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

Chatzizisis, Yiannis S.; Toutouzas, Konstantinos; Giannopoulos, Andreas A.; Riga, Maria; Antoniadis, Antonios; Fujinom, Yusuke; Mitsouras, Dimitrios; Koutkias, Vassilis; Cheimariotis, Grigorios-Aris; Doulaverakis, Charalampos; Tsampoulatidis, Ioannis; Chouvarda, Ioanna; Kompatsiaris, Ioannis; Nakamura, Sunao; Rybicki, Frank J.; Maglaveras, Nicos; Tousoulis, Dimitris; Giannoglou, George D.

doi:10.1093/ehjci/jew134

Cited by 31 publications

(20 citation statements)

References 23 publications

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“…In line with previous large studies, this study showed that the large plaque size at baseline was the most powerful predictor of increased plaque burden and worsening of clinically relevant luminal obstructions needing revascularization at follow-up. In a recently published cross-sectional study, optical coherence tomography (OCT)-derived CFD and plaque analysis was done in 30 patients with stable angina or ACS [51]. WSS was classified into low (≤25 th percentile), moderate (between 25th and 75th percentiles), and high (≥75 percentile) based on the distribution of WSS values in each artery.…”

Section: High Wall Shear Stressmentioning

confidence: 99%

“…), and endpoints [27,53]. Overall, it seems that the few studies [36,37,51] that failed to show an association between high WSS and high-risk plaques or showed an association between low WSS and features of high-risk plaques suffered from two common limitations: 1) dividing segments to only low and non-low WSS (no separation of high from normal/intermediate WSS) and/or 2) lack or limited number of segments with significant disease and therefore limited number of segments with high WSS. While the interplay between atherosclerotic plaque, artery, and WSS seems to be very dynamic and the exact mechanism of rapid plaque progression and triggers of expansive remodeling as well as the role of WSS in these processes is unclear, it is possible that both extremes of WSS (lower and higher than normal/physiologic WSS) are associated with high-risk plaque features at different phases of atherosclerotic plaque development.…”

Section: High Wall Shear Stressmentioning

confidence: 99%

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High wall shear stress and high-risk plaque: an emerging concept

Eshtehardi

Brown

Bhargava

et al. 2017

Int J Cardiovasc Imaging

117

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In recent years, there has been a significant effort to identify high-risk plaques in vivo prior to acute events. While number of imaging modalities have been developed to identify morphologic characteristics of high-risk plaques, prospective natural-history observational studies suggest that vulnerability is not solely dependent on plaque morphology and likely involves additional contributing mechanisms. High wall shear stress (WSS) has recently been proposed as one possible causative factor, promoting the development of high-risk plaques. High WSS has been shown to induce specific changes in endothelial cell behavior, exacerbating inflammation and stimulating progression of the atherosclerotic lipid core. In line with experimental and autopsy studies, several human studies have shown associations between high WSS and known morphological features of high-risk plaques. However, despite increasing evidence, there is still no longitudinal data linking high WSS to clinical events. As the interplay between atherosclerotic plaque, artery, and WSS is highly dynamic, large natural history studies of atherosclerosis that include WSS measurements are now warranted. This review will summarize the available clinical evidence on high WSS as a possible etiological mechanism underlying high-risk plaque development.

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Section: High Wall Shear Stressmentioning

confidence: 99%

Section: High Wall Shear Stressmentioning

confidence: 99%

High wall shear stress and high-risk plaque: an emerging concept

Eshtehardi

Brown

Bhargava

et al. 2017

Int J Cardiovasc Imaging

117

View full text Add to dashboard Cite

show abstract

“…Low fluid shear makes it easier for inflammatory cells such as leukocytes to initiate the inflammatory process. 26,27 High intramural stresses and strain stretch the cell gap junctions, enhancing inflammatory cells' infiltration into the vessel wall. 17,24,25 A previous simulation study on patient selection found that the prosthetic valve is especially beneficial for CVD CEAP clinical class 4e6 with significant reflux that enhances valve motion.…”

Section: The Role Of Solid Stresses On Mechanobiologymentioning

confidence: 99%

Search for an Optimal Design of a Bioprosthetic Venous Valve: In silico and in vitro Studies

