Detailed behaviour of endothelial wall shear stress across coronary lesions from non-invasive imaging with coronary computed tomography angiography.

Abstract

AIMS:

Evolving evidence suggests that endothelial wall shear stress (ESS) plays a crucial role in the rupture and progression of coronary plaques by triggering biological signalling pathways. We aimed to investigate the patterns of ESS across coronary lesions from non-invasive imaging with coronary computed tomography angiography (CCTA), and to define plaque-associated ESS values in patients with coronary artery disease (CAD).

METHODS AND RESULTS:

Symptomatic patients with CAD who underwent a clinically indicated CCTA scan were identified. Separate core laboratories performed blinded analysis of CCTA for anatomical and ESS features of coronary atherosclerosis. ESS was assessed using dedicated software, providing minimal and maximal ESS values for each 3 mm segment. Each coronary lesion was divided into upstream, start, minimal luminal area (MLA), end and downstream segments. Also, ESS ratios were calculated using the upstream segment as a reference. From 122 patients (mean age 64 ± 7 years, 57% men), a total of 237 lesions were analyzed. Minimal and maximal ESS values varied across the lesions with the highest values at the MLA segment [minimal ESS 3.97 Pa (IQR 1.93-8.92 Pa) and maximal ESS 5.64 Pa (IQR 3.13-11.21 Pa), respectively]. Furthermore, minimal and maximal ESS values were positively associated with stenosis severity (P < 0.001), percent atheroma volume (P < 0.001), and lesion length (P ≤ 0.023) at the MLA segment. Using ESS ratios, similar associations were observed for stenosis severity and lesion length.

CONCLUSIONS:

Detailed behaviour of ESS across coronary lesions can be derived from routine non-invasive CCTA imaging. This may further improve risk stratification.

• Authors: Inge J van den Hoogen, Jussi Schultz, Jurrien H Kuneman, Michiel A de Graaf, Vasileios Kamperidis, Alexander Broersen, J Wouter Jukema, Antonis Sakellarios, Sotirios Nikopoulos, Savvas Kyriakidis, Katerina K Naka, Lampros Michalis, Dimitrios I Fotiadis, Teemu Maaniitty, Antti Saraste, Jeroen J Bax, Juhani Knuuti
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 23 Issue 12 Pg. 1708-1716 (11 17 2022) ISSN: 2047-2412 [Electronic] England
• PMID: 35616068 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: [email protected].

Topics

• Male
• Humans
• Middle Aged
• Aged
• Female
• Computed Tomography Angiography
• Coronary Angiography (methods)
• Coronary Vessels (pathology)
• Constriction, Pathologic
• Plaque, Atherosclerotic (diagnostic imaging, pathology)
• Coronary Artery Disease (diagnostic imaging, pathology)
• Coronary Stenosis (diagnostic imaging, pathology)
• Predictive Value of Tests