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Atherosclerotic diseases such as carotid artery diseases (CAD) and chronic kidney diseases (CKD) are the major causes of death worldwide. The onset of these atherosclerotic diseases in the arteries are governed by complex blood flow dynamics and hemodynamic parameters. Atherosclerosis in renal arteries leads to reduction in arterial efficiency, which ultimately leads to Reno-vascular hypertension. This work attempts to identify the localization of atherosclerotic plaque in human abdominal aorta — renal artery junction using Computational fluid dynamics (CFD).

The atherosclerosis prone regions in an idealized human abdominal aorta-renal artery junction are identified by calculating relevant hemodynamic indicators from computational simulations using the rheologically accurate shear-thinning Yeleswarapu model for human blood. Blood flow is numerically simulated in a 3-D model of the artery junction using ANSYS FLUENT v18.2.

Hemodynamic indicators calculated are average wall shear stress (AWSS), oscillatory shear index (OSI), and relative residence time (RRT). Simulations of pulsatile flow (f=1.25 Hz, Re = 1000) show that low AWSS, and high OSI manifest in the regions of renal artery downstream of the junction and on the infrarenal section of the abdominal aorta lateral to the junction. High RRT, which is a relative index and dependent on AWSS and OSI, is found to overlap with the low AWSS and high OSI at the cranial surface of renal artery proximal to the junction and on the surface of the abdominal aorta lateral to the bifurcation: this indicates that these regions of the junction are prone to atherosclerosis. The results match qualitatively with the findings reported in literature and serve as initial step to illustrate utility of CFD for the location of atherosclerotic plaque.

Hemostasis system is one of the key body’s defense systems, which is presented in all the liquid tissues and especially important in blood. Hemostatic response is triggered as a result of the vessel injury. The interaction between specialized cells and humoral systems leads to the formation of the initial hemostatic clot, which stops bleeding. After that the slow process of clot dissolution occurs. The formation of hemostatic plug is a unique physiological process, because during several minutes the hemostatic system generates complex structures on a scale ranging from microns for microvessel injury or damaged endothelial cell-cell contacts, to centimeters for damaged systemic arteries. Hemostatic response depends on the numerous coordinated processes, which include platelet adhesion and aggregation, granule secretion, platelet shape change, modification of the chemical composition of the lipid bilayer, clot contraction, and formation of the fibrin mesh due to activation of blood coagulation cascade. Computer modeling is a powerful tool, which is used to study this complex system at different levels of organization. This includes study of intracellular signaling in platelets, modelling humoral systems of blood coagulation and fibrinolysis, and development of the multiscale models of thrombus growth. There are two key issues of the computer modeling in biology: absence of the adequate physico-mathematical description of the existing experimental data due to the complexity of the biological processes, and high computational complexity of the models, which doesn’t allow to use them to test physiologically relevant scenarios. Here we discuss some key unresolved problems in the field, as well as the current progress in experimental research of hemostasis and thrombosis. New findings lead to reevaluation of the existing concepts and development of the novel computer models. We focus on the arterial thrombosis, venous thrombosis, thrombosis in microcirculation and the problems of fibrinolysis and thrombolysis. We also briefly discuss basic types of the existing mathematical models, their computational complexity, and principal issues in simulation of thrombus growth in arteries.

The results of determination of the risk of cardiovascular failure of young athletes and adolescents in stressful physical activity have been demonstrated. The method of screening diagnostics of the risk of developing heart failure has been described. The results of contactless measurement of the form of the pulse wave of the radial artery using semiconductor laser autodyne have been presented. In the measurements used laser diode type RLD-650 specifications: output power of 5 mW, emission wavelength 654 nm. The problem was solved by the reduced form of the reflector movement, which acts as the surface of the skin of the human artery, tested method of assessing the risk of cardiovascular disease during exercise and the analysis of the results of its application to assess the risk of cardiovascular failure reactions of young athletes. As analyzed parameters were selected the following indicators: the steepness of the rise in the systolic portion of the fast and slow phase, the rate of change in the pulse wave catacrota variability of cardio intervals as determined by the time intervals between the peaks of the pulse wave. It analyzed pulse wave form on its first and second derivative with respect to time. The zeros of the first derivative of the pulse wave allow to set aside time in systolic rise. A minimum of the second derivative corresponds to the end of the phase and the beginning of the slow pressure build-up in the systole. Using the first and second derivative of the pulse wave made it possible to separately analyze the pulse wave form phase of rapid and slow pressure increase phase during systolic expansion. It has been established that the presence of anomalies in the form of the pulse wave in combination with vagotonic nervous regulation of the cardiovascular system of a patient is a sign of danger collapse of circulation during physical exercise.

