Abstract 13156: The Location of Combined High-Risk Low Endothelial Shear Stress and High Plaque Structural Stress is Distant From the Minimal Lumen Area in the Majority of Coronary Plaques Responsible for Major Adverse Cardiac Events
Abstract 13156: The Location of Combined High-Risk Low Endothelial Shear Stress and High Plaque Structural Stress is Distant From the Minimal Lumen Area in the Majority of Coronary Plaques Responsible for Major Adverse Cardiac Events
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摘要 13156：在导致主要不良心脏事件的大多数冠状动脉斑块中，高风险低内皮剪切应力和高斑块结构应力的组合位置远离最小管腔区域
DOI：
10.1161/circ.146.suppl_1.13156
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发表时间：
2022
期刊：
影响因子：
37.8
通讯作者：
Ahmed M
中科院分区：
文献类型：
--
作者：
Ahmed M
引言：多个高风险预后特征的存在增强了易发生不稳定和主要不良心脏事件（MACE）的斑块的风险分层。高风险特征的空间叠加（一致性）可能会放大局部风险。局部内皮剪切应力（ESS）和斑块结构应力（PSS）指标可预测MACE，但其空间一致性及其相对于最小管腔面积（MLA）的位置尚不清楚。如果最高风险的斑块面积是远离MLA，然后PCI的MLA单独将离开高风险斑块areas untreated.Purpose：为了确定低ESS和高PSS异质性（HI）的高风险特征的网站沿着的过程中的一个斑块的患者谁开发MACE，和网站的空间一致性相对于MLA.Methods：我们检查ESS，PSS，PSS HI在22个非罪犯病变（NCL）导致MACE，和64个随机选择的对照NCL没有MACE的前景研究。ESS通过计算流体动力学计算，PSS通过有限元分析计算。结果< 1.3 Pa and PSS HI >：3年随访时，低ESS+高PSS HI斑块与单纯低ESS斑块相比，MACE发生率显著增高（72.7%vs27.3%，p <0.001）。在16个低ESS+高PSS HI的MACE斑块中，14个表现出空间一致的高风险值，2个表现出空间不一致的高风险值（87.5% vs 12.5%，p=0.01）。在14个具有一致性值的斑块中，有26个具有高风险一致性的局灶性斑块区域。从一致的高风险区域到MLA的平均距离为13.2 ± 11.6 mm（图）。结论：高风险ESS和PSS措施经常共同定位于导致未来MACE的斑块中，并且远离MLA。仅对MLA区域进行PCI可能会使许多高风险区域得不到治疗。
Introduction:The presence of multiple high-risk prognostic features enhances risk-stratification of plaques prone to destabilization and major adverse cardiac events (MACE). Spatial superimposition of high-risk features (concordance) likely amplifies local risk. Local endothelial shear stress (ESS) and plaque structural stress (PSS) metrics predict MACE, but their spatial concordance and their location relative to the minimal lumen area (MLA) is unknown. If the highest-risk plaque area is distant from the MLA, then PCI of the MLA alone will leave high-risk plaque areas untreated.Purpose:To identify the site of high-risk features of low ESS and high PSS heterogeneity (HI) along the course of a plaque in patients who develop MACE, and the site of their spatial concordance relative to the MLA.Methods:We examined ESS, PSS, and PSS HI in 22 non-culprit lesions (NCL) leading to MACE, and 64 randomly selected control NCLs without MACE from the PROSPECT study. ESS was calculated by computational fluid dynamics and PSS by finite element analysis on co-registered lesions. We examined high-risk plaques with empirically-derived (ROC curve) ESS < 1.3 Pa and PSS HI > 0.29 in 16 lesions leading to future MACE, and 11 control lesions without MACE.Results:MACE outcomes were significantly more frequent in plaques with combined low ESS+high PSS HI vs plaques with low ESS alone (72.7% vs 27.3%, p<0.001) at 3 years follow-up. Of the 16 MACE plaques with both low ESS+high PSS HI, 14 exhibited high-risk values that were spatially concordant vs 2 that were discordant (87.5% v 12.5%, p=0.01). In the 14 plaques with concordant values, there were 26 focal plaque areas with high-risk concordance. The mean distance from the concordant high-risk areas to the MLA was 13.2 ± 11.6 mm (Figure).Conclusion:High-risk ESS and PSS measures frequently co-localize in plaques responsible for future MACE, and are substantially distant from the MLA. PCI of the MLA area alone may leave many high-risk areas untreated.