Personalized and uncertainty-aware coronary hemodynamics simulations: From Bayesian estimation to improved multi-fidelity uncertainty quantification

Simulations of coronary hemodynamics have improved non-invasive clinical risk stratification and treatment outcomes for coronary artery disease, compared to relying on anatomical imaging alone. However, simulations typically use empirical approaches to distribute total coronary flow amongst the arteries in the coronary tree. This ignores patient variability, the presence of disease, and other clinical factors. Further, uncertainty in the clinical data often remains unaccounted for in the modeling pipeline. We present an end-to-end uncertainty-aware pipeline to (1) personalize coronary flow simulations by incorporating branch-specific coronary flows as well as cardiac function; and (2) predict clinical and biomechanical quantities of interest with improved precision, while accounting for uncertainty in the clinical data. We assimilate patient-specific measurements of myocardial blood flow from CT myocardial perfusion imaging to estimate branch-specific coronary flows. We use adaptive Markov Chain Monte Carlo sampling to estimate the joint posterior distributions of model parameters with simulated noise in the clinical data. Additionally, we determine the posterior predictive distribution for relevant quantities of interest using a new approach combining multi-fidelity Monte Carlo estimation with non-linear, data-driven dimensionality reduction. Our framework recapitulates clinically measured cardiac function as well as branch-specific coronary flows under measurement uncertainty. We substantially shrink the confidence intervals for estimated quantities of interest compared to single-fidelity and state-of-the-art multi-fidelity Monte Carlo methods. This is especially true for quantities that showed limited correlation between the low- and high-fidelity model predictions. Moreover, the proposed estimators are significantly cheaper to compute for a specified confidence level or variance.