TY - JOUR
TI - Local Low Shear Stress and Endothelial Dysfunction in Patients With Nonobstructive Coronary Atherosclerosis
AU - Siasos, G.
AU - Sara, J.D.
AU - Zaromytidou, M.
AU - Park, K.H.
AU - Coskun, A.U.
AU - Lerman, L.O.
AU - Oikonomou, E.
AU - Maynard, C.C.
AU - Fotiadis, D.
AU - Stefanou, K.
AU - Papafaklis, M.
AU - Michalis, L.
AU - Feldman, C.
AU - Lerman, A.
AU - Stone, P.H.
JO - Journal of the American College of Cardiology
PY - 2018
VL - 71
TODO - 19
SP - 2092-2102
PB - ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
SN - 0735-1097, 1558-3597
TODO - 10.1016/j.jacc.2018.02.073
TODO - 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
TODO - 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
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