CBS 2019




Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study Coronary Microcirculation in Ischemic Heart Disease Evolving understanding of the heterogeneous natural history of individual coronary artery plaques and the role of local endothelial shear stress Low Endothelial Shear Stress Predicts Evolution to High-Risk Coronary Plaque Phenotype in the Future: A Serial Optical Coherence Tomography and Computational Fluid Dynamics Study Local Low Shear Stress and Endothelial Dysfunction in Patients With Nonobstructive Coronary Atherosclerosis Angiographic derived endothelial shear stress: a new predictor of atherosclerotic disease progression Low shear stress induces vascular eNOS uncoupling via autophagy-mediated eNOS phosphorylation Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study High Coronary Shear Stress in Patients With Coronary Artery Disease Predicts Myocardial Infarction Low shear stress induces endothelial reactive oxygen species via the AT1R/eNOS/NO pathway
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Clinical Trial2018 Jul 17.[Epub ahead of print]

JOURNAL:Eur Heart J Cardiovasc Imaging. Article Link

Angiographic derived endothelial shear stress: a new predictor of atherosclerotic disease progression

Bourantas CV, Ramasamy A, Karagiannis A et al. Keywords: vulnerable plaque , shear stress , IVUS


AIMS - To examine the efficacy of angiography derived endothelial shear stress (ESS) in predicting atherosclerotic disease progression.

METHODS AND RESULTS - Thirty-five patients admitted with ST-elevation myocardial infarction that had three-vessel intravascular ultrasound (IVUS) immediately after revascularization and at 13 months follow-up were included. Three dimensional (3D) reconstruction of the non-culprit vessels were performed using (i) quantitative coronary angiography (QCA) and (ii) methodology involving fusion of IVUS and biplane angiography. In both models, blood flow simulation was performed and the minimum predominant ESS was estimated in 3 mm segments. Baseline plaque characteristics and ESS were used to identify predictors of atherosclerotic disease progression defied as plaque area increase and lumen reduction at follow-up. Fifty-four vessels were included in the final analysis. A moderate correlation was noted between ESS estimated in the 3D QCA and the IVUS-derived models (r = 0.588, P < 0.001); 3D QCA accurately identified segments exposed to low (<1 Pa) ESS in the IVUS-based reconstructions (AUC: 0.793, P < 0.001). Low 3D QCA-derived ESS (<1.75 Pa) was associated with an increase in plaque area, burden, and necrotic core at follow-up. In multivariate analysis, low ESS estimated either in 3D QCA [odds ratio (OR): 2.07, 95% confidence interval (CI): 1.17-3.67; P = 0.012) or in IVUS (<1 Pa; OR: 2.23, 95% CI: 1.23-4.03; P = 0.008) models, and plaque burden were independent predictors of atherosclerotic disease progression; 3D QCA and IVUS-derived models had a similar accuracy in predicting disease progression (AUC: 0.826 vs. 0.827, P = 0.907).

CONCLUSIONS - 3D QCA-derived ESS can predict disease progression. Further research is required to examine its value in detecting vulnerable plaques.