High Coronary Wall Shear Stress Worsens Plaque Vulnerability: A Systematic Review and Meta-Analysis.

Artan Bajraktari,Ibadete Bytyçi,Michael Y Henein

doi:10.1177/0003319721991722

Abstract

Aim:The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability.Methods:We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) −0.11 (95% CI: −0.20 to −0.02, P = .02) and fibrofatty area, WMD −0.09 (95% CI: −0.17 to −0.01, P = .02), reduction in plaque total area, WMD −0.09 (95% CI: −0.14 to −0.04, P = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm2; P > .05). High WSS resulted in profound remodeling (40% vs 18%, P < .05) and with more constructive remodeling than low WSS (78% vs 40%, P < .01).Conclusions:High WSS in coronary arteries is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared with low WSS.

Highlights

Atherosclerosis is a major health problem worldwide because of its related high morbidity, hospitalization, and mortality.1 Despite major advances in the treatment of coronary artery disease (CAD), a large number of patients who are apparently healthy have a cardiovascular (CV) event or die suddenly without prior symptoms
Additional searches for potential trials which included the references of review articles and the abstracts from selected congresses including the scientific sessions of the European Society of Cardiology, the American Heart Association, American College of Cardiology (ACC), and European Association of Cardiovascular Imaging were undertaken
18 of the 25 articles were further excluded according to the eligibility criteria (Table 1) leaving 7 articles to be included in the final analysis5,6,18-22 (Supplementary file 2)

Summary

Introduction

Atherosclerosis is a major health problem worldwide because of its related high morbidity, hospitalization, and mortality. Despite major advances in the treatment of coronary artery disease (CAD), a large number of patients who are apparently healthy have a cardiovascular (CV) event or die suddenly without prior symptoms. Despite major advances in the treatment of coronary artery disease (CAD), a large number of patients who are apparently healthy have a cardiovascular (CV) event or die suddenly without prior symptoms. Available diagnostic techniques are not adequate for identifying patients at high risk of developing events. Recognizing the role of arterial vulnerable plaque as a cause for those events has become an important diagnostic target in CV medicine.. If evidence is provided regarding the role of WSS in predicting plaque stability, it would promote further research. The aim of this meta-analysis is to assess the impact of WSS on coronary artery plaque features and vulnerability

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Conclusion