Coronary Artery Wall Shear Stress Is Associated With Progression and Transformation of Atherosclerotic Plaque and Arterial Remodeling in Patients With Coronary Artery Disease

• Published in: Circulation (New York, N.Y.) Vol. 124; no. 7; pp. 779 - 788
• Main Authors: SAMADY, Habib, ESHTEHARDI, Parham, MCDANIEL, Michael C, JIN SUO, DHAWAN, Saurabh S, MAYNARD, Charles, TIMMINS, Lucas H, QUYYUMI, Arshed A, GIDDENS, Don P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 16-08-2011
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Calcinosis - diagnostic imaging; Calcinosis - pathology; Calcinosis - physiopathology; Cardiology. Vascular system; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary Artery Disease - physiopathology; Coronary heart disease; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Coronary Vessels - physiopathology; Disease Progression; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Fibrosis; Heart; Humans; Hydrodynamics; Male; Medical sciences; Middle Aged; Necrosis; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - pathology; Plaque, Atherosclerotic - physiopathology; Prospective Studies; Stress, Mechanical; Ultrasonography, Interventional - methods; Human; coronary artery disease; intravascular ultrasonography; Coronary artery; Cardiovascular disease; Coronary heart disease; interventional; Vascular disease; Atherosclerotic plaque; Atherosclerosis; Echography; wall shear stress; Shear stress; Hemodynamics
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.111.021824

Experimental studies suggest that low wall shear stress (WSS) promotes plaque development and high WSS is associated with plaque destabilization. We hypothesized that low-WSS segments in patients with coronary artery disease develop plaque progression and high-WSS segments develop necrotic core progression with fibrous tissue regression.
Twenty patients with coronary artery disease underwent baseline and 6-month radiofrequency intravascular ultrasound (virtual histology intravascular ultrasound) and computational fluid dynamics modeling for WSS calculation. For each virtual histology intravascular ultrasound segment (n=2249), changes in plaque area, virtual histology intravascular ultrasound-derived plaque composition, and remodeling were compared in low-, intermediate-, and high-WSS categories. Compared with intermediate-WSS segments, low-WSS segments developed progression of plaque area (P=0.027) and necrotic core (P<0.001), whereas high-WSS segments had progression of necrotic core (P<0.001) and dense calcium (P<0.001) and regression of fibrous (P<0.001) and fibrofatty (P<0.001) tissue. Compared with intermediate-WSS segments, low-WSS segments demonstrated greater reduction in vessel (P<0.001) and lumen area (P<0.001), and high-WSS segments demonstrated an increase in vessel (P<0.001) and lumen (P<0.001) area. These changes resulted in a trend toward more constrictive remodeling in low- compared with high-WSS segments (73% versus 30%; P=0.06) and more excessive expansive remodeling in high- compared with low-WSS segments (42% versus 15%; P=0.16).
Compared with intermediate-WSS coronary segments, low-WSS segments develop greater plaque and necrotic core progression and constrictive remodeling, and high-WSS segments develop greater necrotic core and calcium progression, regression of fibrous and fibrofatty tissue, and excessive expansive remodeling, suggestive of transformation to a more vulnerable phenotype. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00576576.