Abstract
Epidemiological studies have proposed heart rate as an independent risk factor for cardiovascular disease [1]. Animal studies demonstrated that elevated heart rate and heart rate fluctuation are associated with plaque formation [2]. A subgroup analysis of the BEAUTIFUL study has shown the significance of lower heart rate in patients with stable coronary disease and left ventricular dysfunction [3]. Endothelial shear stress (ESS) is the tangential frictional force of the flowing blood on the endothelium. Low ESS promotes atherosclerosis through endothelial receptors and a mechanotransduction cytoplasmic process [4,5]. Molecular viscosity (MV) represents the intrinsic blood resistance as the friction between the adjacent parallel fluid layers. The Edinburg Artery Study suggested that highMV promotes ischemic heart disease and is a risk factor of cardiovascular disease in addition to conventional ones [6]. Mechanical forces and cardiac motion play a possible key role in atherosclerosis. During cardiac cycle coronary arteries are subject to forces which may affect the localization of plaque growth. Curvature refers to the deviation from straightness and is an index of the mechanical forces exerted on the coronary arteries, depicting the flexibility of a vessel during the cardiac cycle [7]. We investigated 22 subjects (19 men, mean age 62 ± 12.1 years) undergoing coronary computed tomography angiography for the investigation of suspectedmoderate/low risk coronary artery disease or with known coronary artery disease but unable to undergo invasive coronary angiography. All patients provided written informed consent and the institutional Medical Ethics Committee approved the study. The studyprotocol conforms to theethical guidelines of the1975Declaration of Helsinki. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. Multislice computed tomography (128-slice) was performed in held inspirationwith SOMATOMDefinition AS+ SIEMENS. Based on
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