Quantifying the effect of side branches in endothelial shear stress estimates.
Quantifying the effect of side branches in endothelial shear stress estimates.
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DOI：
10.1016/j.atherosclerosis.2016.06.038
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发表时间：
2016-08
期刊：
影响因子：
5.3
通讯作者：
Mitsouras D
中科院分区：
文献类型：
--
作者：
Giannopoulos AA;Chatzizisis YS;Maurovich-Horvat P;Antoniadis AP;Hoffmann U;Steigner ML;Rybicki FJ;Mitsouras D
低和高内皮切应力（ESS）与冠状动脉粥样硬化进展和高危斑块特征相关。冠状动脉ESS目前是通过计算流体动力学（CFD）模拟管腔几何形状进行评估的，管腔几何形状是通过侵入性成像（如血管内超声和光学相干断层扫描）确定的。该过程通常省略CFD模型中的靶血管的侧支，因为这些血管的侵入性成像不是临床指示的。本研究的目的是确定在何种程度上这种简化影响的决定，这些地区的冠状动脉内皮病理ESS。我们确定了诊断的准确性ESS分析没有侧支检测病理ESS在5心脏成像离体冠状动脉CT血管造影。使用之前验证的CFD方法，在不包含（测试模型）和包含（参考模型）所有直径>1.5 mm的侧支的情况下计算了三条主要冠状动脉的ESS。针对每条主要冠状动脉的全长以及仅近端部分（大多数高风险斑块发生的位置），评估了参考模型的诊断试验特征（准确性、灵敏度、特异性和阴性和阳性预测值[NPV/PPV]）。无侧支模型检测低ESS的准确性、敏感性、特异性、NPV和PPV分别为83.4%、54.0%、96%、95.9%和55.1%，检测高ESS的准确性、敏感性、特异性、NPV和PPV分别为87.0%、67.7%、90.7%、93.7%和57.5%。低ESS和高ESS的测试特性不同，灵敏度低（67.7%）和高特异性（90.7%）检测低ESS，和低灵敏度（44.7%）和高特异性（95.5%）在ESS血管分析研究中排除侧支极大地降低了检测主要冠状动脉区域的能力单导管模型通常只能用于排除病理性ESS。
Low and high endothelial shear stress (ESS) is associated with coronary atherosclerosis progression and high-risk plaque features. Coronary ESS is currently assessed via computational fluid dynamic (CFD) simulation in the lumen geometry determined from invasive imaging such as intravascular ultrasound and optical coherence tomography. This process typically omits side branches of the target vessel in the CFD model as invasive imaging of those vessels is not clinically-indicated. The purpose of this study was to determine the extent to which this simplification affects the determination of those regions of the coronary endothelium subjected to pathologic ESS. We determined the diagnostic accuracy of ESS profiling without side branches to detect pathologic ESS in the major coronary arteries of 5 hearts imaged ex vivo with CT angiography. ESS of the three major coronary arteries was calculated both without (test model), and with (reference model) inclusion of all side branches >1.5 mm in diameter, using previously-validated CFD approaches. Diagnostic test characteristics (accuracy, sensitivity, specificity and negative and positive predictive value [NPV/PPV]) with respect to the reference model were assessed for both the entire length as well as only the proximal portion of each major coronary artery, where the majority of high-risk plaques occur. Using the model without side branches overall accuracy, sensitivity, specificity, NPV and PPV were 83.4%, 54.0%, 96%, 95.9% and 55.1%, respectively to detect low ESS, and 87.0%, 67.7%, 90.7%, 93.7% and 57.5%, respectively to detect high ESS. When considering only the proximal arteries, test characteristics differed for low and high ESS, with low sensitivity (67.7%) and high specificity (90.7%) to detect low ESS, and low sensitivity (44.7%) and high specificity (95.5%) to detect high ESS. The exclusion of side branches in ESS vascular profiling studies greatly reduces the ability to detect regions of the major coronary arteries subjected to pathologic ESS. Single-conduit models can in general only be used to rule out pathologic ESS.