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. 2022 Nov 17;23(12):1708-1716.
doi: 10.1093/ehjci/jeac095.

Detailed behaviour of endothelial wall shear stress across coronary lesions from non-invasive imaging with coronary computed tomography angiography

Inge J van den Hoogen  1 , Jussi Schultz  2 , Jurrien H Kuneman  1 , Michiel A de Graaf  1 , Vasileios Kamperidis  1 , Alexander Broersen  3 , J Wouter Jukema  1 , Antonis Sakellarios  4   5 , Sotirios Nikopoulos  6 , Savvas Kyriakidis  4   5 , Katerina K Naka  6 , Lampros Michalis  6 , Dimitrios I Fotiadis  4   5 , Teemu Maaniitty  2 , Antti Saraste  2   7 , Jeroen J Bax  1   7 , Juhani Knuuti  1   2
Affiliations

Detailed behaviour of endothelial wall shear stress across coronary lesions from non-invasive imaging with coronary computed tomography angiography

Inge J van den Hoogen et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Evolving evidence suggests that endothelial wall shear stress (ESS) plays a crucial role in the rupture and progression of coronary plaques by triggering biological signalling pathways. We aimed to investigate the patterns of ESS across coronary lesions from non-invasive imaging with coronary computed tomography angiography (CCTA), and to define plaque-associated ESS values in patients with coronary artery disease (CAD).

Methods and results: Symptomatic patients with CAD who underwent a clinically indicated CCTA scan were identified. Separate core laboratories performed blinded analysis of CCTA for anatomical and ESS features of coronary atherosclerosis. ESS was assessed using dedicated software, providing minimal and maximal ESS values for each 3 mm segment. Each coronary lesion was divided into upstream, start, minimal luminal area (MLA), end and downstream segments. Also, ESS ratios were calculated using the upstream segment as a reference. From 122 patients (mean age 64 ± 7 years, 57% men), a total of 237 lesions were analyzed. Minimal and maximal ESS values varied across the lesions with the highest values at the MLA segment [minimal ESS 3.97 Pa (IQR 1.93-8.92 Pa) and maximal ESS 5.64 Pa (IQR 3.13-11.21 Pa), respectively]. Furthermore, minimal and maximal ESS values were positively associated with stenosis severity (P < 0.001), percent atheroma volume (P < 0.001), and lesion length (P ≤ 0.023) at the MLA segment. Using ESS ratios, similar associations were observed for stenosis severity and lesion length.

Conclusions: Detailed behaviour of ESS across coronary lesions can be derived from routine non-invasive CCTA imaging. This may further improve risk stratification.

Keywords: atherosclerosis; computational fluid dynamics; coronary artery disease; coronary computed tomography angiography; endothelial wall shear stress.

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Conflict of interest statement

Conflict of interest: Dr Saraste received consultancy fees from Amgen, Astra Zeneca, Boehringer Ingelheim, and Pfizer and speaker fees from Abbott, Astra Zeneca, and Bayer. Dr Bax received speaker fees from Abbot Vascular and Edwards Lifesciences. Dr Knuuti received consultancy fees from GE Healthcare and AstraZeneca and speaker fees from GE Healthcare, Bayer, Lundbeck, and Merck, outside of the submitted work. The Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands has received unrestricted research grants from Bayer, Abbott Vascular, Medtronic, Biotronik, Boston Scientific, GE Healthcare, and Edwards Lifesciences. The remaining authors have no relevant disclosures.

Figures

Graphical Abstract
Graphical Abstract
Schematic representation of the study design and patients (left panel), the comprehensive image analysis process including blinded analysis of anatomical and ESS features of coronary atherosclerosis (middle panel), and the patterns of ESS across lesions (right panel). Images are partly derived and adjusted from Ohayon et al., Biomechanics of coronary atherosclerotic plaque: from model to patient, Academic Press, 1st edition, chapter 9, page 207, copyright 2020 and Puchner et al., High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial, Journal of the American College of Cardiology, volume 64, page 687, copyright 2014, both with permission from Elsevier., CAD, coronary artery disease; CCTA, coronary computed tomography angiography; ESS, endothelial wall shear stress.
Figure 1
Figure 1
ESS characteristics of coronary lesions. Bar charts depict the median minimal (A) and maximal (B) ESS values with IQR bars (y-axis: increased values = increased median ESS in Pa) for 5 locations across the 237 lesions (x-axis; upstream segment, start segment, MLA segment, end segment, downstream segment). ESS, endothelial wall shear stress; MLA, minimal luminal area.
Figure 2
Figure 2
ESS characteristics of coronary lesions using ratios. Bar charts depict the median minimal (A) and maximal (B) ESS ratios with IQR bars (y-axis: increased values = increased median ratio) for 5 locations across the 237 lesions (x-axis; upstream segment, start segment, MLA segment, end segment, downstream segment). Minimal and maximal ESS ratios were calculated as: minimal or maximal ESS value at the segment of that specific location/minimal or maximal ESS value at the upstream segment. Hence, these ratios were always 1.0 at the upstream segment (i.e. reference). ESS, endothelial wall shear stress; MLA, minimal luminal area.
See this image and copyright information in PMC

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