scholarly journals Low Endothelial Shear Stress Predicts Evolution to High-Risk Coronary Plaque Phenotype in the Future

2017 ◽  
Vol 10 (8) ◽  
Author(s):  
Erika Yamamoto ◽  
Gerasimos Siasos ◽  
Marina Zaromytidou ◽  
Ahmet U. Coskun ◽  
Lei Xing ◽  
...  
Keyword(s):  
Shear Stress ◽  
High Risk ◽  
Coronary Plaque ◽  
The Future ◽  
Plaque Phenotype ◽  
Endothelial Shear Stress

Low Endothelial Shear Stress Is Associated With High-Risk Coronary Plaque Features and Microcalcification Activity

2021 ◽  
Author(s):  
Lachlan J. Kelsey ◽  
Jamie W. Bellinge ◽  
Kamran Majeed ◽  
Louis P. Parker ◽  
Samantha Richards ◽  
...  
Keyword(s):  
Shear Stress ◽  
High Risk ◽  
Coronary Plaque ◽  
Endothelial Shear Stress

Abstract 12063: High-risk Plaque Co-localizes With Low Endothelial Shear Stress and Expansive Remodeling in Human Coronary Arteries: A 3D Optical Coherence Tomography Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yiannis S Chatzizisis ◽  
Konstantinos Toutouzas ◽  
Andreas A Giannopoulos ◽  
Maria Riga ◽  
Antonios P Antoniadis ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Shear Stress ◽  
High Risk ◽  
Coronary Arteries ◽  
Vascular Remodeling ◽  
Pool Size ◽  
Optical Coherence ◽  
Fibrous Cap ◽  
Endothelial Shear Stress

Background: High risk plaque accounts for the majority of acute coronary events. Low endothelial shear stress (ESS) is a key factor of the natural history of atherosclerosis. The role of ESS in high risk plaque formation is not well studied in man. Hypothesis: To explore the association of low ESS with high risk plaque and to identify the ESS milieu and vascular remodeling response in high risk vs. non high risk plaque. Methods: 35 coronary arteries from 30 patients were 3D reconstructed with fusion of coronary angiography and optical coherence tomography (Fig A-D) . ESS was calculated in the 3D reconstructed arteries using computational fluid dynamics (Fig E) and classified into low, moderate and high in 3 mm long segments. In each segment: i) fibroatheromas were classified into high risk and non high risk based on fibrous cap thickness and lipid pool size ii) vascular remodeling was classified into constrictive, compensatory and expansive. Results: Fibroatheromas in low ESS segments had significantly thinner fibrous cap compared to high ESS segments (89±84 vs.138±83 μm, p<0.05). Lipid pool size was comparable across all ESS categories. The majority of low ESS segments co-localized with high risk plaques (29 vs. 9%, p<0.05), whereas the majority of high ESS co-localized with non high risk plaques (24 vs. 9%, p<0.05, Fig F ). Compensatory and expansive remodeling was the predominant remodeling response in low ESS segments containing high risk plaques. In non-stenotic fibroatheromas (expansive or compensatory remodeling) low ESS was predominantly associated with high risk plaques (29 vs. 3%, p<0.05) whereas high ESS was associated with non high risk plaques (Fig F) . Conclusions: Novel combined anatomic and functional imaging with 3D OCT showed that low ESS and non-constrictive remodeling are associated with high risk plaque in man. Further studies are needed to assess the role of ESS and vascular remodeling in high risk plaque rupture and precipitation of clinical outcomes.

P869Predictive value of the endothelial shear stress distribution in three-dimensional quantitative coronary angiography models in detecting vulnerable plaques

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Zanchin ◽  
C Bourantas ◽  
R Torii ◽  
P W S Serruys ◽  
A Karagiannis ◽  
...  
Keyword(s):  
Shear Stress ◽  
High Risk ◽  
Coronary Angiography ◽  
Intravascular Ultrasound ◽  
Three Dimensional ◽  
Quantitative Coronary Angiography ◽  
Low Risk ◽  
Plaque Burden ◽  
Vulnerable Plaques ◽  
Endothelial Shear Stress

