Multidirectional wall shear stress promotes advanced coronary plaque development: comparing five shear stress metrics
Multidirectional wall shear stress promotes advanced coronary plaque development: comparing five shear stress metrics
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DOI：
10.1093/cvr/cvz212
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发表时间：
2020-05-01
影响因子：
10.8
通讯作者：
Wentzel, Jolanda J.
中科院分区：
文献类型：
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作者：
Hoogendoorn, Ayla;Kok, Annette M.;Wentzel, Jolanda J.
目的动脉粥样硬化斑块的发展与壁切应力（WSS）相关。然而，血流的多向性，因此WSS，很少考虑。这项研究的目的是全面比较五个指标，方法和结果成年家族性高胆固醇血症猪（n=10）被喂食高脂肪饮食，在三个时间点[3（T-1），9（T-2），和10-12（T-3）个月]。使用动脉腔的三维几何结构结合局部流速测量值计算T-1和T-2时的WSS。为了进行分析，将动脉分成3 mm/45度扇区（n=3648）。通过近红外光谱血管内超声、光学相干断层扫描成像和组织学评估了壁厚和最终斑块组成的变化。在晚期和轻度疾病的猪中，最高的斑块进展率仅在T-1和T-2的低时间平均WSS（TAWSS）或高多向WSS区域发现。然而，最终最大的菌斑生长位于初始低TAWSS或高多向WSS的区域，随着时间的推移，在T-2时暴露于高TAWSS或低多向WSS。除斑块大小外，最后一个时间点易损斑块成分的存在也与低和多向WSS相关。几乎所有的WSS指标对斑块的发展（47-50%）和晚期纤维帽粥样硬化（FCA）的发展（59-61%）具有良好的预测价值。FCA发展的多方向WSS指标的高预测值表明其作为易感疾病的额外临床标志物的潜力。
Aims Atherosclerotic plaque development has been associated with wall shear stress (WSS). However, the multidirectionality of blood flow, and thus of WSS, is rarely taken into account. The purpose of this study was to comprehensively compare five metrics that describe (multidirectional) WSS behaviour and assess how WSS multidirectionality affects coronary plaque initiation and progression.Methods and results Adult familial hypercholesterolaemic pigs (n=10) that were fed a high-fat diet, underwent imaging of the three main coronary arteries at three-time points [3 (T-1), 9 (T-2), and 10-12 (T-3) months]. Three-dimensional geometry of the arterial lumen, in combination with local flow velocity measurements, was used to calculate WSS at T-1 and T-2. For analysis, arteries were divided into 3mm/45 degrees sectors (n=3648). Changes in wall thickness and final plaque composition were assessed with near-infrared spectroscopy-intravascular ultrasound, optical coherence tomography imaging, and histology. Both in pigs with advanced and mild disease, the highest plaque progression rate was exclusively found at low time-averaged WSS (TAWSS) or high multidirectional WSS regions at both T-1 and T-2. However, the eventually largest plaque growth was located in regions with initial low TAWSS or high multidirectional WSS that, over time, became exposed to high TAWSS or low multidirectional WSS at T-2. Besides plaque size, also the presence of vulnerable plaque components at the last time point was related to low and multidirectional WSS. Almost all WSS metrics had good predictive values for the development of plaque (47-50%) and advanced fibrous cap atheroma (FCA) development (59-61%).Conclusion This study demonstrates that low and multidirectional WSS promote both initiation and progression of coronary atherosclerotic plaques. The high-predictive values of the multidirectional WSS metrics for FCA development indicate their potential as an additional clinical marker for the vulnerable disease.