Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of ‘shear stress score’

Aims The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes. Methods and results A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89 ± 84 vs.138 ± 83 µm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina. Conclusion Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.

[1]  P. Stone,et al.  Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling: current understanding and remaining questions. , 2012, Cardiovascular research.

[2]  R. Virmani,et al.  Biomechanical factors in atherosclerosis: mechanisms and clinical implications. , 2014, European heart journal.

[3]  Anouk L. Post,et al.  Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs , 2015, Circulation.

[4]  V. Fuster,et al.  The myth of the "vulnerable plaque": transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment. , 2015, Journal of the American College of Cardiology.

[5]  E. Edelman,et al.  Risk stratification of individual coronary lesions using local endothelial shear stress: a new paradigm for managing coronary artery disease , 2007, Current opinion in cardiology.

[6]  Michail I. Papafaklis,et al.  Natural History of Experimental Coronary Atherosclerosis and Vascular Remodeling in Relation to Endothelial Shear Stress: A Serial, In Vivo Intravascular Ultrasound Study , 2010, Circulation.

[7]  N. Bruining,et al.  Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures , 2012, European heart journal.

[8]  Yiannis Kompatsiaris,et al.  IVUSAngio Tool: A publicly available software for fast and accurate 3D reconstruction of coronary arteries , 2013, Comput. Biol. Medicine.

[9]  R. Virmani,et al.  Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[10]  Michael Jonas,et al.  Thin-Capped Atheromata With Reduced Collagen Content in Pigs Develop in Coronary Arterial Regions Exposed to Persistently Low Endothelial Shear Stress , 2013, Arteriosclerosis, thrombosis, and vascular biology.

[11]  Michail I. Papafaklis,et al.  Endothelial Shear Stress and Coronary Plaque Characteristics in Humans: Combined Frequency-Domain Optical Coherence Tomography and Computational Fluid Dynamics Study , 2014, Circulation. Cardiovascular imaging.

[12]  Michail I. Papafaklis,et al.  Prediction of Progression of Coronary Artery Disease and Clinical Outcomes Using Vascular Profiling of Endothelial Shear Stress and Arterial Plaque Characteristics: The PREDICTION Study , 2012, Circulation.

[13]  Michael C. McDaniel,et al.  Coronary Artery Wall Shear Stress Is Associated With Progression and Transformation of Atherosclerotic Plaque and Arterial Remodeling in Patients With Coronary Artery Disease , 2011, Circulation.

[14]  E. Edelman,et al.  Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. , 2007, Journal of the American College of Cardiology.

[15]  Ioanna Chouvarda,et al.  Accurate and reproducible reconstruction of coronary arteries and endothelial shear stress calculation using 3D OCT: comparative study to 3D IVUS and 3D QCA. , 2015, Atherosclerosis.

[16]  Milan Sonka,et al.  Remodeling characteristics of minimally diseased coronary arteries are consistent along the length of the artery. , 2006, The American journal of cardiology.

[17]  Akiko Maehara,et al.  Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. , 2012, Journal of the American College of Cardiology.

[18]  R. Virmani,et al.  Clinical classification of plaque morphology in coronary disease , 2014, Nature Reviews Cardiology.

[19]  E. Edelman,et al.  Prediction of the Localization of High-Risk Coronary Atherosclerotic Plaques on the Basis of Low Endothelial Shear Stress: An Intravascular Ultrasound and Histopathology Natural History Study , 2008, Circulation.

[20]  Dimitrios I Fotiadis,et al.  Anatomically correct three-dimensional coronary artery reconstruction using frequency domain optical coherence tomographic and angiographic data: head-to-head comparison with intravascular ultrasound for endothelial shear stress assessment in humans. , 2015, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[21]  Michael Jonas,et al.  Augmented Expression and Activity of Extracellular Matrix-Degrading Enzymes in Regions of Low Endothelial Shear Stress Colocalize With Coronary Atheromata With Thin Fibrous Caps in Pigs , 2011, Circulation.

[22]  Hang Lee,et al.  Reproducibility of in vivo measurements for fibrous cap thickness and lipid arc by OCT. , 2012, JACC. Cardiovascular imaging.