Chen

Tien

Chambers

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Valve incompetence is a progressive disease of the venous system that may lead to deep venous thrombosis. There is a need for a venous valve prosthesis to replace incompetent valves. However, computational and experimental studies on venous valve and associated haemodynamics are limited. The current study addresses this gap and creates a scientific platform for potential correlations with clinical pathological development and effective venous prostheses. Objective/background: Valve incompetence is a progressive disease of the venous system that may eventually lead to venous hypertension, pain, and ulcers. There is a need for a venous valve prosthesis to replace incompetent valves. Computational and experimental investigations on venous valve design and associated haemodynamics will undoubtedly advance prosthesis design and treatments. Here, the objective is to investigate the effect of venous valve on the fluid and solid mechanics. The hypothesis is that there exists a valve geometry that maximises leaflet shear stress (LSS) but minimises leaflet intramural stress (LIS; i.e., minimise stress ratio ¼ LIS/LSS). Methods: To address the hypothesis, fully dynamic fluidestructure interaction (FSI) models were developed. The entire cycle of valve opening and closure was simulated. The flow validation experiments were conducted using a stented venous valve prosthesis and a pulse duplicator flow loop. Results: Agreement between the output of FSI simulations and output of pulse duplicator was confirmed. The maximum flow rates were within 6% difference, and the total flow during the cycle was within 10% difference. The simulated high stress ratio region at the leaflet base (five times the leaflet average) predicted the disease location of the vast majority of explanted venous valves reported in clinical literature. The study found that the reduced valve height and leaflet dome shape resulted in optimal performance to provide the lowest stress ratio. Conclusion: This study proposes an effective design of venous prostheses and elaborates on the correlations of venous valve with clinical observations.

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“…Clinical studies using computed tomography (CT) angiography, quantitative coronary angiography, and intravascular ultrasound have frequently detected atherosclerotic lesions at the bifurcation or curvature of coronary arteries 2 – 6 ) . Blood flow was found to be disturbed in these areas, and arterial wall shear stress was low and oscillated 5 , 7 ) . Seneviratne et al 8 ) reviewed the relationship between changes in arterial wall shear stress and plaque development and destabilization.…”

Section: Introductionmentioning

confidence: 98%

The Coronary Artery Running Pattern is One of the Causes of Individual Differences in the Progression of Coronary Atherosclerosis in WHHLMI Rabbits, an Animal Model for Coronary Atherosclerosis

Nagasaka

Koike

Tsukada

et al. 2018

JAT

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Aims: The relationship between the coronary artery running pattern and development of coronary lesions was re-examined herein using WHHLMI rabbits, an animal model of spontaneous coronary atherosclerosis.Methods: The coronary artery running pattern was analyzed using an X-ray computed tomography (CT) apparatus after perfusion. Pathological sections were prepared (Victoria blue-HE staining) at 100 µm intervals from the origin of the left circumflex artery (LCX). The severity of coronary lesions was evaluated based on cross-sectional narrowing (lesion area/inner area of the internal elastic lamina).Results: In the CT analysis, the angle of the main curvature of the LCX negatively correlated with the percentage of sections with lesions and cross-sectional narrowing. The percentage of sections with lesions was significantly higher in acute angle-type LCX than in obtuse angle-type LCX. Cross-sectional narrowing was also significantly greater in acute angle-type LCX than in obtuse angle-type LCX. The percentage of fibrous lesions was high at the proximal region of LCX, whereas that of lipid-rich lesions was high at the curvature. In 24 months age group, the percentage of sections with calcification in acute angle-type LCX was about twice that in obtuse angle-type LCX.Conclusions: Individual differences were observed in the angle of the main curvature of the LCX, which affected the occurrence and extension of atherosclerotic lesions.

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

Abstract: 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.

Cited by 31 publications

References 23 publications

High wall shear stress and high-risk plaque: an emerging concept

High wall shear stress and high-risk plaque: an emerging concept

Search for an Optimal Design of a Bioprosthetic Venous Valve: In silico and in vitro Studies

The Coronary Artery Running Pattern is One of the Causes of Individual Differences in the Progression of Coronary Atherosclerosis in WHHLMI Rabbits, an Animal Model for Coronary Atherosclerosis

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