Association of Coronary Wall Shear Stress With Atherosclerotic Plaque Burden, Composition, and Distribution in Patients With Coronary Artery Disease

• Type of Material: Article
• Authors: Parham Eshtehardi, Emory University; Michael C McDaniel, Emory University; Jin Suo, Georgia Institute of Technology; Saurabh Dhawan, Emory University; Lucas Timmins, Emory University; Jose N Binongo, Emory University; Lucas J Golub, Emory University; Michel T Corban, Emory University; Aloke Finn, Emory University; John Oshinski, Emory University; Arshed Ali Quyyumi, Emory University; Don P Giddens, Emory University; Habib Samady, Emory University
• Language: English
• Date: 2012-08-01
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2012 Eshtehardi et al. Published on behalf of the American Heart Association, Inc., by Wiley-Blackwell.
• License: Creative Commons Attribution-NonCommercial 2.5 Generic
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.112.002543
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 1
• Issue: 4
• Start Page: e002543
• End Page: e002543
• Grant/Funding Information: This study was funded by The Wallace H Coulter Translational/Clinical Research Seed Grant Program of Georgia Institute of Technology and Emory University, Atlanta, GA, USA, and Volcano Corp, and supported in part by PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources.
• Keywords: ENDOTHELIAL DYSFUNCTION; computational fluid dynamics; atherosclerosis; LOCALIZATION; PULSATILE FLOW; BLOOD-FLOW; IN-VIVO; Science & Technology; Life Sciences & Biomedicine; wall shear stress; Cardiovascular System & Cardiology; INTRAVASCULAR ULTRASOUND; FLOW PATTERNS; NATURAL-HISTORY; coronary arteries; histology, virtual; HUMAN CAROTID BIFURCATION; RADIOFREQUENCY DATA-ANALYSIS; ultrasonography, intravascular; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Public Health; Biology, Biostatistics; Engineering, Biomedical

Abstract

BACKGROUND: Extremes of wall shear stress (WSS) have been associated with plaque progression and transformation, which has raised interest in the clinical assessment of WSS. We hypothesized that calculated coronary WSS is predicted only partially by luminal geometry and that WSS is related to plaque composition. METHODS AND RESULTS: Twenty-seven patients with coronary artery disease underwent virtual histology intravascular ultrasound and Doppler velocity measurement for computational fluid dynamics modeling for WSS calculation in each virtual histology intravascular ultrasound segment (N=3581 segments). We assessed the association of WSS with plaque burden and distribution and with plaque composition. WSS remained relatively constant across the lower 3 quartiles of plaque burden (P=0.08) but increased in the highest quartile of plaque burden (P<0.001). Segments distal to lesions or within bifurcations were more likely to have low WSS (P<0.001). However, the majority of segments distal to lesions (80%) and within bifurcations (89%) did not exhibit low WSS. After adjustment for plaque burden, there was a negative association between WSS and percent necrotic core and calcium. For every 10 dynes/cm(2) increase in WSS, percent necrotic core decreased by 17% (P=0.01), and percent dense calcium decreased by 17% (P<0.001). There was no significant association between WSS and percent of fibrous or fibrofatty plaque components (P=NS). CONCLUSIONS: IN PATIENTS WITH CORONARY ARTERY DISEASE: (1) Luminal geometry predicts calculated WSS only partially, which suggests that detailed computational techniques must be used to calculate WSS. (2) Low WSS is associated with plaque necrotic core and calcium, independent of plaque burden, which suggests a link between WSS and coronary plaque phenotype. (J Am Heart Assoc. 2012;1:e002543 doi: 10.1161/JAHA.112.002543.).