Shear Stress Estimated by Quantitative Coronary Angiography Predicts Plaques Prone to Progress and Cause Events

Abstract

This study examined the value of endothelial shear stress (ESS) estimated in 3-dimensional quantitative coronary angiography (3D-QCA) models in detecting plaques that are likely to progress and cause events. BackgroundCumulative evidence has shown that plaque characteristics and ESS derived from intravascular ultrasound (IVUS)−based reconstructions enable prediction of lesions that will cause cardiovascular events. However, the prognostic value of ESS estimated by 3D-QCA in nonflow limiting lesions is yet unclear. MethodsThis study analyzed baseline virtual histology (VH)-IVUS and angiographic data from 28 lipid-rich lesions (i.e., fibroatheromas) that caused major adverse cardiovascular events or required revascularization (MACE-R) at 5-year follow-up and 119 lipid-rich plaques from a control group that remained quiescent. The segments studied by VH-IVUS at baseline were reconstructed using 3D-QCA software. In the obtained geometries, blood flow simulation was performed, and the pressure gradient across the lipid-rich plaque and the mean ESS values in 3-mm segments were estimated. The additive value of these hemodynamic indexes in predicting MACE-R beyond plaque characteristics was examined. ResultsMACE-R lesions were longer, had smaller minimum lumen area, increased plaque burden (PB), were exposed to higher ESS, and exhibited a higher pressure gradient. In multivariable analysis, PB (hazard ratio: 1.08; p = 0.004) and the maximum 3-mm ESS value (hazard ratio: 1.11; p = 0.001) were independent predictors of MACE-R. Lesions exposed to high ESS (>4.95 Pa) with a high-risk anatomy (minimal lumen area <4 mm 2 and PB >70%) had a higher MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS who had high-(20.0%) or low-risk anatomy (7.1%; p < 0.001). ConclusionsIn the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information, and, in combination with lesion anatomy, enabled more accurate identification of MACE-R lesions.

Risk of myocardial infarction based on endothelial shear stress analysis using coronary angiography

“…Based on recent studies confirming the reliability of angiographically-derived WSS [25], the present work nurtured from the combination of conventional coronary angiography and CFD algorithms, allowing for a multidimensional lesion evaluation. Despite this complexity, a remarkable clinical implication of the present study is that all analyses were obtained by a clinician in 10.8 ± 1.41 min from conventional angiography using a standard computer.…”

Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome

“…Intravascular ultrasound (IVUS)-derived ESS or PSS has consistently predicted plaque progression, vulnerable plaque formation, and future coronary events ( 27 – 32 ). Recently proposed quantitative coronary angiography-derived ESS showed a correlation with IVUS-derived models ( r = 0.588, p < 0.001) ( 33 ) and was an independent predictor of major adverse cardiovascular events at 5-year follow-up ( 13 ), suggesting a possibility of real-time assessment of local hemodynamic parameters in daily practice. A novel approach for computational tool ( 14 ) or hybrid multimodal imaging ( 34 ) has also broadened the clinical applicability of local hemodynamics.…”

“…Therefore, it has been speculated that identification of local hemodynamic parameters displayed better prediction of plaque rupture risk (12). Nonetheless, their clinical utilization has still been limited in daily practice since it requires additional resources and is a time-consuming process (13,14). Moreover, whether the assessment of all diverse local hemodynamic indices provides incremental value has not been fully understood.…”

Coronary plaque composition influences biomechanical stress and predicts plaque rupture in a morpho-mechanic OCT analysis

“…In this range, a linear equation adequately depicts the behavior of the material. Also, stress on the lesion in patients is not only derived from the static factors included in our analysis, but also dynamic flow shear stress caused by blood flow ( Bourantas et al, 2020 ), which was not included in our study.…”