAD in individuals representative of large populations and how this may translate to the patient’s bedside.