Lipid-rich Plaques Detected by Near-infrared Spectroscopy Are More Frequently Exposed to High Shear Stress

Abstract

High wall shear stress (WSS) and near-infrared spectroscopy (NIRS) detected lipid-rich plaque (LRP) are both known to be associated with plaque destabilization and future adverse cardiovascular events. However, knowledge of spatial co-localization of LRP and high WSS is lacking. This study investigated the co-localization of LRP based on NIRS and high WSS. Fifty-three patients presenting acute coronary syndrome underwent NIRS-intravascular-ultrasound (NIRS-IVUS) imaging of a non-culprit coronary artery. WSS was obtained using WSS profiling in 3D-reconstructions of the coronary arteries based on fusion of IVUS-segmented lumen and CT-derived 3D-centerline. Thirty-eight vessels were available for final analysis and divided into 0.5 mm/45° sectors. LRP sectors, as identified by NIRS, were more often colocalized with high WSS than sectors without LRP. Moreover, there was a dose-dependent relationship between lipid content and high WSS exposure. This study is a first step in understanding the evolution of LRPs to vulnerable plaques.

Relationship between high shear stress and OCT-verified thin-cap fibroatheroma in patients with coronary artery disease

“…Consistent with our findings, high WSS was strongly associated with TCFA and lipid-rich plaques in an OCT based CFD analysis of intermediate stenoses [24]. Lipid-rich plaques detected by NIRS have been shown to co-localize with high WSS in an IVUS based CFD study in non-culprit lesions of patients presenting with ACs [23]. In a recent 3D QCA based CFD analysis, a combination of high WSS and high-risk plaque morphology provided an accurate identification of nonobstructive lesions responsible for the future events.…”

“…progression necessarily encroaches on the lumen and causes luminal narrowing [16,17]. In the advanced stages of atherosclerosis, both low [18][19][20] and high [5][6][7][8][9][21][22][23][24][25][26] wall shear stress have been associated with plaque vulnerability and clinical events. Although some MI may be caused by rupture of plaques with a mild degree of lumen narrowing, in the majority of cases there is a rapid progression of high-risk plaques with lumen narrowing before MI [17].…”

Comparison of Swine and Human Computational Hemodynamics Models for the Study of Coronary Atherosclerosis

“…Forty-eight hemodynamically stable patients from the IMPACT study data set ( Hartman et al, 2020 ) were involved in the analysis. Clinical characteristics are listed in Table 1 .…”

“…The same imaging protocol was applied to human- and swine-specific coronary segments. Each coronary artery was imaged by computed coronary tomography angiography (CCTA) (SOMATOM Force, Siemens Healthineers, Germany) and intravascular ultrasound (IVUS) (InfraRedX, Burlington, MA, United States), as detailed elsewhere ( De Nisco et al, 2019 , 2020 ; Hartman et al, 2020 ; Hoogendoorn et al, 2020 ). Coronary lumen contours were segmented on IVUS images (QCU-CMS, Medis Medical Imaging, Leiden) and aligned along the 3D CCTA centerline in order to reconstruct the 3D vessel geometry.…”

“…Coronary lumen contours were segmented on IVUS images (QCU-CMS, Medis Medical Imaging, Leiden) and aligned along the 3D CCTA centerline in order to reconstruct the 3D vessel geometry. Additional luminal regions proximally (up to the aorta) and at least two diameters distally to the IVUS-imaged segment were reconstructed using CCTA images ( De Nisco et al, 2019 , 2020 ; Hartman et al, 2020 ; Hoogendoorn et al, 2020 ). The 79 reconstructed luminal surfaces of the coronary arteries (49 human-specific models: 18 RCA, 18 LAD, and 13 LCX; 30 swine-specific models: 10 RCA, 10 LAD, and 10 LCX) are presented in Figure 2 and Figure 3 for humans and animal models, respectively.…”