Heart rate (HR) is the most affordable indicator for measuring. In order to control the individual response to physical exercises of different load types heart rate is measured when the athletes perform different types of muscular work (strength machines, various types of training and competitive exercises). The magnitude of heart rate and its dynamics during muscular work and recovery can be objectively judged on the functional status of the cardiovascular system of an athlete, the level of its individual physical performance, as well as an adaptive response to a particular exercise. However, the heart rate is not an independent determinant of the physical condition of an athlete. HR size is formed by the interaction of the basic physiological mechanisms underlying cardiac hemodynamic ejection mode. Heart rate depends on one hand, on contractility of the heart, the venous return, the volumes of the atria and ventricles of the heart and from vascular heart load, the main components of which are elastic and peripheral resistance of the arterial system on the other hand. The values of arterial system vascular resistances depend on the power of muscular work and its duration. HR sensitivity to changes in heart load and vascular contraction was determined in athletes by pair regression analysis simultaneously recorded heart rate data, and peripheral $(R)$ and elastic $(E_a)$ resistance (heart vascular load), and the power $(W)$ of heartbeats (cardiac contractility). The coefficients of sensitivity and pair correlation between heart rate indicators and vascular load and contractility of left ventricle of the heart were determined in athletes at rest and during the muscular work on the cycle ergometer. It is shown that increase in both ergometer power load and heart rate is accompanied by the increase of correlation coefficients and coefficients of the heart rate sensitivity to $R$, $E_a$ and $W$.

We consider a one-dimensional three velocity kinetic lattice Boltzmann model, which represents a secondorder difference scheme for hydrodynamic equations. In the framework of kinetic theory this system describes the propagation and interaction of three types of particles. It has been shown previously that the lattice Boltzmann model with external virtual force is equivalent at the hydrodynamic limit to the one-dimensional hemodynamic equations for elastic vessels, this equivalence can be achieved with use of the Chapman – Enskog expansion. The external force in the model is responsible for the ability to adjust the functional dependence between the lumen area of the vessel and the pressure applied to the wall of the vessel under consideration. Thus, the form of the external force allows to model various elastic properties of the vessels. In the present paper the physiological boundary conditions are considered at the inlets and outlets of the arterial network in terms of the lattice Boltzmann variables. We consider the following boundary conditions: for pressure and blood flow at the inlet of the vascular network, boundary conditions for pressure and blood flow for the vessel bifurcations, wave reflection conditions (correspond to complete occlusion of the vessel) and wave absorption at the ends of the vessels (these conditions correspond to the passage of the wave without distortion), as well as RCR-type conditions, which are similar to electrical circuits and consist of two resistors (corresponding to the impedance of the vessel, at the end of which the boundary conditions are set and the friction forces in microcirculatory bed) and one capacitor (describing the elastic properties of arterioles). The numerical simulations were performed: the propagation of blood in a network of three vessels was considered, the boundary conditions for the blood flow were set at the entrance of the network, RCR boundary conditions were stated at the ends of the network. The solutions to lattice Boltzmann model are compared with the benchmark solutions (based on numerical calculations for second-order McCormack difference scheme without viscous terms), it is shown that the both approaches give very similar results.

