Local Low Shear Stress and Endothelial Dysfunction in Patients With Nonobstructive Coronary Atherosclerosis

• Published in: Journal of the American College of Cardiology Vol. 71; no. 19; pp. 2092 - 2102
• Main Authors: Siasos, Gerasimos, Sara, Jaskanwal D., Zaromytidou, Marina, Park, Kyoung H., Coskun, Ahmet Umit, Lerman, Lilach O., Oikonomou, Evangelos, Maynard, Charles C., Fotiadis, Dimitris, Stefanou, Kostas, Papafaklis, Michail, Michalis, Lampros, Feldman, Charles, Lerman, Amir, Stone, Peter H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-05-2018; Elsevier Limited
• Subjects: Acetylcholine; Adult; Angiography; Arteries; Arteriosclerosis; Atherosclerosis; Blood pressure; Cardiology; Cardiovascular disease; Computational fluid dynamics; coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary vessels; endothelial function; endothelial shear stress; Endothelium; Endothelium, Vascular - diagnostic imaging; Endothelium, Vascular - physiopathology; Female; Fluid dynamics; Health risk assessment; Humans; Hydrodynamics; Hypertension; Male; Medical imaging; microvascular disease; Microvasculature; Middle Aged; Patients; Prospective Studies; Random Allocation; Regression analysis; Retrospective Studies; Segments; Shear Strength - physiology; Shear stress; Stenosis; Stress, Mechanical; Ultrasound; atherosclerosis; coronary artery disease; endothelial function; endothelium; NO; MLA; endothelial shear stress; ESS; PT; CBF; IVUS; microvascular disease; LAD; PA; PB; hs-CRP
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.02.073

Local hemodynamic factors are important determinants of atherosclerotic plaque development and progression.
The goal of this study was to determine the association between low endothelial shear stress (ESS) and microvascular and epicardial endothelial dysfunction in patients with early atherosclerosis.
Sixty-five patients (mean age 52 ± 11 years) with nonobstructive coronary atherosclerosis (luminal diameter stenosis <30%) were included. Microvascular and epicardial coronary endothelial function was assessed by using intracoronary acetylcholine infusion. Vascular profiling, using 2-plane coronary angiography and intravascular ultrasound, was used to reconstruct the three-dimensional anatomy of the left anterior descending artery. Each reconstructed artery was divided into sequential 3-mm segments and analyzed for local ESS with computational fluid dynamics; that is, lower ESS levels at both a 3-mm regional level (average ESS and low ESS) and at a vessel level (lowest ESS per artery) and for plaque characteristics (plaque area, plaque thickness, and plaque burden).
Coronary segments in arteries with abnormal microvascular function exhibited lower ESS compared with segments in arteries with normal microvascular function (average ESS: 1.67 ± 1.04 Pa vs. 2.03 ± 1.72 Pa [p = 0.050]; lowest ESS: 0.54 ± 0.25 Pa vs. 0.72 ± 0.32 Pa [p = 0.014]). Coronary segments in arteries with abnormal epicardial endothelial function also exhibited significantly lower ESS compared with segments in arteries with normal epicardial function (average ESS: 1.49 ± 0.89 Pa vs. 1.93 ± 1.50 Pa [p < 0.0001]; low ESS: 1.26 ± 0.81 Pa vs. 1.56 ± 1.30 Pa [p = 0.001]; lowest ESS: 0.51 ± 0.27 Pa vs. 0.65 ± 0.29 Pa [p = 0.080]). Patients with abnormal microvascular endothelial function exhibited a progressive decrease in average and low ESS, starting from patients with normal epicardial endothelial function to those with both microvascular and epicardial endothelial dysfunction (p < 0.0001 and p = 0.004, respectively).
These data indicate an association between dysfunction of the microvascular and epicardial endothelium and local ESS at the early stages of coronary atherosclerosis in humans.
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