Detailed behaviour of endothelial wall shear stress across coronary lesions from non-invasive imaging with coronary computed tomography angiography. (25th May 2022)

• Record Type: Journal Article
• Authors: van den Hoogen, Inge J; Schultz, Jussi; Kuneman, Jurrien H; de Graaf, Michiel A; Kamperidis, Vasileios; Broersen, Alexander; Jukema, J Wouter; Sakellarios, Antonis; Nikopoulos, Sotirios; Kyriakidis, Savvas; Naka, Katerina K; Michalis, Lampros; Fotiadis, Dimitrios I; Maaniitty, Teemu; Saraste, Antti; Bax, Jeroen J; Knuuti, Juhani
• Is Part Of: European heart journal. Volume 23:Number 12(2022)
• Page Start: 1708
• Page End: 1716
• Publication Date: 2022-05-25
• Subjects: atherosclerosis -- coronary artery disease -- endothelial wall shear stress -- computational fluid dynamics -- coronary computed tomography angiography; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeac095
• Languages: English
• ISSNs: 2047-2404

Abstract

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. Graphical Abstract: Graphical Abstract Schematic representation of the study design and patients (left panel), the comprehensive image analysis process including blinded analysis of anatomical and ESS features of coronary atherosclerosis (middle panel), and the patterns of ESS across lesions (right panel). Images are partly derived and adjusted from Ohayon et al., Biomechanics of coronary atherosclerotic plaque: from model to patient, Academic Press, 1st edition, chapter 9, page 207, copyright 2020 and Puchner et al., High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial, Journal of the American College of Cardiology, volume 64, page 687, copyright 2014, both with permission from Elsevier. 31, 32 CAD, coronary artery disease; CCTA, coronary computed tomography angiography; ESS, endothelial wall shear stress.