Implications of the local haemodynamic forces on the phenotype of coronary plaques.

MedStar author(s):
Citation: Heart. 105(14):1078-1086, 2019 07.PMID: 30877239Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Coronary Vessels | *Endothelium, Vascular | *Myocardial Infarction | *Plaque, Atherosclerotic | *Regional Blood Flow | *Tomography, Optical Coherence/mt [Methods] | *Ultrasonography, Interventional/mt [Methods] | Coronary Artery Disease/di [Diagnosis] | Coronary Artery Disease/pp [Physiopathology] | Coronary Artery Disease/th [Therapy] | Coronary Vessels/dg [Diagnostic Imaging] | Coronary Vessels/pp [Physiopathology] | Dimensional Measurement Accuracy | Disease Progression | Endothelium, Vascular/pa [Pathology] | Endothelium, Vascular/pp [Physiopathology] | Female | Humans | Male | Middle Aged | Multimodal Imaging | Myocardial Infarction/di [Diagnosis] | Myocardial Infarction/et [Etiology] | Myocardial Infarction/su [Surgery] | Percutaneous Coronary Intervention/is [Instrumentation] | Percutaneous Coronary Intervention/mt [Methods] | Plaque, Atherosclerotic/co [Complications] | Plaque, Atherosclerotic/dg [Diagnostic Imaging] | Plaque, Atherosclerotic/pp [Physiopathology] | Shear Strength/ph [Physiology]Year: 2019Local holdings: Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1355-6037
Name of journal: Heart (British Cardiac Society)Abstract: AIM: To examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque phenotype.CLINICAL TRIAL REGISTRATION: NCT00962416; Post-results. Copyright (c) Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.CONCLUSIONS: The effect of ESS on plaque progression is similar in all phenotypes and cannot be accurately assessed by standalone IVUS-VH which often misclassifies plaque morphology. Therefore, multimodality imaging should be considered to examine the implications of ESS on plaque evolution.METHODS: Patients with myocardial infarction that had intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT) at baseline and 13-month follow-up were studied. The IVUS-VH data were used to reconstruct the nonculprit vessels, and in the obtained models the ESS was estimated in 3 mm segments. Plaque morphology was derived in each segment from IVUS-VH and OCT. Disease progression was defined as the presence of >=2 out of the following criteria: reduction in lumen area, increase in plaque burden and change of plaque morphology to a more vulnerable phenotype. Linear mixed effects models were used to assess the effect of ESS in different phenotypes.RESULTS: Sixty-eight vessels were included in the analysis. Low ESS was associated with plaque progression in all phenotypes. The effect of ESS on plaque burden (p for interaction=0.467) and phenotype (p for interaction=0.188) was similar in all plaque types, whereas the effect of ESS on the changes in lumen dimensions was more prominent in disease-free (beta=0.70, p<0.001) than fibrotic/fibrocalcific (beta=0.28, p<0.001) or lipid-rich plaques (beta=0.15, p=0.015). Standalone IVUS-VH misclassified plaque morphology in one-third of the cases leading to erroneous estimations about the effect of ESS on plaque evolution in different phenotypes.All authors: Baumbach A, Bourantas CV, Fotiadis D, Garcia-Garcia HM, Heg D, Karagiannis A, Mihalis L, Moschovitis A, Raber L, Ramasamy A, Sakellarios A, Serruys P, Taniwaki M, Torii R, Windecker S, Yamaji K, Zanchin TOriginally published: Heart. 105(14):1078-1086, 2019 07.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30877239 Available 30877239

Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006

AIM: To examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque phenotype.

CLINICAL TRIAL REGISTRATION: NCT00962416; Post-results. Copyright (c) Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

CONCLUSIONS: The effect of ESS on plaque progression is similar in all phenotypes and cannot be accurately assessed by standalone IVUS-VH which often misclassifies plaque morphology. Therefore, multimodality imaging should be considered to examine the implications of ESS on plaque evolution.

METHODS: Patients with myocardial infarction that had intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT) at baseline and 13-month follow-up were studied. The IVUS-VH data were used to reconstruct the nonculprit vessels, and in the obtained models the ESS was estimated in 3 mm segments. Plaque morphology was derived in each segment from IVUS-VH and OCT. Disease progression was defined as the presence of >=2 out of the following criteria: reduction in lumen area, increase in plaque burden and change of plaque morphology to a more vulnerable phenotype. Linear mixed effects models were used to assess the effect of ESS in different phenotypes.

RESULTS: Sixty-eight vessels were included in the analysis. Low ESS was associated with plaque progression in all phenotypes. The effect of ESS on plaque burden (p for interaction=0.467) and phenotype (p for interaction=0.188) was similar in all plaque types, whereas the effect of ESS on the changes in lumen dimensions was more prominent in disease-free (beta=0.70, p<0.001) than fibrotic/fibrocalcific (beta=0.28, p<0.001) or lipid-rich plaques (beta=0.15, p=0.015). Standalone IVUS-VH misclassified plaque morphology in one-third of the cases leading to erroneous estimations about the effect of ESS on plaque evolution in different phenotypes.

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