scholarly journals The definition of low wall shear stress and its effect on plaque progression estimation in human coronary arteries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eline M. J. Hartman ◽  
Giuseppe De Nisco ◽  
Frank J. H. Gijsen ◽  
Suze-Anne Korteland ◽  
Anton F. W. van der Steen ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Coronary Arteries ◽  
Multimodality Imaging ◽  
Population Level ◽  
Plaque Progression ◽  
Specific Flow ◽  
The Absolute ◽  
Wall Shear ◽  
The Individual

AbstractWall shear stress (WSS), the frictional force of the blood on the vessel wall, plays a crucial role in atherosclerotic plaque development. Low WSS has been associated with plaque growth, however previous research used different approaches to define low WSS to investigate its effect on plaque progression. In this study, we used four methodologies to allocate low, mid and high WSS in one dataset of human coronary arteries and investigated the predictive power of low WSS for plaque progression. Coronary reconstructions were based on multimodality imaging, using intravascular ultrasound and CT-imaging. Vessel-specific flow was measured using Doppler wire and computational fluid dynamics was performed to calculate WSS. The absolute WSS range varied greatly between the coronary arteries. On the population level, the established pattern of most plaque progression at low WSS was apparent in all methodologies defining the WSS categories. However, for the individual patient, when using measured flow to determine WSS, the absolute WSS values range so widely, that the use of absolute thresholds to determine low WSS was not appropriate to identify regions at high risk for plaque progression.

P3588The synergistic effect of NIRS-detected lipid-rich plaque and 5 different multidirectional wall shear stress metrics on human coronary plaque growth

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E M J Hartman ◽  
A M Kok ◽  
A Hoogendoorn ◽  
F J H Gijsen ◽  
A F W Steen ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Synergistic Effect ◽  
Coronary Arteries ◽  
Wall Thickness ◽  
Plaque Progression ◽  
Lipid Rich Plaque ◽  
Plaque Growth ◽  
Wall Shear ◽  
The Impact

Abstract Introduction Local wall shear stress (WSS) metrics, high local lipid levels (as detected by near-infrared spectroscopy (NIRS)), as well as systemic lipid levels, have been individually associated with atherosclerotic disease progression. However, a possible synergistic effect remains to be elucidated. This study is the first study to combine WSS metrics with NIRS-detected local lipid content to investigate a potential synergistic effect on plaque progression in human coronary arteries. Methods The IMPACT study is a prospective, single centre study investigating the relation between atherosclerotic plaque progression and WSS in human coronary arteries. Patients with ACS treated with PCI were included. At baseline and after 1-year follow-up, patients underwent near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) imaging and intravascular doppler flow measurements of at least one non-culprit coronary artery. After one month, a CT angiography was made. CT derived centreline combined with IVUS lumen contours resulted in a 3D reconstruction of the vessel. The following WSS metrics were computed using computational fluid dynamics applying the vessel specific invasive flow measurements: time-average wall shear stress (TAWSS), relative residence time (RRT), cross-flow index, oscillatory shear index and transverse wall shear stress. Low TAWSS is known as pro atherogenic, in contrast to all the other shear stress metrics, at which a high magnitude is pro-atherogenic. The arteries were divided into 1.5mm/45° sectors. Based on NIRS-IVUS, wall thickness change over time was determined and NIRS positive sectors detected. Furthermore, per vessel the shear stress was divided into tertiles (low, intermediate, high). To investigate the synergistic effect of local lipids on shear stress related plaque growth, wall thickness change over time was related to the different shear stress metrics comparing the NIRS-positive with the NIRS-negative sectors. Results 15 non-culprit coronary arteries from the first 14 patients were analyzed (age 62±10 years old and 92.9% male). A total of 2219 sectors were studied (5.2%, N=130, NIRS-positive) for wall thickness changes. After studying all five shear stress metrics, we found for TAWSS and RRT that presence of lipids, as detected by NIRS, amplified the effect of shear stress on plaque progression (see figure). Sectors presenting with lipid-rich plaque, compared to NIRS-negative sectors, showed more progression when they were exposed to low TAWSS (p=0.07) or high RRT (p=0.012) and more regression in sectors exposed to high TAWSS (p=0.10) or low RRT (p=0.06). Delta wall thickness vs shear stress Conclusion We presented the first preliminary results of the IMPACT study, showing the synergistic effect of lipid rich plaque and shear stress on plaque progression. Therefore, intravascular lipid-rich plaque (NIRS) assessment has added value to shear stress profiling for the prediction of plaque growth, leading to improved risk stratification. Acknowledgement/Funding ERC starting grant 310457

scholarly journals An assessment of intra-patient variability on observed relationships between wall shear stress and plaque progression in coronary arteries

2015 ◽  
Vol 14 (Suppl 1) ◽  
pp. S2 ◽  
Author(s):  
David S Molony ◽  
Lucas H Timmins ◽  
Olivia Y Hung ◽  
Emad Rasoul-Arzrumly ◽  
Habib Samady ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Coronary Arteries ◽  
Plaque Progression ◽  
Wall Shear

