Multiscale Coronary Arterial Network Generation and Hemodynamics Using Patient-Specific Fractional Myocardial Blood Volume

Ischemic heart disease (IHD) is the leading cause of death worldwide. Although 90% of the intramyocardial blood volume resides in the microvasculature, clinical imaging methods cannot visualize the microvascular coronary network in vivo, and non-invasive hemodynamic estimates overlook patient-specific microcirculatory contributions. Herein, we present a multiscale framework to extend the epicardial coronary tree and generate 1D microvascular networks in the myocardium based on ferumoxytol-enhanced magnetic resonance coronary imaging and fractional myocardial blood volume (fMBV) maps. Synthetic arterial networks were constructed from MRI data belonging to three swine, four healthy volunteers, and one IHD patient using a modified multistage, adaptive constrained constructive optimization approach. Hemodynamic simulations were performed in synthetic arterial networks. Morphological parameters were compared with empirical models. In 126 arterial networks (<i>n</i> = 6000 terminal segments per subject per seed; six seeds per coronary vessel), the morphometry was strongly correlated with empirical data (<i>r</i> > 0.87), with low variability (<i>CoV</i> < 0.01) across multiple rounds of network simulations. Mixed-effects models and a Dynamic Time Warping analysis confirmed robustness and repeatability. In the IHD patient, simulated arterial networks (<i>n</i> = 15) reproduced tissue-dependent morphological and functional signatures consistent with coronary autoregulation in scar and hypoperfused tissues. The findings establish an early potential for patient-specific microvascular network synthesis and hemodynamic simulations from MRI data.