Blood Pressure Prediction for Coronary Artery Disease Diagnosis using Coronary Computed Tomography Angiography

Computational fluid dynamics (CFD) based simulation of coronary blood flow provides valuable hemodynamic markers, such as pressure gradients, for diagnosing coronary artery disease (CAD). However, CFD is computationally expensive, time-consuming, and difficult to integrate into large-scale clinical workflows. These limitations restrict the availability of labeled hemodynamic data for training AI models and hinder broad adoption of non-invasive, physiology based CAD assessment. To address these challenges, we develop an end to end pipeline that automates coronary geometry extraction from coronary computed tomography angiography (CCTA), streamlines simulation data generation, and enables efficient learning of coronary blood pressure distributions. The pipeline reduces the manual burden associated with traditional CFD workflows while producing consistent training data. We further introduce a diffusion-based regression model designed to predict coronary blood pressure directly from CCTA derived features, bypassing the need for slow CFD computation during inference. Evaluated on a dataset of simulated coronary hemodynamics, the proposed model achieves state of the art performance, with an R2 of 64.42%, a root mean squared error of 0.0974, and a normalized RMSE of 0.154, outperforming several baseline approaches. This work provides a scalable and accessible framework for rapid, non-invasive blood pressure prediction to support CAD diagnosis.