Implications of the local haemodynamic forces on the phenotype of coronary plaques.
Implications of the local haemodynamic forces on the phenotype of coronary plaques.
- 2019
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.
English
1355-6037
10.1136/heartjnl-2018-314086 [doi] heartjnl-2018-314086 [pii]
*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]
MedStar Heart & Vascular Institute
Journal Article
Research Support, Non-U.S. Gov't
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.
English
1355-6037
10.1136/heartjnl-2018-314086 [doi] heartjnl-2018-314086 [pii]
*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]
MedStar Heart & Vascular Institute
Journal Article
Research Support, Non-U.S. Gov't