Localized elevation of shear stress is related to coronary plaque rupture - A 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution
Localized elevation of shear stress is related to coronary plaque rupture - A 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution
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DOI：
10.1016/j.jacc.2007.10.030
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发表时间：
2008-02-12
影响因子：
24
通讯作者：
Matsuzaki, Masunori
中科院分区：
文献类型：
--
作者：
Fukumoto, Yusaku;Hiro, Takafumi;Matsuzaki, Masunori
目的应用三维血管内超声（IVUS）技术，通过一种新的剪切力彩色成像程序，评价剪切力分布与冠状动脉斑块破裂的关系。背景各种体外研究表明，血管腔剪切力是冠状动脉斑块易损性的重要决定因素之一。然而，在体内之间的关系剪切应力和斑块rupture.Methods在本研究中，三维血管内超声被用来获得空间信息的管腔几何形状从20例急性冠状动脉综合征有一个明显的溃疡性病变。首先将每个管腔的这些三维轮廓重建成网格多边形，然后通过用于计算流体动力学的程序进行分析。流动被认为是一个恒定的层流。然后，对流线、血压和剪切应力的分布进行彩色映射。通过平滑和外推获得每个破裂病变的原始管腔轮廓。结果所有患者的冠状动脉斑块破裂均位于斑块山的近端或顶部。在颜色映射中，可以在每个斑块表面上观察到血压和切应力的局部升高。结论虽然切应力的绝对值不足以直接引起纤维帽的机械破坏，但局部高切应力可能是纤维帽破裂的触发因素。
Objectives The purpose of the present study was to assess the relationship between shear stress distribution and coronary plaque rupture by means of a new color-mapping program of shear stress with 3-dimensional intravascular ultrasound (IVUS).Background Various in-vitro studies have demonstrated that shear stress of the vascular lumen is one of the important determinants of coronary plaque vulnerability. However, the in-vivo relationship between shear stress and plaque rupture is still unclear.Methods In the present study, 3-dimensional IVUS was used to obtain spatial information on luminal geometry from 20 patients with acute coronary syndrome having a distinct ulcerative lesion. These 3-dimensional contours for each lumen were first reconstructed into mesh polygons, and then analyzed by means of a program for calculating the fluid dynamics. The flow was considered to be a constant laminar one. Then, colorized mappings of the distribution of the streamline, blood pressure, and shear stress were performed. The original luminal contour for each ruptured lesion was obtained by smoothing and extrapolation.Results All patients had a coronary plaque rupture in the proximal or top portion of the plaque hill. In the color mapping, localized elevation of blood pressure and shear stress could be observed on each plaque surface. The shear stress concentration was frequently correlated with the plaque rupture site (kappa = 0.79).Conclusions Although the absolute value of shear stress is not sufficient to directly provoke mechanical destruction of the fibrous cap, localized high shear stress might be a trigger of fibrous cap rupture.