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Coronary Artery Wall Shear Stress Is Associated With Progression and Transformation of Atherosclerotic Plaque and Arterial Remodeling in Patients With Coronary Artery Disease
被引:620
作者:
Samady, Habib
[1
]
Eshtehardi, Parham
[1
]
McDaniel, Michael C.
[1
]
Suo, Jin
[2
]
Dhawan, Saurabh S.
[1
]
Maynard, Charles
[3
]
Timmins, Lucas H.
[1
,2
]
Quyyumi, Arshed A.
[1
]
Giddens, Don P.
[2
]
机构:
[1] Emory Univ, Sch Med, Dept Med, Div Cardiol, Atlanta, GA 30322 USA
[2] Georgia Inst Technol, Wallace H Coulter Dept Biomed Engn, Atlanta, GA 30332 USA
[3] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA
关键词:
atherosclerosis;
coronary artery disease;
hemodynamics;
intravascular ultrasonography;
interventional;
wall shear stress;
HISTOLOGY INTRAVASCULAR ULTRASOUND;
EXPERT CONSENSUS DOCUMENT;
NATURAL-HISTORY;
BLOOD-FLOW;
ENDOTHELIAL DYSFUNCTION;
PATTERNS;
LOCALIZATION;
ACQUISITION;
EXPRESSION;
RUPTURE;
D O I:
10.1161/CIRCULATIONAHA.111.021824
中图分类号:
R5 [内科学];
学科分类号:
1002 ;
100201 ;
摘要:
Background-Experimental studies suggest that low wall shear stress (WSS) promotes plaque development and high WSS is associated with plaque destabilization. We hypothesized that low-WSS segments in patients with coronary artery disease develop plaque progression and high-WSS segments develop necrotic core progression with fibrous tissue regression. Methods and Results-Twenty patients with coronary artery disease underwent baseline and 6-month radiofrequency intravascular ultrasound (virtual histology intravascular ultrasound) and computational fluid dynamics modeling for WSS calculation. For each virtual histology intravascular ultrasound segment (n=2249), changes in plaque area, virtual histology intravascular ultrasound-derived plaque composition, and remodeling were compared in low-, intermediate-, and high-WSS categories. Compared with intermediate-WSS segments, low-WSS segments developed progression of plaque area (P=0.027) and necrotic core (P < 0.001), whereas high-WSS segments had progression of necrotic core (P < 0.001) and dense calcium (P < 0.001) and regression of fibrous (P < 0.001) and fibrofatty (P < 0.001) tissue. Compared with intermediate-WSS segments, low-WSS segments demonstrated greater reduction in vessel (P < 0.001) and lumen area (P < 0.001), and high-WSS segments demonstrated an increase in vessel (P < 0.001) and lumen (P < 0.001) area. These changes resulted in a trend toward more constrictive remodeling in low-compared with high-WSS segments (73% versus 30%; P=0.06) and more excessive expansive remodeling in high-compared with low-WSS segments (42% versus 15%; P=0.16). C onclusions-Compared with intermediate-WSS coronary segments, low-WSS segments develop greater plaque and necrotic core progression and constrictive remodeling, and high-WSS segments develop greater necrotic core and calcium progression, regression of fibrous and fibrofatty tissue, and excessive expansive remodeling, suggestive of transformation to a more vulnerable phenotype.
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页码:779 / 788
页数:10
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