Abstract Background Low Endothelial shear stress (ESS) is a well-known instigator of coronary atherosclerosis. Prospective intravascular ultrasound (IVUS)-based imaging studies with computational fluid dynamic analysis revealed its predictive merit in-vivo. However, whether coronary modelling derived from quantitative coronary angiography (QCA) is equally effective in detecting high-risk plaques remains to be established. Purpose To examine the value of endothelial shear stress (ESS) estimated in three-dimensional (3D) QCA models in detecting plaques that are likely to progress and cause events. Method We analysed the baseline intravascular ultrasound virtual histology (IVUS-VH) and angiographic data from 28 non-culprit lesions with a vulnerable phenotype (i.e., fibroatheroma or thin cap fibroatheroma) that caused major adverse cardiac events or required revascularization (nc-MACE-R) at 5-year follow-up and from a control group of 119 vulnerable plaques that remained quiescent. The segments studied by IVUS-VH at baseline were reconstructed using 3D-QCA software and in the obtained geometries blood flow simulation was performed and we estimated the resting Pd/Pa across the vulnerable plaque and the mean ESS values in 3mm sub-segments. A propensity score was built by the baseline plaque characteristics and the hemodynamic indices and its efficacy in detecting nc-MACE-R lesions was examined. Results Nc-MACE-R lesions were longer (32.5mm [18.0, 41.6], vs. 19.6mm [12.7, 31.3], p=0.03), had smaller minimum lumen area (MLA) (3.65mm2 [3.26, 4.36] vs. 5.03mm2 [3.98, 6.66], p<0.01), increased plaque burden (PB) (69.4% [63.5, 72.0] vs. 60.8% [53.7, 66.5], p<0.01), were exposed to higher ESS (9.40Pa [6.3, 12.5] vs. 4.1Pa [3.0, 6.9], p<0.01), and exhibited a lower resting Pd/Pa (0.97 [0.95, 0.98] vs. 0.98 [0.97, 0.99], p<0.01]. In multivariable analysis the only independent predictor of nc-MACE-R was the maximum 3mm ESS value (hazard ratio: 1.08 [1.02, 1.16], P=0.016). Lesions exposed to high ESS (>4.95Pa) with a high-risk anatomy (MLA<4mm2and PB>70%) had a higher nc-MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS that had high (20.0%) or low-risk anatomy (7.1%, P<0.001). Conclusion In the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information and in combination with lesion anatomy enabled more accurate identification of nc-MACE-R lesions. Further research in a larger number of patients is need to confirm these findings before the conduction of large scale prospective studies that will combine intravascular imaging and 3D-QCA modelling to more accurately detect vulnerable plaques.

scholarly journals Prediction of the Localization of High-Risk Coronary Atherosclerotic Plaques on the Basis of Low Endothelial Shear Stress

Circulation ◽  
2008 ◽  
Vol 117 (8) ◽  
pp. 993-1002 ◽  
Author(s):  
Yiannis S. Chatzizisis ◽  
Michael Jonas ◽  
Ahmet U. Coskun ◽  
Roy Beigel ◽  
Benjamin V. Stone ◽  
...  
Keyword(s):  
Shear Stress ◽  
High Risk ◽  
Atherosclerotic Plaques ◽  
Endothelial Shear Stress

Coronary plaque erosion developing in an area of high endothelial shear stress

2019 ◽  
Vol 30 (1) ◽  
pp. 74-75 ◽  
Author(s):  
Rocco Vergallo ◽  
Michail I. Papafaklis ◽  
Domenico D’Amario ◽  
Lampros K. Michalis ◽  
Filippo Crea ◽  
...  
Keyword(s):  
Shear Stress ◽  
Coronary Plaque ◽  
Plaque Erosion ◽  
Endothelial Shear Stress

scholarly journals Low endothelial shear stress, microcalcification activity and high-risk plaque features: merging computational flow modelling, OCT and 18F-NaF PET/CT

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B J Doyle ◽  
L J Kelsey ◽  
K Majeed ◽  
J Bellinge ◽  
L P Parker ◽  
...  
Keyword(s):  
Shear Stress ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Critical Role ◽  
Biologically Active ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Positron Emission ◽  
Arterial Plaque ◽  
Endothelial Shear Stress

