@article{3123400,
    title = "Local Low Shear Stress and Endothelial Dysfunction in Patients With Nonobstructive Coronary Atherosclerosis",
    author = "Siasos, G. and Sara, J.D. and Zaromytidou, M. and Park, K.H. and Coskun, A.U. and Lerman, L.O. and Oikonomou, E. and Maynard, C.C. and Fotiadis, D. and Stefanou, K. and Papafaklis, M. and Michalis, L. and Feldman, C. and Lerman, A. and Stone, P.H.",
    journal = "Journal of the American College of Cardiology",
    year = "2018",
    volume = "71",
    number = "19",
    pages = "2092-2102",
    publisher = "ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA",
    issn = "0735-1097, 1558-3597",
    doi = "10.1016/j.jacc.2018.02.073",
    keywords = "acetylcholine, adult;  Article;  atherosclerotic plaque;  cardiovascular parameters;  computational fluid dynamics;  coronary angiography;  coronary artery atherosclerosis;  disease association;  disease course;  early diagnosis;  endothelial dysfunction;  endothelial sheer stress;  epicardial endothelial dysfunction;  female;  functional anatomy;  human;  image segmentation;  intermethod comparison;  intravascular ultrasound;  left anterior descending coronary artery;  major clinical study;  male;  microvascular endothelial dysfunction;  middle aged;  nonobstructive coronary artery atherosclerosis;  plaque area;  plaque burden;  plaque thickness;  priority journal;  retrospective study;  shear stress;  three dimensional echocardiography;  coronary artery disease;  diagnostic imaging;  mechanical stress;  pathophysiology;  physiology;  prospective study;  randomization;  shear strength;  vascular endothelium, Adult;  Coronary Artery Disease;  Endothelium, Vascular;  Female;  Humans;  Male;  Middle Aged;  Prospective Studies;  Random Allocation;  Retrospective Studies;  Shear Strength;  Stress, Mechanical",
    abstract = "Background: Local hemodynamic factors are important determinants of atherosclerotic plaque development and progression. Objectives: The goal of this study was to determine the association between low endothelial shear stress (ESS) and microvascular and epicardial endothelial dysfunction in patients with early atherosclerosis. Methods: Sixty-five patients (mean age 52 ± 11 years) with nonobstructive coronary atherosclerosis (luminal diameter stenosis <30%) were included. Microvascular and epicardial coronary endothelial function was assessed by using intracoronary acetylcholine infusion. Vascular profiling, using 2-plane coronary angiography and intravascular ultrasound, was used to reconstruct the three-dimensional anatomy of the left anterior descending artery. Each reconstructed artery was divided into sequential 3-mm segments and analyzed for local ESS with computational fluid dynamics; that is, lower ESS levels at both a 3-mm regional level (average ESS and low ESS) and at a vessel level (lowest ESS per artery) and for plaque characteristics (plaque area, plaque thickness, and plaque burden). Results: Coronary segments in arteries with abnormal microvascular function exhibited lower ESS compared with segments in arteries with normal microvascular function (average ESS: 1.67 ± 1.04 Pa vs. 2.03 ± 1.72 Pa [p = 0.050]; lowest ESS: 0.54 ± 0.25 Pa vs. 0.72 ± 0.32 Pa [p = 0.014]). Coronary segments in arteries with abnormal epicardial endothelial function also exhibited significantly lower ESS compared with segments in arteries with normal epicardial function (average ESS: 1.49 ± 0.89 Pa vs. 1.93 ± 1.50 Pa [p < 0.0001]; low ESS: 1.26 ± 0.81 Pa vs. 1.56 ± 1.30 Pa [p = 0.001]; lowest ESS: 0.51 ± 0.27 Pa vs. 0.65 ± 0.29 Pa [p = 0.080]). Patients with abnormal microvascular endothelial function exhibited a progressive decrease in average and low ESS, starting from patients with normal epicardial endothelial function to those with both microvascular and epicardial endothelial dysfunction (p < 0.0001 and p = 0.004, respectively). Conclusions: These data indicate an association between dysfunction of the microvascular and epicardial endothelium and local ESS at the early stages of coronary atherosclerosis in humans. © 2018 American College of Cardiology Foundation"
}