Impact of combined plaque structural stress and wall shear stress on coronary plaque progression, regression, and changes in composition
Impact of combined plaque structural stress and wall shear stress on coronary plaque progression, regression, and changes in composition
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DOI：
10.1093/eurheartj/ehz132
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发表时间：
2019-05-07
影响因子：
39.3
通讯作者：
Bennett, Martin R.
中科院分区：
文献类型：
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作者：
Costopoulos, Charis;Timmins, Lucas H.;Bennett, Martin R.
目的动脉粥样硬化斑块的局灶性分布表明，局部生物力学因素可能会影响斑块development.Methods和结果我们研究了40例患者在基线和超过12个月的虚拟组织学血管内超声和双平面冠状动脉造影。我们计算了斑块结构应力（PSS）和壁面剪切应力（WSS），前者定义为管腔周围区域最大主应力的平均值，后者定义为血流在进展或消退区域的内皮表面上施加的平行摩擦力。计算每个配准帧的斑块面积、斑块负荷（PB）、坏死核心（NC）、纤维组织（FT）、纤维脂肪组织和致密钙的变化。共生成4029个共配准帧。在进展区域，高PSS与NC的较大增加和FT的较小增加相关，而低PSS与之相比（Delta NC差异：0.24 +/- 0.06mm（2）; P < 0.0001，Delta FT差异：-0.15 +/- 0.08mm（2）; P = 0.049）。在退化区域，高PSS与NC增加和FT减少相关（Delta NC差异：0.15 +/- 0.04; P = 0.0005，Delta FT差异：-0.31 +/- 0.06mm（2）; P < 0.0001）。低WSS与进展区域的PB增加相关（Δ PB差异：3.3 +/- 0.4%; P < 0.001），在消退区域观察到类似模式（Δ PB差异：1.2 +/- 0.4%; P = 0.004）。斑块结构应力和WSS在很大程度上相互独立（R-2 = 0.002; P = 0.001）。结论高PSS区域与斑块易损性增加的成分变化相关。WSS低的区域与进展区域中更多的斑块生长和消退区域中更少的斑块损失相关。PSS和WSS的相互作用可能决定斑块大小和组成的重要变化。
Aims The focal distribution of atherosclerotic plaques suggests that local biomechanical factors may influence plaque development.Methods and results We studied 40 patients at baseline and over 12 months by virtual-histology intravascular ultrasound and bi-plane coronary angiography. We calculated plaque structural stress (PSS), defined as the mean of the maximum principal stress at the peri-luminal region, and wall shear stress (WSS), defined as the parallel frictional force exerted by blood flow on the endothelial surface, in areas undergoing progression or regression. Changes in plaque area, plaque burden (PB), necrotic core (NC), fibrous tissue (FT), fibrofatty tissue, and dense calcium were calculated for each co-registered frame. A total of 4029 co-registered frames were generated. In areas with progression, high PSS was associated with larger increases in NC and small increases in FT vs. low PSS (difference in Delta NC: 0.24 +/- 0.06mm(2); P < 0.0001, difference in Delta FT: -0.15 +/- 0.08mm(2); P = 0.049). In areas with regression, high PSS was associated with increased NC and decreased FT (difference in Delta NC: 0.15 +/- 0.04; P = 0.0005, difference in Delta FT: -0.31 +/- 0.06mm(2); P < 0.0001). Low WSS was associated with increased PB vs. high WSS in areas with progression (difference in Delta PB: 3.3 +/- 0.4%; P < 0.001) with a similar pattern observed in areas with regression (difference in Delta PB: 1.2 +/- 0.4%; P = 0.004). Plaque structural stress and WSS were largely independent of each other (R-2 = 0.002; P = 0.001).Conclusion Areas with high PSS are associated with compositional changes consistent with increased plaque vulnerability. Areas with low WSS are associated with more plaque growth in areas that progress and less plaque loss in areas that regress. The interplay of PSS and WSS may govern important changes in plaque size and composition.