Local Low Shear Stress and Endothelial Dysfunction in Patients With Nonobstructive Coronary Atherosclerosis

Area of Science:

• Cardiovascular Research
• Biomedical Engineering
• Translational Medicine

Background:

• Local hemodynamic forces significantly influence the development and progression of atherosclerotic plaques.
• Understanding these forces is crucial for early detection and intervention in cardiovascular diseases.

Purpose of the Study:

• To investigate the association between low endothelial shear stress (ESS) and both microvascular and epicardial endothelial dysfunction.
• To explore the role of hemodynamic factors in the early stages of coronary atherosclerosis.

Main Methods:

• Utilized 2-plane coronary angiography and intravascular ultrasound to create 3D models of the left anterior descending artery in 65 patients with early atherosclerosis.
• Employed computational fluid dynamics to analyze local ESS at regional and vessel levels.
• Assessed coronary endothelial function using intracoronary acetylcholine infusion.

Main Results:

• Coronary segments with impaired microvascular function showed significantly lower average and lowest ESS compared to those with normal function.
• Abnormal epicardial endothelial function was also associated with significantly reduced average, low, and lowest ESS.
• A progressive decline in ESS was observed with increasing severity of endothelial dysfunction, from normal to combined microvascular and epicardial dysfunction.

Conclusions:

• Demonstrates a clear association between reduced local endothelial shear stress (ESS) and both microvascular and epicardial endothelial dysfunction.
• These findings underscore the importance of hemodynamic factors in the early pathogenesis of coronary atherosclerosis.
• Highlights ESS as a potential biomarker for early detection of endothelial dysfunction in at-risk populations.