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. 2021 Jul 1;28(7):742-753.
doi: 10.5551/jat.56598. Epub 2020 Oct 2.

High Wall Shear Stress Is Related to Atherosclerotic Plaque Rupture in the Aortic Arch of Patients with Cardiovascular Disease: A Study with Computational Fluid Dynamics Model and Non-Obstructive General Angioscopy

Keisuke Kojima  1 , Takafumi Hiro  1 , Yutaka Koyama  1 , Akihito Ohgaku  1 , Hidesato Fujito  1 , Yasunari Ebuchi  1 , Riku Arai  1 , Masaki Monden  1 , Suguru Migita  1 , Tomoyuki Morikawa  1 , Takehiro Tamaki  1 , Nobuhiro Murata  1 , Naotaka Akutsu  1 , Toshihiko Nishida  1 , Daisuke Kitano  1 , Mitsumasa Sudo  1 , Daisuke Fukamachi  1 , Shunichi Yoda  1 , Tadateru Takayama  2 , Atsushi Hirayama  1   3 , Yasuo Okumura  1
Affiliations

High Wall Shear Stress Is Related to Atherosclerotic Plaque Rupture in the Aortic Arch of Patients with Cardiovascular Disease: A Study with Computational Fluid Dynamics Model and Non-Obstructive General Angioscopy

Keisuke Kojima et al. J Atheroscler Thromb. .

Abstract

Aims: Wall shear stress (WSS) has been considered a major determinant of aortic atherosclerosis. Recently, non-obstructive general angioscopy (NOGA) was developed to visualize various atherosclerotic pathologies, including in vivo ruptured plaque (RP) in the aorta. However, the relationship between aortic RP and WSS distribution within the aortic wall is unclear. This study aimed to investigate the relationship between aortic NOGA-derived RP and the stereographic distribution of WSS by computational fluid dynamics (CFD) modeling using three-dimensional computed tomography (3D-CT) angiography.

Methods: We investigated 45 consecutive patients who underwent 3D-CT before coronary angiography and NOGA during coronary angiography. WSS in the aortic arch was measured by CFD analysis based on the finite element method using uniform inlet and outlet flow conditions. Aortic RP was detected by NOGA.

Results: Patients with a distinct RP showed a significantly higher maximum WSS value in the aortic arch than those without aortic RP (56.2±30.6 Pa vs 36.2±19.8 Pa, p=0.017), no significant difference was noted in the mean WSS between those with and without aortic RP. In a multivariate logistic regression analysis, the presence of a maximum WSS value more than a specific value was a significant predictor of aortic RP (odds ratio 7.21, 95% confidence interval 1.78-37.1,p=0.005).

Conclusions: Aortic RP detected by NOGA was strongly associated with a higher maximum WSS in the aortic arch derived by CFD using 3D-CT. The maximum WSS value may have an important role in the underlying mechanism of not only aortic atherosclerosis, but also aortic RP.

Keywords: Aortic arch; Atherosclerotic ruptured plaque; Computational fluid dynamics; Non-obstructive general angioscopy; Wall shear stress.

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Figures

Supplemental Fig.1. Measurement of CT-derived geometric parameters of the aortic arch of interest
Supplemental Fig.1. Measurement of CT-derived geometric parameters of the aortic arch of interest
Markers A and B are first determined on the vessel adventitia along the inner curvature of the aortic wall within the same horizontal plane where the distance between the ascending and descending aortas is the minimum at the height of the bifurcation of the pulmonary trunk. Markers A' and B' are the gravity centers of the horizontal luminal cross-section of the ascending and descending aortas (the proximal and distal planes: P-plane and D-plane) within the same plane including Markers A and B. Then, the cross-sectional diameters at P-plane and D-plane are calculated by doubling distances of A-A’ and B-B’, and the center lumen line length (CLL) is measured along the aortic arch. The radius of the arch curvature (R-inc) is defined as half of the distance between A and B. The aortic arch tortuosity index is defined as CLL divided by R-inc. The maximum diameter of the aortic arch of interest is defined as the maximum lumen diameter perpendicular to the center lumen line.
Fig.1. Quantification of WSS in the aortic arch using CFD modeling on 3D-CT
Fig.1. Quantification of WSS in the aortic arch using CFD modeling on 3D-CT
(A) Initial reconstructed volume-rendered image of the whole body trunk. (B) The aorta was clipped from other tissue and extracted. (C) The aorta was applied to define a mesh polygon structure that was used for the analysis of CFD. (D) The CFD analysis was performed to calculate the distribution of WSS by using uniform inlet and outlet flow conditions. (E) Color mapping of the WSS distribution was then performed. CFD, computational fluid dynamics; WSS, wall shear stress
Fig. 2. Relationships between maximum and mean values of WSS and the presence of ruptured plaque in the whole, greater, and lesser curvatures of the aortic arch
Fig. 2. Relationships between maximum and mean values of WSS and the presence of ruptured plaque in the whole, greater, and lesser curvatures of the aortic arch
(A) maximum WSS; (B) mean WSS. WSS, wall shear stress
Fig.3. Representative images of color mapping of WSS and NOGA findings of the aortic arch
Fig.3. Representative images of color mapping of WSS and NOGA findings of the aortic arch
A 71-year-old man with hypertension, dyslipidemia, and smoking was admitted to our hospital due to a diagnosis of ischemic heart disease. Coronary arteriography and angioscopy were performed after CT angiography of the aortic arch. The maximum WSS value was higher in the greater curvature than in the lesser curvature. Then, NOGA finding showed aortic ruptured plaques (A, B) in the greater curvature which had much high WSS, although lipid plaques without ruptured plaque (C, D, E) were observed in the lesser curvature with relatively low WSS value. NOGA, non-obstructive general angioscopy; WSS, wall shear stress
Fig.4. ROC curve for maximum WSS predicting ruptured plaque in the aortic arch
Fig.4. ROC curve for maximum WSS predicting ruptured plaque in the aortic arch
ROC, receiver operating characteristics; WSS, wall shear stress
See this image and copyright information in PMC

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