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The Relationship between Coronary Artery Wall Shear Strain and Plaque Morphology: A Systematic Review and
Artan Bajraktari1, Ibadete Bytyçi1,2, Michael Y Henein1,3,4
1Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden.
Insights
Low arterial wall shear strain (WSS) is linked to less vulnerable atherosclerotic plaques in coronary artery disease. High WSS, however, correlates with unstable plaque features, suggesting WSS is a key factor in plaque vulnerability assessment.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Medical Imaging
Background:
- Arterial wall shear strain (WSS) influences atherosclerotic plaque development and characteristics.
- Understanding the relationship between WSS and plaque morphology is crucial for managing coronary artery disease (CAD).
Purpose of the Study:
- To conduct a meta-analysis assessing the impact of different WSS types on plaque features in patients with CAD.
- To evaluate the role of intravascular ultrasound (IVUS) in determining plaque vulnerability based on WSS.
Main Methods:
- Systematic literature search of major databases (PubMed-Medline, EMBASE, Scopus, Google Scholar, Cochrane Central Registry) from 1989 to January 2020.
- Inclusion of clinical trials and observational studies measuring WSS via IVUS and assessing plaque morphology in CAD patients.
- Pooled analysis of data from four studies involving 72 patients and 13,098 coronary artery segments.
Main Results:
- Low WSS was associated with larger lumen area, smaller plaque area, and lower plaque burden.
- Low WSS also correlated with reduced necrotic core and fibrous areas.
- No significant difference in dense calcium score was observed between low and high WSS groups.
Conclusions:
- High WSS is linked to indicators of plaque instability, including increased necrotic core and plaque burden.
- Low WSS is associated with less unstable plaque characteristics.
- Intravascular ultrasound (IVUS) is highlighted as a valuable tool for assessing plaque vulnerability through WSS analysis.
Background And Aim:
Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different types of WSS on plaque features in coronary artery disease (CAD).
Methods:
We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar, and the Cochrane Central Registry, from 1989 up to January 2020 and selected clinical trials and observational studies which assessed the relationship between WSS, measured by intravascular ultrasound (IVUS), and plaque morphology in patients with CAD.
Results:
In four studies, a total of 72 patients with 13,098 coronary artery segments were recruited, with mean age 57.5 ± 9.5 years. The pooled analysis showed that low WSS was associated with larger baseline lumen area (WMD 2.55 [1.34 to 3.76, p < 0.001]), smaller plaque area (WMD -1.16 [-1.84 to -0.49, p = 0.0007]), lower plaque burden (WMD -12.7 [-21.4 to -4.01, p = 0.04]), and lower necrotic core area (WMD -0.32 [-0.78 to 0.14, p = 0.04]). Low WSS also had smaller fibrous area (WMD -0.79 [-1.88 to 0.30, p = 0.02]) and smaller fibro-fatty area (WMD -0.22 [-0.57 to 0.13, p = 0.02]), compared with high WSS, but the dense calcium score was similar between the two groups (WMD -0.17 [-0.47 to 0.13, p = 0.26]). No differences were found between intermediate and high WSS.
Conclusions:
High WSS is associated with signs of plaque instability such as higher necrotic core, higher calcium score, and higher plaque burden compared with low WSS. These findings highlight the role of IVUS in assessing plaque vulnerability.
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