TY - JOUR
T1 - Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography
T2 - Introduction of 'shear stress score
AU - Chatzizisis, Yiannis S.
AU - Toutouzas, Konstantinos
AU - Giannopoulos, Andreas A.
AU - Riga, Maria
AU - Antoniadis, Antonios P.
AU - Fujinom, Yusuke
AU - Mitsouras, Dimitrios
AU - Koutkias, Vassilis G.
AU - Cheimariotis, Grigorios
AU - Doulaverakis, Charalampos
AU - Tsampoulatidis, Ioannis
AU - Chouvarda, Ioanna
AU - Kompatsiaris, Ioannis
AU - Nakamura, Sunao
AU - Rybicki, Frank J.
AU - Maglaveras, Nicos
AU - Tousoulis, Dimitris
AU - Giannoglou, George D.
N1 - Funding Information:
This work was supported by the Behrakis Foundation, Boston, MA, USA; European Commission, Marie Curie International Reintegration Grant, FP7, Project: SMILE (249303); General Secretariat of Research and Technology, Program: Heracleitus II, Athens, Greece; National Institute of Biomedical Imaging and Bioengineering, Grant Number K01-EB015868, NIH, Bethesda, MA, USA.
Publisher Copyright:
© 2017 The Author.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Aims The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes. Methods and results A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89+ 84 vs.138+ 83 mm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina. Conclusion Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.
AB - Aims The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes. Methods and results A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89+ 84 vs.138+ 83 mm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina. Conclusion Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.
KW - Clinical events
KW - Coronary artery disease
KW - Endothelial shear stress
KW - High-risk plaque
KW - Optical coherence tomography
KW - Shear stress score
KW - Vascular remodelling
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U2 - 10.1093/ehjci/jew134
DO - 10.1093/ehjci/jew134
M3 - Article
C2 - 27461211
AN - SCOPUS:85037737855
SN - 2047-2404
VL - 18
SP - 888
EP - 897
JO - European heart journal cardiovascular Imaging
JF - European heart journal cardiovascular Imaging
IS - 8
ER -