A Commentary on Patient-Specific CFD for Coronary Stenosis: Methodological and Statistical Critique of Tajeddini et al.

The article ”High Precision Invasive FFR, Low-Cost Invasive iFR, Or Non-Invasive CFR?” by Tajeddini et al. presents an ambitious application of computational fluid dynamics (CFD) for the comprehensive assessment of coronary artery stenosis1. The study’s aim to concurrently simulate multiple physiological indices and propose novel diagnostic metrics is innovative2. A stringent methodological evaluation, however, uncovers foundational flaws that substantially compromise the evidentiary strength and clinical significance of the conclusions. This commentary provides a detailed technical and statistical critique, arguing that the study’s findings are critically undermined by an insufficient sample size that invalidates its statistical claims, and by methodological oversimplifications that diverge significantly from physiological reality. The study’s quantitative conclusions, particularly the proposed diagnostic cut-off values, are statistically indefensible and should be considered preliminary hypotheses at best, requiring substantial further investigation before any clinical consideration.