High spatial endothelial shear stress gradient independently predicts site of acute coronary plaque rupture and erosion

Abstract

Aims To investigate local haemodynamics in the setting of acute coronary plaque rupture and erosion. Methods and Results Intracoronary optical coherence tomography performed in 37 patients with acute coronary syndromes caused by plaque rupture (n = 19) or plaque erosion (n = 18) was used for 3D reconstruction and computational fluid dynamic simulation. Endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI) were compared between plaque rupture and erosion through mixed-effects logistic regression. Lipid, calcium, macrophages, layered plaque, and cholesterol crystals were also analysed. By multivariable analysis, only high ESSG (odds ratio [OR] 5.29, 95% confidence interval [CI] 2.57-10.89, p < 0.001), lipid (OR 12.98, 95% CI 6.57-25.67 p < 0.001), and layered plaque (OR 3.17, 95% CI 1.82-5.50, p < 0.001) were independently associated with plaque rupture. High ESSG (OR 13.28, 95% CI 6.88-25.64, p < 0.001), ESS (OR 2.70, 95% CI 1.34-5.42, p = 0.005) and OSI (OR 2.18, 95% CI 1.33-3.54, p = 0.002) independently associated with plaque erosion. ESSG was higher at rupture sites than erosion sites (median (interquartile range): 5.78 (2.47, 21.15) versus 2.62 (1.44, 6.18) Pa/mm, p = 0.009), OSI was higher at erosion sites than rupture sites (1.04x10−2 (2.3x10−3, 4.74x10−2) versus 1.29x10−3 (9.39x10−5, 3.0x10−2), p < 0.001), but ESS was similar (p = 0.29). Conclusions High ESSG is independently associated with plaque rupture while high ESSG, ESS, and OSI associate with plaque erosion. While ESSG is higher at rupture sites than erosion sites, OSI is higher at erosion sites and ESS was similar. These results suggest that ESSG and OSI may play critical roles in acute plaque rupture and erosion, respectively. Translational Perspective Plaque rupture and erosion are distinct pathological and clinical entities with possibly different optimal treatments. This study demonstrates that high endothelial shear stress gradient is independently associated with site of both rupture and erosion, and is significantly higher in rupture. High oscillatory shear index is independently associated with the site of erosion only, and is higher in erosion than rupture. Larger studies are necessary to determine whether these indices may detect and distinguish plaque rupture and erosion in a clinical setting or to assess overall risk for acute coronary syndromes.

The Association Between Plasma Hyaluronan Level and Plaque Types in ST-Segment–Elevation Myocardial Infarction Patients

“…A recent study demonstrated that plaque erosion was associated with high endothelial shear stress (ESS), spatial ESS gradient (ESSG), and oscillatory shear index (OSI). Particularly, the OSI in PE was significantly higher than PR (19,24). Meanwhile, an experimental study suggested that hyaluronan expression on the endothelial surface was reduced when exposed to oscillatory flow, which was regulated by Krüppel-like Factor 2 (25).…”

Focal Geometry and Characteristics of Erosion-Prone Coronary Plaques in vivo Angiography and Optical Coherence Tomography Study

“…Disturbed flow and oscillatory WSS can influence the site of atherosclerotic plaque formation and development of culprit PE. Low ESS has been associated with lipid, and high ESS has been correlated with the site of acute erosion and thrombosis ( 19 ). Moreover, reduced ability to repair wounds of endothelial cells near sidebranches compared with non-branch regions might also facilitate culprit PE formation ( 20 ).…”

Predictors of Coronary Plaque Erosion in Current and Non-Current Smokers With ST-Segment Elevation Myocardial Infarction ― An Optical Coherence Tomography Study ―

“…A nearby bifurcation will increase the endothelial sheer stress of the main vessel and further accelerate coronary endothelial injury, leading to thrombosis and plaque erosion. 38,39 Furthermore, in vivo local shear stress directly influences endothelial cell apoptosis in plaques associated with oscillatory shear stress downstream of the plaques, where plaque erosion tends to occur. 40,41 Also, unlike plaque rupture that is mostly associated with TCFAs, plaque erosion is not only typically associated with fibrous plaque, but also lipid plaque including LRP and TCFA.…”