Yiannis S Chatzizisis1,2,3, Konstantinos Toutouzas4, Andreas A Giannopoulos3,5, Maria Riga4, Antonios P Antoniadis2,3, Yusuke Fujinom6, Dimitrios Mitsouras5, Vassilis G Koutkias7,8, Grigorios Cheimariotis8, Charalampos Doulaverakis9, Ioannis Tsampoulatidis9, Ioanna Chouvarda7,8, Ioannis Kompatsiaris9, Sunao Nakamura6, Frank J Rybicki5, Nicos Maglaveras7,8, Dimitris Tousoulis4, George D Giannoglou3. 1. Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA. 2. Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 3. First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. 4. First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece. 5. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. 7. Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece. 8. Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece. 9. Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece.
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 µm, 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. Published on behalf of the European Society of Cardiology. All rights reserved.
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 µm, 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. Published on behalf of the European Society of Cardiology. All rights reserved.
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