Numerical modeling of shear-induced platelet activation in haemodialysis arteriovenous fistulas was carried out in this work. The goal was to investigate the mechanisms of threshold shear-induced platelet activation in fistulas. For shear-induced platelet activation to take place, shear stress accumulated by platelets along corresponding trajectories in blood flow had to exceed a definite threshold value. The threshold value of cumulative shear stress was supposed to depend on the multimer size of von Willebrand factor macromolecules acting as hydrodynamic sensors for platelets. The effect of arteriovenous fistulas parameters, such as the anastomotic angle, blood flow rate, and the multimer size of von Willebrand factor macromolecules, on platelet activation risk was studied. Parametric diagrams have been constructed that make it possible to distinguish the areas of parameters corresponding to the presence or absence of shear-induced platelet activation. Scaling relations that approximate critical curves on parametric diagrams were obtained. Analysis showed that threshold fistula flow rate is higher for obtuse anastomotic angle than for sharp ones. This means that a fistula with obtuse angle can be used in wider flow rate range without risk of platelet activation. In addition, a study of different anastomosis configurations of arteriovenous fistulas showed that the configuration “end of vein to end of artery” is among the safest. For all the investigated anastomosis configurations, the critical curves on the parametric diagrams were monotonically decreasing functions of von Willebrand factor multimer size. It was shown that fistula flow rate should have a significant impact on the probability of thrombus formation initiation, while the direction of flow through the distal artery did not affect platelet activation. The obtained results allowed to determine the safest fistula configurations with respect to thrombus formation triggering. The authors believe that the results of the work may be of interest to doctors performing surgical operations for creation of arteriovenous fistulas for haemodialysis. In the final section of the work, possible clinical applications of the obtained results by means of mathematical modeling are discussed.

The possibility of numerical 3D simulation of thrombi formation is considered.

The developed up to now detailed mathematical models describing formation of thrombi and clots include a great number of equations. Being implemented in a CFD code, the detailed mathematical models require essential computer resources for simulation of the thrombi growth in a blood flow. A reasonable alternative way is using reduced mathematical models. Two models based on the reduced mathematical model for the thrombin generation are described in the given paper.

The first model describes growth of a thrombus in a great vessel (artery). The artery flows are essentially unsteady. They are characterized by pulse waves. The blood velocity here is high compared to that in the vein tree. The reduced model for the thrombin generation and the thrombus growth in an artery is relatively simple. The processes accompanying the thrombin generation in arteries are well described by the zero-order approximation.

A vein flow is characterized lower velocity value, lower gradients, and lower shear stresses. In order to simulate the thrombin generation in veins, a more complex system of equations has to be solved. The model must allow for all the non-linear terms in the right-hand sides of the equations.

The simulation is carried out in the industrial software FlowVision.

The performed numerical investigations have shown the suitability of the reduced models for simulation of thrombin generation and thrombus growth. The calculations demonstrate formation of the recirculation zone behind a thrombus. The concentration of thrombin and the mass fraction of activated platelets are maximum here. Formation of such a zone causes slow growth of the thrombus downstream. At the upwind part of the thrombus, the concentration of activated platelets is low, and the upstream thrombus growth is negligible.

When the blood flow variation during a hart cycle is taken into account, the thrombus growth proceeds substantially slower compared to the results obtained under the assumption of constant (averaged over a hard cycle) conditions. Thrombin and activated platelets produced during diastole are quickly carried away by the blood flow during systole. Account of non-Newtonian rheology of blood noticeably affects the results.

Most biomechanical tasks of interest to clinicians can be solved only using personalized mathematical models. Such models allow to formalize and relate key pathophysiological processes, basing on clinically available data evaluate non-measurable parameters that are important for the diagnosis of diseases, predict the result of a therapeutic or surgical intervention. The use of models in clinical practice imposes additional restrictions: clinicians require model validation on clinical cases, the speed and automation of the entire calculated technological chain, from processing input data to obtaining a result. Limitations on the simulation time, determined by the time of making a medical decision (of the order of several minutes), imply the use of reduction methods that correctly describe the processes under study within the framework of reduced models or machine learning tools.

Personalization of models requires patient-oriented parameters, personalized geometry of a computational domain and generation of a computational mesh. Model parameters are estimated by direct measurements, or methods of solving inverse problems, or methods of machine learning. The requirement of personalization imposes severe restrictions on the number of fitted parameters that can be measured under standard clinical conditions. In addition to parameters, the model operates with boundary conditions that must take into account the patient’s characteristics. Methods for setting personalized boundary conditions significantly depend on the clinical setting of the problem and clinical data. Building a personalized computational domain through segmentation of medical images and generation of the computational grid, as a rule, takes a lot of time and effort due to manual or semi-automatic operations. Development of automated methods for setting personalized boundary conditions and segmentation of medical images with the subsequent construction of a computational grid is the key to the widespread use of mathematical modeling in clinical practice.

The aim of this work is to review our solutions for personalization of mathematical models within the framework of three tasks of clinical cardiology: virtual assessment of hemodynamic significance of coronary artery stenosis, calculation of global blood flow after hemodynamic correction of complex heart defects, calculating characteristics of coaptation of reconstructed aortic valve.

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