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

by Garcia-Garcia, Hector M.

Citation: ; Heart. 105(14):1078-1086, 2019 07..Journal: Heart (British Cardiac Society).Published: ; 2019; ISSN: 1355-6037.Full author list: 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 T.UI/PMID: 30877239.Subject(s): Coronary Artery Disease/di [Diagnosis] | *Ultrasonography, Interventional/mt [Methods] | *Tomography, Optical Coherence/mt [Methods] | Shear Strength/ph [Physiology] | *Regional Blood Flow | *Plaque, Atherosclerotic | Plaque, Atherosclerotic/pp [Physiopathology] | Plaque, Atherosclerotic/dg [Diagnostic Imaging] | Plaque, Atherosclerotic/co [Complications] | Percutaneous Coronary Intervention/mt [Methods] | Percutaneous Coronary Intervention/is [Instrumentation] | *Myocardial Infarction | Myocardial Infarction/su [Surgery] | Myocardial Infarction/et [Etiology] | Myocardial Infarction/di [Diagnosis] | Multimodal Imaging | Middle Aged | Male | Humans | Female | *Endothelium, Vascular | Endothelium, Vascular/pp [Physiopathology] | Endothelium, Vascular/pa [Pathology] | Disease Progression | Dimensional Measurement Accuracy | *Coronary Vessels | Coronary Vessels/pp [Physiopathology] | Coronary Vessels/dg [Diagnostic Imaging] | Coronary Artery Disease/th [Therapy] | Coronary Artery Disease/pp [Physiopathology]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, Non-U.S. Gov'tDigital Object Identifier: https://dx.doi.org/10.1136/heartjnl-2018-314086 (Click here) Abbreviated citation: ; Heart. 105(14):1078-1086, 2019 07.Local Holdings: Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006.Abstract: AIM: To examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque phenotype.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: 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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