Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of 'shear stress score

Yiannis S. Chatzizisis, Konstantinos Toutouzas, Andreas A. Giannopoulos, Maria Riga, Antonios P. Antoniadis, Yusuke Fujinom, Dimitrios Mitsouras, Vassilis G. Koutkias, Grigorios Cheimariotis, Charalampos Doulaverakis, Ioannis Tsampoulatidis, Ioanna Chouvarda, Ioannis Kompatsiaris, Sunao Nakamura, Frank J. Rybicki, Nicos Maglaveras, Dimitris Tousoulis, George D. Giannoglou

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)888-897
Number of pages10
JournalEuropean heart journal cardiovascular Imaging
Volume18
Issue number8
DOIs
StatePublished - Aug 1 2017

Keywords

  • Clinical events
  • Coronary artery disease
  • Endothelial shear stress
  • High-risk plaque
  • Optical coherence tomography
  • Shear stress score
  • Vascular remodelling

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Chatzizisis, Y. S., Toutouzas, K., Giannopoulos, A. A., Riga, M., Antoniadis, A. P., Fujinom, Y., Mitsouras, D., Koutkias, V. G., Cheimariotis, G., Doulaverakis, C., Tsampoulatidis, I., Chouvarda, I., Kompatsiaris, I., Nakamura, S., Rybicki, F. J., Maglaveras, N., Tousoulis, D., & Giannoglou, G. D. (2017). Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of 'shear stress score. European heart journal cardiovascular Imaging, 18(8), 888-897. https://doi.org/10.1093/ehjci/jew134