Exploring wall shear stress spatiotemporal heterogeneity in coronary arteries combining correlation-based analysis and complex networks with computational hemodynamics

2020 ◽  
Vol 234 (11) ◽  
pp. 1209-1222 ◽  
Author(s):  
Karol Calò ◽  
Giuseppe De Nisco ◽  
Diego Gallo ◽  
Claudio Chiastra ◽  
Ayla Hoogendoorn ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Complex Networks ◽  
Coronary Arteries ◽  
Early Stage ◽  
Flow Direction ◽  
Computational Hemodynamics ◽  
Time Histories ◽  
Wall Shear

Atherosclerosis at the early stage in coronary arteries has been associated with low cycle-average wall shear stress magnitude. However, parallel to the identification of an established active role for low wall shear stress in the onset/progression of the atherosclerotic disease, a weak association between lesions localization and low/oscillatory wall shear stress has been observed. In the attempt to fully identify the wall shear stress phenotype triggering early atherosclerosis in coronary arteries, this exploratory study aims at enriching the characterization of wall shear stress emerging features combining correlation-based analysis and complex networks theory with computational hemodynamics. The final goal is the characterization of the spatiotemporal and topological heterogeneity of wall shear stress waveforms along the cardiac cycle. In detail, here time-histories of wall shear stress magnitude and wall shear stress projection along the main flow direction and orthogonal to it (a measure of wall shear stress multidirectionality) are analyzed in a representative dataset of 10 left anterior descending pig coronary artery computational hemodynamics models. Among the main findings, we report that the proposed analysis quantitatively demonstrates that the model-specific inlet flow-rate shapes wall shear stress time-histories. Moreover, it emerges that a combined effect of low wall shear stress magnitude and of the shape of the wall shear stress–based descriptors time-histories could trigger atherosclerosis at its earliest stage. The findings of this work suggest for new experiments to provide a clearer determination of the wall shear stress phenotype which is at the basis of the so-called arterial hemodynamic risk hypothesis in coronary arteries.

scholarly journals Fusion of fibrous cap thickness and wall shear stress to assess plaque vulnerability in coronary arteries: a pilot study

2016 ◽  
Vol 11 (10) ◽  
pp. 1779-1790 ◽  
Author(s):  
Guillaume Zahnd ◽  
Jelle Schrauwen ◽  
Antonios Karanasos ◽  
Evelyn Regar ◽  
Wiro Niessen ◽  
...  
Keyword(s):  
Shear Stress ◽  
Pilot Study ◽  
Wall Shear Stress ◽  
Coronary Arteries ◽  
Plaque Vulnerability ◽  
Fibrous Cap ◽  
Wall Shear ◽  
Fibrous Cap Thickness

scholarly journals Temporal and spatial changes in wall shear stress during atherosclerotic plaque progression in mice

2018 ◽  
Vol 5 (3) ◽  
pp. 171447 ◽  
Author(s):  
R. Xing ◽  
A. M. Moerman ◽  
Y. Ridwan ◽  
M. J. Daemen ◽  
A. F. W. van der Steen ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Mouse Model ◽  
Atherosclerotic Plaque ◽  
Proximal Part ◽  
Plaque Progression ◽  
Plaque Composition ◽  
Spatial Changes ◽  
Temporal And Spatial ◽  
Wall Shear

Wall shear stress (WSS) is involved in atherosclerotic plaque initiation, yet its role in plaque progression remains unclear. We aimed to study (i) the temporal and spatial changes in WSS over a growing plaque and (ii) the correlation between WSS and plaque composition, using animal-specific data in an atherosclerotic mouse model. Tapered casts were placed around the right common carotid arteries (RCCA) of ApoE −/− mice. At 5, 7 and 9 weeks after cast placement, RCCA geometry was reconstructed using contrast-enhanced micro-CT. Lumen narrowing was observed in all mice, indicating the progression of a lumen intruding plaque. Next, we determined the flow rate in the RCCA of each mouse using Doppler Ultrasound and computed WSS at all time points. Over time, as the plaque developed and further intruded into the lumen, absolute WSS significantly decreased. Finally at week 9, plaque composition was histologically characterized. The proximal part of the plaque was small and eccentric, exposed to relatively lower WSS. Close to the cast a larger and concentric plaque was present, exposed to relatively higher WSS. Lower WSS was significantly correlated to the accumulation of macrophages in the eccentric plaque. When pooling data of all animals, correlation between WSS and plaque composition was weak and no longer statistically significant. In conclusion, our data showed that in our mouse model absolute WSS strikingly decreased during disease progression, which was significantly correlated to plaque area and macrophage content. Besides, our study demonstrates the necessity to analyse individual animals and plaques when studying correlations between WSS and plaque composition.

