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Author Notes:

Habib Samady, MD, FACC, FSCAI, Professor of Medicine, Director, Interventional Cardiology, Emory University School of Medicine, 1364 Clifton Road, Suite F606, Atlanta, GA 30322, Telephone: (404) 778-1237, Fax: (404) 712-7102, hsamady@emory.edu.

We thank the Emory interventional cardiology fellows and catheterization staff for participation in the study performance.

HS: SIG. Research grants from Abbott Vascular, Medtronic, NIH, St. Jude Medical, Gilead.


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.

OYH and PE were supported by the Ruth L. Kirschstein National Research Service Awards training grant (5T32HL007745).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • computational fluid dynamics
  • coronary wall shear stress
  • endothelial dysfunction
  • nonobstructive coronary artery disease

Low Coronary Wall Shear Stress Is Associated With Severe Endothelial Dysfunction in Patients With Nonobstructive Coronary Artery Disease

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Journal Title:

JACC: Cardiovascular Interventions


Volume 11, Number 20


, Pages 2072-2080

Type of Work:

Article | Post-print: After Peer Review


Objectives: This study investigated the relationship between low wall shear stress (WSS) and severe endothelial dysfunction (EDFx). Background: Local hemodynamic forces such as WSS play an important role in atherogenesis through their effect on endothelial cells. The study hypothesized that low WSS independently predicts severe EDFx in patients with coronary artery disease (CAD). Methods: Forty-four patients with CAD underwent coronary angiography, fractional flow reserve, and endothelial function testing. Segments with >10% vasoconstriction after acetylcholine (Ach) infusion were defined as having severe EDFx. WSS, calculated using 3-dimensional angiography, velocity measurements, and computational fluid dynamics, was defined as low (<1 Pa), intermediate (1 to 2.5 Pa), or high (>2.5 Pa). Results: Median age was 52 years, 73% were women. Mean fractional flow reserve was 0.94 ± 0.06. In 4,510 coronary segments, median WSS was 3.67 Pa. A total of 24% had severe EDFx. A higher proportion of segments with low WSS had severe EDFx (71%) compared with intermediate WSS (22%) or high WSS (23%) (p < 0.001). Segments with low WSS demonstrated greater vasoconstriction in response to Ach than did intermediate or high WSS segments (−10.7% vs. −2.5% vs. +1.3%, respectively; p < 0.001). In a multivariable logistic regression analysis, female sex (odds ratio [OR]: 2.44; p = 0.04), diabetes (OR: 5.01; p = 0.007), and low WSS (OR: 9.14; p < 0.001) were independent predictors of severe EDFx. Conclusions: In patients with nonobstructive CAD, segments with low WSS demonstrated more vasoconstriction in response to Ach than did intermediate or high WSS segments. Low WSS was independently associated with severe EDFx.

Copyright information:

© 2018 American College of Cardiology Foundation

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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