Implications of the local haemodynamic forces on the phenotype of coronary plaques
2019
Aim To examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque
phenotype. Methods Patients with myocardial infarction that had
intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT) at baseline and 13-month follow-up were studied. The IVUS-VH data were used to reconstruct the nonculprit vessels, and in the obtained models the ESS was estimated in 3 mm segments. Plaque morphology was derived in each segment from IVUS-VH and OCT. Disease progression was defined as the presence of ≥2 out of the following criteria: reduction in lumen area, increase in plaque burden and change of plaque morphology to a more vulnerable
phenotype. Linear mixed effects models were used to assess the effect of ESS in different
phenotypes. Results Sixty-eight vessels were included in the analysis. Low ESS was associated with plaque progression in all
phenotypes. The effect of ESS on plaque burden (p for interaction=0.467) and
phenotype(p for interaction=0.188) was similar in all plaque types, whereas the effect of ESS on the changes in lumen dimensions was more prominent in disease-free (β=0.70, p Conclusions The effect of ESS on plaque progression is similar in all
phenotypesand cannot be accurately assessed by standalone IVUS-VH which often misclassifies plaque morphology. Therefore, multimodality imaging should be considered to examine the implications of ESS on plaque evolution. Clinical
trial registrationNCT00962416; Post-results.
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