Wall shear stress estimated by 3D-QCA can predict cardiovascular events in lesions with borderline negative fractional flow reserve

Tufaro, Vincenzo; Safi, Hannah; Torii, Ryo; Koo, Bon Kwon; Kitslaar, Pieter H.; Ramasamy, Anantharaman; Mathur, Anthony; Jones, Daniel A.; Bajaj, Retesh; Erdoğan, Emrah; Lansky, Alexandra J.; Zhang, Jinlong; Konstantinou, Klio; Little, Callum; Rakhit, Roby; Karamasis, Grigoris V.; Baumbach, Andreas; Bourantas, Christos V.

doi:10.1016/j.atherosclerosis.2021.02.018

Cited by 25 publications

(13 citation statements)

References 25 publications

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“…However, in contrast with the EMERALD study and the FAME 2 WSS sub-analysis [7,22] the present study cohort had a lower functional lesion severity as depicted by the proportion of hemodynamically significant lesions (19.7% vs. 49.0% vs. 100.0% in the current study, EMERALD and FAME 2, respectively). More recently, vessels with borderline FFR values (0.81-0.85) and lesions with %AS <58% and maximum TAWSS <7.69 Pa had a long-term prevalence of lesion-oriented events below 6% [26]. Our study confirmed similar predictive cutoffs for both %AS (55.5%) and maximum TAWSS (7.30 Pa).…”

Section: Inclusion Of Computational Hemodynamics For MI Predictionsupporting

confidence: 86%

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

et al. 2022

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Section: Inclusion Of Computational Hemodynamics For MI Predictionsupporting

confidence: 86%

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

et al. 2022

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“…However, in that study multivariable analysis demonstrated that wall shear stress gradient is a stronger predictor than time average WSS ( 18 ). Other studies in coronary arteries already showed the association between high WSS (>4.71) and coronary events ( 36 , 37 ).…”

Section: Discussionmentioning

confidence: 88%

The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study

Dilba

Dam-Nolen

Korteland

et al. 2021

Front. Cardiovasc. Med.

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Background and Purpose: Shear stress (WSS) is involved in the pathophysiology of atherosclerotic disease and might affect plaque ulceration. In this case-control study, we compared carotid plaques that developed a new ulcer during follow-up and plaques that remained silent for their exposure to time-dependent oscillatory shear stress parameters at baseline.Materials and Methods: Eighteen patients who underwent CTA and MRI of their carotid arteries at baseline and 2 years follow-up were included. These 18 patients consisted of six patients who demonstrated a new ulcer and 12 control patients selected from a larger cohort with similar MRI-based plaque characteristics as the ulcer group. (Oscillatory) WSS parameters [time average WSS, oscillatory shear index (OSI), and relative residence time (RRT)] were calculated using computational fluid dynamics applying the MRI-based geometry of the carotid arteries and compared among plaques (wall thickness>2 mm) with and without ulceration (Mann–Whitney U test) and ulcer-site vs. non-ulcer-site within the plaque (Wilcoxon signed rank test). More detailed analysis on ulcer cases was performed and the predictive value of oscillatory WSS parameters was calculated using linear and logistic mixed-effect regression models.Results: The ulcer group demonstrated no difference in maximum WSS [9.9 (6.6–18.5) vs. 13.6 (9.7–17.7) Pa, p = 0.349], a lower maximum OSI [0.04 (0.01–0.10) vs. 0.12 (0.06–0.20) p = 0.019] and lower maximum RRT [1.25 (0.78–2.03) Pa−1 vs. 2.93 (2.03–5.28) Pa−1, p = 0.011] compared to controls. The location of the ulcer (ulcer-site) within the plaque was not always at the maximal WSS, but demonstrated higher average WSS, lower average RRT and OSI at the ulcer-site compared to the non-ulcer-sites. High WSS (WSS>4.3 Pa) and low RRT (RRT < 0.25 Pa) were associated with ulceration with an odds ratio of 3.6 [CI 2.1–6.3] and 2.6 [CI 1.54–4.44] respectively, which remained significant after adjustment for wall thickness.Conclusion: In this explorative study, ulcers were not exclusively located at plaque regions exposed to the highest WSS, OSI, or RRT, but high WSS and low RRT regions had a significantly higher odds to present ulceration within the plaque even after adjustment for wall thickness.

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“…As it is less time-consuming, 3D QCA can be performed during percutaneous coronary intervention (PCI). WSS measurement using 3D QCA in the coronary arteries of patients with stable CAD served to predict the risk of future cardiovascular events, such as myocardial infarction or cardiac death [ 92 , 93 ]. Apart from the use of fractional flow reserve as a prognostic factor, higher WSS in proximal segments of the occlusion site was shown to be predictive of future myocardial infarction.…”

Section: Measurement Of Wall Shear Stress (Wss) In Clinical Settingsmentioning

confidence: 99%

Investigation of Wall Shear Stress in Cardiovascular Research and in Clinical Practice—From Bench to Bedside

Urschel

Tauchi

Achenbach

et al. 2021

IJMS

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In the 1900s, researchers established animal models experimentally to induce atherosclerosis by feeding them with a cholesterol-rich diet. It is now accepted that high circulating cholesterol is one of the main causes of atherosclerosis; however, plaque localization cannot be explained solely by hyperlipidemia. A tremendous amount of studies has demonstrated that hemodynamic forces modify endothelial athero-susceptibility phenotypes. Endothelial cells possess mechanosensors on the apical surface to detect a blood stream-induced force on the vessel wall, known as “wall shear stress (WSS)”, and induce cellular and molecular responses. Investigations to elucidate the mechanisms of this process are on-going: on the one hand, hemodynamics in complex vessel systems have been described in detail, owing to the recent progress in imaging and computational techniques. On the other hand, investigations using unique in vitro chamber systems with various flow applications have enhanced the understanding of WSS-induced changes in endothelial cell function and the involvement of the glycocalyx, the apical surface layer of endothelial cells, in this process. In the clinical setting, attempts have been made to measure WSS and/or glycocalyx degradation non-invasively, for the purpose of their diagnostic utilization. An increasing body of evidence shows that WSS, as well as serum glycocalyx components, can serve as a predicting factor for atherosclerosis development and, most importantly, for the rupture of plaques in patients with high risk of coronary heart disease.

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Wall shear stress estimated by 3D-QCA can predict cardiovascular events in lesions with borderline negative fractional flow reserve

Cited by 25 publications

References 25 publications

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

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

The Association Between Time-Varying Wall Shear Stress and the Development of Plaque Ulcerations in Carotid Arteries From the Plaque at Risk Study

Investigation of Wall Shear Stress in Cardiovascular Research and in Clinical Practice—From Bench to Bedside

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