Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of 'shear stress score'
Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of 'shear stress score'
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DOI：
10.1093/ehjci/jew134
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发表时间：
2017-08-01
影响因子：
6.2
通讯作者：
Giannoglou, George D.
中科院分区：
文献类型：
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作者：
Chatzizisis, Yiannis S.;Toutouzas, Konstantinos;Giannoglou, George D.
低内皮剪切应力（ESS）与高危斑块（HRP）的相关性尚未在人体中进行彻底研究。我们使用光学相干断层扫描（OCT）研究了HRP中的局部ESS和管腔重塑模式，开发了剪切应力评分，方法与结果30例稳定型心绞痛或急性冠状动脉综合征（ACS）患者的35支冠状动脉采用三维重建技术（3D）进行三维重建，并与正常对照组比较。使用计算流体动力学计算ESS，并在3 mm长的子节段中将其分为低、中和高。在每个亚段中，（i）根据纤维帽（FC）厚度和脂质池大小将纤维粥样硬化（FA）分为HRP和非HRP，（ii）将管腔重塑分为收缩性、代偿性和扩张性。在每个动脉中，计算剪切应力评分作为低ESS的范围和严重程度的度量。与高ESS相比，低ESS亚段中的FA具有更薄的FC（89 +/- 84 vs. 138 +/- 83 μ m，P，0.05）。低ESS亚段主要与HRP共定位，而非HRP（29 vs. 9%，P，0. 05），高ESS亚段主要与非HRP共定位（9 vs. 24%，P，0. 05）。代偿性和扩张性管腔重塑是ESS和HRPs低的亚段内的主要反应。在非狭窄性FA中，低ESS与HRPs vs.非HRPs相关（29 vs. 3%，P，0.05）。结论局部ESS评分降低和扩张性管腔重构与HRP有关。剪切应力评分增加的动脉具有增加的HRP频率和出现ACS的倾向。
Aims The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes.Methods and results A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89 +/- 84 vs. 138 +/- 83 mu m, P, 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P, 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P, 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P, 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina.Conclusion Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.