Insights on atherosclerosis by non-invasive assessment of wall stress and arterial morphology along the length of human coronary plaques

Abstract

Wall stress (WS) is associated with high arterial pressure and affects the localization of atherosclerotic lesions. We sought to non-invasively investigate the distribution of WS along the length of human coronary arteries and investigate its potential effect on atherosclerosis in association with vascular stiffness, local arterial curvature and plaque volume. We reconstructed three-dimensionally 28 coronary arteries from 22 subjects who had undergone coronary computed tomography angiography. Coronary arteries were divided in 2 mm-long segments. WS, vascular stiffness, plaque volume and curvature were calculated in each segment using computational fluid dynamics and morphology measurements. Plaque segments exhibited lower WS compared to their adjacent normal segments. Within plaques, WS was lower in the mid plaque portion compared to the upstream portion. Plaque volume was higher in the mid plaque portion compared to upstream and downstream portions. Low WS was associated with high curvature and both low WS and high curvature were associated with increased plaque volume. The current study demonstrates that WS and plaque volume are not uniform in the longitudinal axis of human coronary plaque. Calculation of WS could serve as a surrogate for the localization of plaque development and the identification of plaques at a more advanced stage of progression.

Assessment of Dynamic Change of Coronary Artery Geometry and Its Relationship to Coronary Artery Disease, Based on Coronary CT Angiography

“…To our knowledge, this is the first patient study quantifying coronary geometry during the cardiac cycle based on straightforward post-processing of four-dimensional non-invasive imaging data. Previous studies focusing on the relation between vessel geometry, corresponding hemodynamics [7][8][9]11], and plaque development [6,18,19,24] were often based on computational fluid dynamics and were thus accompanied by modeling assumptions requiring a considerable amount of time and computational capacity [6,25]. These studies found that hemodynamic and geometric parameters can be linked to (early) plaque development, but conclusions were drawn based on modeling or static approaches of the coronary arteries.…”

“…The novelty of this research resides in its uniqueness to quantify characteristics of movement of the coronary arteries during the cardiac cycle in a non-invasive and three-dimensional way, and in the derivation of new quantitative imaging biomarkers based on cCTA scans. This study did not investigate the relationship between the absolute coronary artery geometry values and CAD as this relationship has already been assessed previously [17][18][19]. The current study is exploratory.…”

Novel Applications of Cardiovascular Magnetic Resonance Imaging-Based Computational Fluid Dynamics Modeling in Pediatric Cardiovascular and Congenital Heart Disease

“…Similarly, many other CFD studies have shown low WSS and high OSI are associated with atherosclerosis. In an adult coronary CT study, coronary segments with established plaque exhibited lower WSS compared to adjacent normal areas [53]. Within plaques, WSS was lower, and plaque volume was higher in mid-plaque compared to upstream and downstream areas (Figure 7) [53].…”

“…In an adult coronary CT study, coronary segments with established plaque exhibited lower WSS compared to adjacent normal areas [53]. Within plaques, WSS was lower, and plaque volume was higher in mid-plaque compared to upstream and downstream areas (Figure 7) [53]. In a study of carotid atherosclerosis, low time-averaged WSS and high OSI were seen in areas of increased mature plaque volume (Figure 8) [54].…”

“…Variation of wall stress (WS), wall stiffness, plaque volume, and curvature along a plaque (note that within plaques, wall shear stress was lower and plaque volume higher in mid-plaque compared to upstream and downstream areas)[53]. With permission from Katranas et al[53].…”