Abstract
PurposeThe relationship between low endothelial shear stress (ESS) and coronary atherosclerosis is well established. ESS assessment so far depended on invasive procedures. The aim of this study was to demonstrate the relationship between ESS and coronary atherosclerosis by using non-invasive coronary computed tomography angiography (CTA) for computational fluid dynamics (CFD) simulations.MethodsA total number of 7 consecutive patients with suspected coronary artery disease who received CTA and invasive angiography with IVUS analysis were included in this study. CTA examinations were performed using a dual-source scanner. These datasets were used to build a 3D mesh model. CFD calculations were performed using a validated CFD solver. The presence of plaque was assumed if the thickness of the intima-media complex exceeded 0.3 mm in IVUS. Plaque composition was derived by IVUS radiofrequency data analysis.ResultsPlaque was present in 32.1% of all analyzed cross-sections. Plaque prevalence was highest in areas of low ESS (49.6%) and high ESS (34.8%). In parts exposed to intermediate-low and intermediate-high ESS few plaques were found (20.0% and 24.0%) (p<0.001). Wall thickness was closely associated with local ESS. Intima-media thickness was 0.43±0.34mm in low and 0.38±0.32mm in high ESS segments. It was significantly lower when the arterial wall was exposed to intermediate ESS (0.25±0.18mm and 0.28 ± 0.20mm) (p<0.001). Fibrofatty tissue was predominately found in areas exposed to low ESS (p≤0.023).ConclusionsIn this study a close association of atherosclerotic plaque distribution and ESS pattern could be demonstrated in-vivo. Adding CFD analysis to coronary CTA offers the possibility to gather morphologic and physiologic data within one non-invasive examination.
Highlights
The localization of coronary atherosclerotic lesions is not randomly distributed but shows a characteristic pattern with preferred locations at branches or bends [1]
The aim of this study was to demonstrate the relationship between endothelial shear stress (ESS) and coronary atherosclerosis by using non-invasive coronary computed tomography angiography (CTA) for computational fluid dynamics (CFD) simulations
A total number of 7 consecutive patients with suspected coronary artery disease who received CTA and invasive angiography with intravascular ultrasound (IVUS) analysis were included in this study
Summary
The localization of coronary atherosclerotic lesions is not randomly distributed but shows a characteristic pattern with preferred locations at branches or bends [1]. The complex geometry of the vessel causes a distortion of the laminar flow up to local flow stagnation or reversal. This results in locally different levels of endothelial shear stress (ESS). Using computational fluid dynamics (CFD) ESS and other flow dependent parameters can be calculated if an accurate description of the vessel geometry is available. In the coronary circulation most CFD studies so far relied on invasive procedures such as invasive angiography and intravascular ultrasound (IVUS), limiting the results to high risk patients with indication for cardiac catheterization [5,6,7]
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