The relationship between coronary lesion characteristics and pathologic shear in human coronary arteries
Ashkan Javadzadegan1, Abouzar Moshfegh1, Yi Qian2
1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; ANZAC Research Institute, The University of Sydney, Sydney, Australia.
Insights
Pathological shear stress in coronary arteries is linked to atherosclerosis. Stenosis severity and lesion length independently predict abnormal shear stress, crucial for understanding coronary thrombosis.
Area of Science:
- Cardiovascular research
- Biomedical engineering
- Medical imaging analysis
Background:
- Pathological shear stress is implicated in coronary thrombosis and atherogenesis.
- The relative importance of lesion characteristics on coronary hemodynamics is not well understood.
Purpose of the Study:
- To investigate the relative importance of coronary lesion characteristics on hemodynamic shear stress.
- To identify independent predictors of pathological shear stress in coronary arteries.
Main Methods:
- Computational fluid dynamics (CFD) was used for hemodynamic analysis of 104 coronary arteries.
- Quantified maximum and average shear stress at stenosis sites, and area of low wall shear stress (ALWSS).
Main Results:
- Stenosis severity and lesion length independently predicted maximum shear stress and ALWSS.
- Increasing stenosis severity and lesion length correlated with increased maximal shear stress and ALWSS.
Conclusions:
- Stenosis severity and lesion length are key independent predictors of abnormal shear stress.
- These factors are critical for understanding pathogenic physiological processes in coronary artery disease.
Background:
Pathological shear stress is associated with distinct pathogenic biological pathways relevant to coronary thrombosis and atherogenesis. Although the individual effects of lesion characteristics including stenosis severity, eccentricity and lesion length on coronary haemodynamics is known, their relative importance remains poorly understood.
Methods:
Computational fluid dynamics (CFD) was implemented for haemodynamic analysis of 104 coronary arteries. For each coronary artery, maximum shear stress at the site of maximal stenosis, average shear stress over the sites of maximal stenosis segment, average shear stress in the proximal segments and average shear stress in the distal segments were determined. In addition, the area of low wall shear stress (ALWSS) sites in post-stenotic regions were quantified as a proportion of the vessel segment.
Results:
With increasing stenosis severity, eccentricity and lesion length, maximal and average shear stress over the sites of maximal stenosis and ALWSS increased whereas average shear stress in the proximal segments decreased. Two-way ANCOVA analysis revealed that stenosis severity and lesion length were both independent predictors of maximum shear at the site of maximal stenosis [F (1, 104) = 10.94, P = 0.001 for diameter stenosis and F (1, 104) = 6.21, P = 0.014 for lesion length] and ALWSS [F (1, 104) = 66.10, P = 0.001 for diameter stenosis and F (1, 104) = 4.23, P = 0.047 for lesion length].
Conclusion:
Our findings demonstrate that although all lesion characteristics correlate with abnormal shear stress, only stenosis severity and lesion length are independent predictors of pathogenic physiological processes.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...