Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients.
Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients.
复制标题
心肌桥患者冠状动脉斑块与壁剪切应力的共定位。
DOI：
10.1007/s13239-022-00616-4
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发表时间：
2022
影响因子：
1.8
通讯作者：
Marsden,Alison
中科院分区：
文献类型：
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作者：
Khan,MuhammadOwais;Nishi,Takeshi;Imura,Shinji;Seo,Jongmin;Wang,Hanjay;Honda,Yasuhiro;Nieman,Koen;Rogers,IanS;Tremmel,JenniferA;Boyd,Jack;Schnittger,Ingela;Marsden,Alison
目的心肌桥患者动脉粥样硬化发生率较高。壁面剪切应力（WSS）先前已与冠状动脉疾病患者的斑块相关，但这种相关性尚未在有症状的MB患者中进行研究。本文的目的是使用多尺度计算流体动力学（CFD）框架来模拟MB患者的血液动力学，并探讨WSS和plaque.MethodsWe identifiedN= 10例患者从先前报道的队列50症状MB患者，所有这些人都有斑块在近端血管。通过冠状动脉计算机断层扫描血管造影（CCTA）、血管内超声（IVUS）和导管血管造影重建动态3D模型。进行CFD模拟以计算MB近端、内部和远端的WSS。从IVUS图像中以2 mm段量化斑块，并将其配准到CFD模型。斑块面积与绝对值和患者标准化WSS.ResultsWSS在近端段低于桥段（6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm 2，p值< 0.01）。IVUS测量的斑块面积和斑块负荷在MB入口近端1-3 cm处达到峰值，与第一对角分支一致。标准化WSS与斑块面积呈中度相关（r= 0.41，p < 0.01）。结论WSS可作为MB患者斑块面积的替代指标。使用CFD，可以非侵入性地评估斑块面积的范围，并识别可以从频繁监测或医疗管理中受益的患者。
PurposePatients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque.MethodsWe identifiedN= 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS.ResultsWSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm2,pvalue < 0.01). Plaque area and plaque burden measured from IVUS peaked at 1–3 cm proximal to the MB entrance, coinciding with the first diagonal branch. Normalized WSS showed a statistically significant moderate correlation with plaque area (r= 0.41,p< 0.01).ConclusionWSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.