Abstract Background Endothelial shear stress (ESS) has a critical role in endothelial function. Abnormal shear stress leads to endothelial dysfunction, which contributes to arterial plaque initiation and development. Four dimensional magnetic resonance can determine shear stress in the larger arteries but cannot resolve the detail needed to calculate shear stress in the coronary arteries and thus methods such as computational fluid dynamics (CFD) are required. Additionally, a key feature of biologically active plaques is microcalcification activity, and this can be detected using 18F-sodium fluoride (18F-NaF) positron emission tomography (PET). Furthermore, using high resolution optical coherence tomography (OCT), the high-risk features plaques can be visualized and quantified. We aimed to merge these three techniques to investigate if low ESS is associated with high-risk plaque features and active microcalcifications in acute coronary syndrome. Methods We began by merging OCT images with CTCA images to obtain detailed 3D reconstructions of the target vessel. We then simulated blood flow and calculated the ESS, from which we extracted the area of low ESS (&lt;0.4 Pa). We quantified plaque features using OCT and measured the maximum 18F-NaF uptake, and compared data at both the coronary segment and whole artery level (Figure 1). Results We investigated 20 arteries from 18 patients which we obtained 38 coronary segments according to the SCCT guidelines. We found that areas of low ESS were were significantly and positively associated with high-risk plaque features: macrophage infiltration (segment, rs=0.33, p=0.043; artery, rs=0.46, p=0.041) and presence of cholesterol crystals (segment, rs=0.45, p=0.005; artery, rs=0.58, p=0.007). Vessel segments with thin-capped fibroatheroma had greater area of low ESS (20 vs 4%). The uptake of 18F-NaF was positively associated with the area of low ESS (segment, rs=0.52, p=0.001; artery, rs=0.64, p=0.002). We found that there were typically more plaque features found in regions of low ESS (Table 1). Conclusion Here we provide the first data associating low ESS with both high-risk plaque features and active microcalcifications in patients with acute coronary syndrome. Although our sample size is small, these data are encouraging and could lead to better understanding of how best to deem a plaque “high risk”. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Royal Perth Hospital Medical Research Foundation Figure 1 Table 1

High Spatial Endothelial Shear Stress Gradient Independently Predicts Site of Acute Coronary Plaque Rupture and Erosion

2020 ◽  
Author(s):  
Vikas Thondapu ◽  
Chris Mamon ◽  
Eric K W Poon ◽  
Osamu Kurihara ◽  
Hyung Oh Kim ◽  
...  
Keyword(s):  
Shear Stress ◽  
Acute Coronary Syndromes ◽  
Plaque Rupture ◽  
Stress Gradient ◽  
Coronary Plaque ◽  
Oscillatory Shear ◽  
Oscillatory Shear Index ◽  
Plaque Erosion ◽  
Coronary Syndromes ◽  
Endothelial Shear Stress

Abstract Aims To investigate local haemodynamics in the setting of acute coronary plaque rupture and erosion. Methods and Results Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by plaque rupture (n = 19) or plaque erosion (n = 18) was used for 3D reconstruction and computational fluid dynamic simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between plaque rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG (odds ratio [OR] 5.29, 95% confidence interval [CI] 2.57-10.89, p &lt; 0.001), lipid (OR 12.98, 95% CI 6.57-25.67 p &lt; 0.001), and layered plaque (OR 3.17, 95% CI 1.82-5.50, p &lt; 0.001) were independently associated with plaque rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, p &lt; 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, p = 0.005) and OSI (OR 2.18, 95% CI 1.33-3.54, p = 0.002) independently associated with plaque erosion. ESSG was higher at rupture sites than erosion sites (median (interquartile range): 5.78 (2.47, 21.15) versus 2.62 (1.44, 6.18) Pa/mm, p = 0.009), OSI was higher at erosion sites than rupture sites (1.04x10−2 (2.3x10−3, 4.74x10−2) versus 1.29x10−3 (9.39x10−5, 3.0x10−2), p &lt; 0.001), but ESS was similar (p = 0.29). Conclusions High ESSG is independently associated with plaque rupture while high ESSG, ESS, and OSI associate with plaque erosion. While ESSG is higher at rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute plaque rupture and erosion, respectively. Translational Perspective Plaque rupture and erosion are distinct pathological and clinical entities with possibly different optimal treatments. This study demonstrates that high endothelial shear stress gradient is independently associated with site of both rupture and erosion, and is significantly higher in rupture. High oscillatory shear index is independently associated with the site of erosion only, and is higher in erosion than rupture. Larger studies are necessary to determine whether these indices may detect and distinguish plaque rupture and erosion in a clinical setting or to assess overall risk for acute coronary syndromes.

Abstract: P285 IDENTIFICATION OF EXTREMELY HIGH-RISK PLAQUES ON THE BASIS OF LOW ENDOTHELIAL SHEAR STRESS: IMPLICATIONS FOR RISK STRATIFICATION

2009 ◽  
Vol 10 (2) ◽  
pp. e592-e593
Author(s):  
K Koskinas ◽  
A Coskun ◽  
Y Chatzizisis ◽  
M Jonas ◽  
C Feldman ◽  
...  
Keyword(s):  
Shear Stress ◽  
High Risk ◽  
Risk Stratification ◽  
Endothelial Shear Stress
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