Coronary fluid mechanics in an ageing cardiovascular system

Coronary artery diseases are a leading cause of mortality and are increasingly prevalent with age. However, the large number of age-increasing co-morbidities make difficult to understand the impact of cardiovascular ageing alone on the coronary flow pattern. The present study aims to shed light on the effect of arterial and ventricular ageing on the coronary circulation, which is here studied by means of a validated mathematical model. Forward and backward pressure and flow waves are analysed, as well as their intensity. Results highlight a complex spatiotemporal coronary wave pattern, where intense waves originate from the aorta (particularly in systole) and from the deep myocardium, during both the isovolumic compression and the diastolic phase. The subendocardial viability ratio decreases with age, the total coronary flow is slightly reduced, and the left-ventricular work increases. Consequently, the left-ventricular work per unit of blood flow increases, thus limiting the cell oxygen availability abundance, and therefore increasing the risk of myocardial infarction. Our results highlight a physiological age-induced supply/demand unbalance, which can augment the risk of myocardial ischemia and can contribute to pave the way to other typical coronary pathological processes.