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Author Notes:

Correspondence to: Habib Samady, MD, FACC, FSCAI, Professor of Medicine, Director, Interventional Cardiology, Emory University School of Medicine, 1365 Clifton Rd, Suite F606, Atlanta, GA 30322, USA. E‐mail: hsamady@emory.edu

We acknowledge the Emory Interventional Cardiology fellows, Catheterization Laboratory staff, and Andrew R. King for participation in the study performance.

Disclosures: None


Research Funding:

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.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • atherosclerosis
  • coronary arteries
  • computational fluid dynamics
  • ultrasonography, intravascular
  • histology, virtual
  • wall shear stress

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

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Journal Title:

Journal of the American Heart Association


Volume 1, Number 4


, Pages e002543-e002543

Type of Work:

Article | Final Publisher PDF


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.).

Copyright information:

© 2012 Eshtehardi et al. Published on behalf of the American Heart Association, Inc., by Wiley-Blackwell.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 2.5 Generic License (http://creativecommons.org/licenses/by-nc/2.5/).

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