Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications

• Authors: Frank Gijsen, Erasmus MC; Yuki Katagiri, University of Amsterdam; Peter Barlis, University of Melbourne; Christos Bourantas, University College London; Carlos Collet, University of Amsterdam; Umit Coskun, Harvard Medical School; Joost Daemen, Erasmus MC; Jouke Dijkstra, Leiden University; Elazer Edelman, Harvard Medical School; Paul Evans, University of Sheffield; Kim van der Heiden, Erasmus MC; Rod Hose, University of Sheffield; Bon-Kwon Koo, Seoul National University Hospital; Rob Krams, Queen Mary University London; Alison Marsden, Stanford University; Francesco Migliavacca, Politecnico di Milano; Yoshinobu Onuma, Erasmus MC; Andrew Ooi, University of Melbourne; Eric Poon, University of Melbourne; Habib Samady, Emory University; Peter Stone, Harvard Medical School; Kuniaki Takahashi, University of Amsterdam; Dalin Tang, Southeast University; Vikas Thondapu, University of Melbourne; Erhan Tenekecioglu, Erasmus MC; Lucas Timmins, Emory University; Ryo Torii, University College London; Jolanda Wentzel, Erasmus MC; Patrick Serruys, Erasmus MC
• Journal Title: European Heart Journal
• Volume: Volume 40, Number 41
• Publisher: Oxford University Press | 2019-11-01, Pages 3421-+
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/eurheartj/ehz551
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Radiology; Engineering, Biomedical
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; OPTICAL COHERENCE TOMOGRAPHY; FRACTIONAL FLOW RESERVE; LOCAL HEMODYNAMIC ENVIRONMENT; METAL STENTS EVIDENCE; IN-VIVO VALIDATION; NF-KAPPA-B; INTRAVASCULAR ULTRASOUND; ANGIOGRAPHIC DATA; ATHEROSCLEROTIC PLAQUE; COMPUTED-TOMOGRAPHY

Abstract

When blood flows through an artery, it exerts forces on the vessel wall (Figure 1). The perpendicular component of that force vector is associated with blood pressure, leading to deformation of the cells in the vessel wall. The tangential component of that force vector is much smaller and can be sensed by the endothelium through a shearing deformation (‘shearing force’). Each force has a magnitude and direction, and for the shear force, they both change during the cardiac cycle. If we normalize this tangential force vector by the area, we obtain the wall shear stress (unit: 1 Pa = 10 dynes/cm2). Wall shear stress has a major impact on endothelial function and therefore plays a key role in atherosclerotic disease development and in long-term evolution and healing of vessels treated by intravascular devices. Wall shear stress is orders of magnitude smaller than other mechanical stresses affecting the coronary arteries, such as tensile stress or compressive stress and exerts its powerful vascular effects not by a mechanical impact on vascular structure per se, but uniquely by triggering biologic signalling. The biological impact of wall shear stress will be reviewed briefly in ‘The biological relevance of wall shear stress’ section.