Abstract 15816: Normal Distribution of Wall Shear Stress in the Coronary Arteries

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anna Starikov ◽  
Guanglei Xiong ◽  
James K Min
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Coronary Arteries ◽  
Cfd Simulation ◽  
Tangential Force ◽  
Significant Coronary Artery Disease ◽  
Improve Patient Care ◽  
Coronary Ct ◽  
Wall Shear ◽  
Multi Center Study

Introduction: The ability to detect hemodynamically significant coronary artery disease non-invasively has been a goal that has the potential to improve patient care significantly. New non-invasive approaches using coronary CT angiograms (CCTAs) have been proposed and appear to show some promise. Hypothesis: One such method is the measurement of measuring wall shear stress (WSS), the tangential force of flowing blood against the artery wall, using computational fluid dynamics (CFD). However, in order to deem this technique useful in clinical practice, the normal values must first be defined. These values have been minimally reported and are limited to the left coronary tree. Methods: We ran a CFD simulation of WSS on 3-D reconstructions of the coronary arteries derived from the CCTAs of 35 patients with either no disease or non-obstructive (< 50%) stenosis from the DeFACTO trial, a multi-center study. The resulting model was segmented according to the Society of Cardiovascular CT guidelines, separating the proximal and distal parts of each artery as well as the major side branches. The segments were composed of WSS values at hundreds of points along the vessel wall. The median value was taken as a representative of each segment. Results: The average values were calculated and varied significantly from one another, especially the proximal and distal parts of the same artery, as showing in Figure 1. Conclusions: These results establish the first known WSS distribution within all of the coronary arteries and serve as a foundation for defining a cut-off for abnormal values. Importantly, they also illuminate the variability of WSS that occurs even throughout a single artery and suggests that perhaps multiple abnormal cutoffs need to be established to evaluate WSS based on the location of the stenosis.

A Review On the Effect of Temporal Geometric Variations of the Coronary Arteries On the Wall Shear Stress and Pressure Drop

2021 ◽  
Author(s):  
Navid Freidoonimehr ◽  
Rey Chin ◽  
Anthony C. Zander ◽  
Maziar Arjomandi
Keyword(s):  
Shear Stress ◽  
Pressure Drop ◽  
Wall Shear Stress ◽  
Coronary Arteries ◽  
Cardiac Cycle ◽  
Temporal Variations ◽  
Hemodynamic Parameters ◽  
Clinical Environment ◽  
Cross Sectional ◽  
Wall Shear

Abstract Temporal variations of the coronary arteries during a cardiac cycle are defined as the superposition of the changes in the position, curvature, and torsion of the coronary artery axis markers and the variations in the lumen cross-sectional shape due to the distensible wall motion induced by the pulse pressure and contraction of the myocardium in a cardiac cycle. This review discusses whether the modelling the temporal variations of the coronary arteries is needed for the investigation of the hemodynamics specifically in time critical applications such as a clinical environment. The numerical modellings in the literature which model or disregard the temporal variations of the coronary arteries on the hemodynamic parameters are discussed. The results in the literature show that neglecting the effects of temporal geometric variations is expected to result in about 5\% deviation of the time-averaged pressure drop and wall shear stress values and also about 20\% deviation of the temporal variations of hemodynamic parameters, such as time-dependent wall shear stress and oscillatory shear index. This review study can be considered as a guide for the future studies to outline the conditions in which temporal variations of the coronary arteries can be neglected, while providing a reliable estimation of hemodynamic parameters.

Plaque Progression in a Human Coronary Artery is Associated With Low Wall Shear Stress and Extended Particle Residence Time

2010 ◽  
Author(s):  
Jin Suo ◽  
Michael McDaniel ◽  
Parham Eshtehardi ◽  
Saurabh Dhawan ◽  
Ravi Prasad Avati Nanjundappa ◽  
...  
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Residence Time ◽  
Vigorous Physical Activity ◽  
Region Of Interest ◽  
Reconstruction Technique ◽  
Plaque Progression ◽  
Human Coronary Artery ◽  
Wall Shear

Intravascular ultrasound (IVUS) evaluation was performed in the coronary arteries of a 45-year-old patient with stable angina during vigorous physical activity. Concurrent angiography demonstrated a mild plaque in the proximal left anterior descending artery (LAD), with obvious lumen dilatation immediately distal to the plaque. Blood velocity was measured by a catheter Doppler transducer at proximal and distal segments of the left coronary artery, and the left main artery (LM) and LAD were reconstructed using a 3D-IVUS reconstruction technique based on biplanar angiography and IVUS images, enabling simulation of the flow field in the artery employing computational fluid dynamics (CFD). Wall shear stress (WSS) and particle path lines were determined from the CFD studies. The patient returned for a follow up evaluation after 6 months, and plaque progression during this period was evaluated from the IVUS data. Results showed that low WSS, less than 5 dynes/cm2, which occurs in the region immediately distal to the plaque, correlates with localized progression of the lesion over the 6 month interval. The path line tracking computations showed that particles near the vessel surface where plaque progression was observed resided near the artery wall longer than one complete cardiac cycle, whereas in other areas particles were flushed through the region of interest rapidly. These observations in a specific individual are consistent with the hypothesis that plaque progression is related to low WSS and relatively long residence time of atherogenic blood-borne substances.

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