Multidirectional wall shear stress promotes advanced coronary plaque development: comparing five shear stress metrics

Area of Science:

• Cardiovascular Research
• Biomedical Engineering
• Translational Medicine

Background:

• Atherosclerotic plaque development is linked to wall shear stress (WSS).
• The multidirectionality of blood flow and WSS is often overlooked in plaque studies.
• Understanding WSS dynamics is crucial for comprehending coronary artery disease progression.

Purpose of the Study:

• To compare five metrics for describing multidirectional WSS behavior.
• To assess the impact of WSS multidirectionality on coronary plaque initiation and progression.
• To identify WSS characteristics associated with vulnerable plaque development.

Main Methods:

• Utilized adult familial hypercholesterolemic pigs fed a high-fat diet.
• Performed coronary artery imaging at three time points.
• Calculated WSS using 3D lumen geometry and flow velocity data.
• Analyzed plaque progression and composition using advanced imaging and histology.

Main Results:

• Highest plaque progression rates occurred in regions with low time-averaged WSS (TAWSS) or high multidirectional WSS.
• Largest plaque growth was observed in areas transitioning from low TAWSS/high multidirectional WSS to high TAWSS/low multidirectional WSS.
• Low and multidirectional WSS correlated with vulnerable plaque components and fibrous cap atheroma (FCA) development.
• WSS metrics demonstrated good predictive values for plaque development (47-50%) and FCA (59-61%).

Conclusions:

• Low and multidirectional WSS promote both the initiation and progression of coronary atherosclerotic plaques.
• Multidirectional WSS metrics are highly predictive of FCA development.
• These metrics hold potential as additional clinical markers for vulnerable atherosclerotic disease.