Journal article
Regions of low endothelial shear stress are the sites where coronary plaque progresses and vascular remodelling occurs in humans: an in vivo serial study
European heart journal, Vol.28(6), pp.705-710
03/2007
DOI: 10.1093/eurheartj/ehl575
PMID: 17347172
Abstract
Aim We performed serial intracoronary studies of patients with stable coronary artery disease (CAD) to investigate the relationships among baseline endothelial shear stress (ESS), CAD progression, and vascular remodelling. Local haemodynamic factors are critical determinants of plaque progression, vascular remodelling, and clinical CAD manifestations.
Methods and results The 3-D anatomy of coronary arteries with lumen obstruction <50% was determined by fusing intracoronary ultrasound and angiographic images in 13 patients at baseline and 8 ± 2 months later. Cross-sectional area of plaque, lumen, and external elastic membrane (EEM), and coronary flow were measured. Local ESS was calculated. Subsegments with similar ESS were categorized based on low (<12 dynes/cm2) and moderate/higher ESS (≥12 dynes/cm2). There were 47 subsegments of similar baseline ESS: nine with low ESS and 38 with moderate/higher ESS. Median subsegment length was 6.9 mm (25th-75th percentiles = 4.2-12.0), and median area of similar ESS of 52.6 mm2 (25th-75th percentiles = 26.9-88.0). Subsegments with low ESS exhibited plaque progression when compared with subsegments with moderate/higher ESS (33.3% vs. 7.9%, respectively, P = 0.009 adjusted for clustering of lesions within patients) and constrictive remodelling (44.0% vs. 5.3%, respectively, P = 0.16 adjusted for clustering of lesions within patients). Expansive remodelling occurred with similar frequency in subsegments with low vs. moderate/higher baseline ESS.
Conclusion Plaque progresses in subsegments with low ESS, associated with either constrictive or expansive remodelling. Different mechanisms are likely responsible for expansive remodelling in different local vascular environments. Early in vivo identification of arterial subsegments likely to develop high-risk plaque characteristics may allow for selective interventions to avoid adverse cardiac outcomes.
Details
- Title: Subtitle
- Regions of low endothelial shear stress are the sites where coronary plaque progresses and vascular remodelling occurs in humans: an in vivo serial study
- Creators
- Peter H Stone - 1 Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USAAhmet Umit Coskun - 2 Northeastern University, USAScott Kinlay - 1 Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USAJeffrey J Popma - 1 Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USAMilan Sonka - 3 University of Iowa, USAAndreas Wahle - 3 University of Iowa, USAYerem Yeghiazarians - 1 Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USACharles Maynard - 4 Department of Health Services, University of Washington, Seattle, WA, USARichard E Kuntz - 1 Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USACharles L Feldman - 1 Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street Boston, MA 02115, USA
- Resource Type
- Journal article
- Publication Details
- European heart journal, Vol.28(6), pp.705-710
- DOI
- 10.1093/eurheartj/ehl575
- PMID
- 17347172
- NLM abbreviation
- Eur Heart J
- ISSN
- 0195-668X
- eISSN
- 1522-9645
- Publisher
- Oxford University Press
- Alternative title
- P.H. Stone et al. Shear stress, plaque progression, and remodelling
- Language
- English
- Date published
- 03/2007
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Electrical and Computer Engineering; Radiation Oncology; Injury Prevention Research Center; Ophthalmology and Visual Sciences
- Record Identifier
- 9984047860002771
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