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Intravascular hemodynamic factors responsible for progression of coronary atherosclerosis and development of

C L Feldman1, P H Stone

  • 1Harvard Medical School, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. clfeldman@bics.bwh.harvard.edu

Current Opinion in Cardiology
|February 24, 2001
PubMed

Insights

Abnormal blood flow and shear stress in coronary arteries drive plaque development and rupture, leading to coronary artery disease. New techniques allow in vivo measurement of these hemodynamic factors during cardiac catheterization.

Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Hemodynamics

Background:

  • Coronary artery disease (CAD) progression, including plaque initiation, growth, and rupture, is intrinsically linked to intracoronary blood flow patterns and endothelial shear stress.
  • Abnormalities in local blood flow and shear stress are implicated in the restenosis of coronary arteries following mechanical recanalization procedures.

Purpose of the Study:

  • To review the mechanisms connecting hemodynamic factors to the development and rupture of atheromatous plaque.
  • To describe novel in vivo techniques for assessing hemodynamic factors in patients undergoing cardiac catheterization.

Main Methods:

  • Literature review of studies investigating the role of hemodynamics in coronary artery disease.
  • Description of recently developed in vivo measurement techniques for intracoronary blood flow and shear stress.

Main Results:

  • Low or reversed shear stress promotes plaque development and progression.
  • High shear stress is a significant factor in plaque rupture.
  • Hemodynamic stasis, resulting from luminal irregularities, can cause thrombosis and myocardial infarction, even without plaque rupture.

Conclusions:

  • Hemodynamic factors, including shear stress and flow patterns, are critical determinants of coronary artery disease progression and clinical events.
  • Emerging in vivo techniques enable direct assessment of these hemodynamic factors in patients, offering new diagnostic and therapeutic insights.

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