Spatial relationships among hemodynamic, anatomic, and biochemical plaque characteristics in patients with coronary
Anubodh S Varshney1, Ahmet U Coskun2, Gerasimos Siasos3
1Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Insights
Plaque destabilizing features show significant spatial heterogeneity. Large lipid-rich plaques exhibit more abnormal features, but their exact spatial relationship requires further study to understand plaque destabilization.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Pathology
Background:
- Atherosclerotic plaques contain features that can lead to destabilization and rupture.
- Understanding the spatial distribution of these features is crucial for risk stratification.
Purpose of the Study:
- To characterize the spatial proximity of plaque destabilizing features: endothelial shear stress (ESS), minimal luminal area (MLA), plaque burden (PB), and near-infrared spectroscopy (NIRS) lipid signal.
- To compare these features in high-risk (large lipid-rich plaque - LRP) versus low-risk plaques.
Main Methods:
- Coronary arteries were imaged using angiography and NIRS-intravascular ultrasound (IVUS).
- 3D reconstruction and computational fluid dynamics were used to calculate local ESS.
- Spatial distributions of MLA, ESS, PB, and lipid core burden index (LCBI) were analyzed in 3-mm segments.
Main Results:
- Significant spatial heterogeneity was observed for all plaque destabilizing features.
- The location of maximum lipid burden (maxLCBI4mm) was often spatially discordant from MLA, minimum ESS (minESS), and maximum ESS (maxESS).
- Large LRP arteries demonstrated higher maxESS, lower minESS, smaller MLA, and larger maxPB compared to non-large LRP arteries.
Conclusions:
- Significant spatial heterogeneity of destabilizing plaque features exists in both large and non-large LRPs.
- Large LRPs exhibit more abnormal destabilizing features than non-large LRPs.
- Further longitudinal studies are needed to determine how these heterogeneous features synergistically cause plaque destabilization.
Background And Aims:
We aimed to characterize the spatial proximity of plaque destabilizing features local endothelial shear stress (ESS), minimal luminal area (MLA), plaque burden (PB), and near-infrared spectroscopy (NIRS) lipid signal in high- vs. low-risk plaques.
Methods:
Coronary arteries imaged with angiography and NIRS-intravascular ultrasound (IVUS) underwent 3D reconstruction and computational fluid dynamics calculations of local ESS. ESS, PB, MLA, and lipid core burden index (LCBI), for each 3-mm arterial segment were obtained in arteries with large lipid-rich plaque (LRP) vs. arteries with smaller LRP. The locations of the MLA, minimum ESS (minESS), maximum ESS (maxESS), maximum PB (maxPB), and maximum LCBI in a 4-mm segment (maxLCBI4mm) were determined along the length of each plaque.
Results:
The spatial distributions of minESS, maxESS, maxPB, and maxLCBI4mm, in reference to the MLA, were significantly heterogeneous within and between each variable. The location of maxLCBI4mm was spatially discordant from sites of the MLA (p<0.0001), minESS (p = 0.003), and maxESS (p = 0.003) in arteries with large LRP (maxLCBI4mm ≥ 400) and non-large LRP. Large LRP arteries had higher maxESS (9.31 ± 4.78 vs. 6.32 ± 5.54 Pa; p = 0.023), lower minESS (0.41 ± 0.16 vs. 0.61 ± 0.26 Pa; p = 0.007), smaller MLA (3.54 ± 1.22 vs. 5.14 ± 2.65 mm2; p = 0.002), and larger maxPB (70.64 ± 9.95% vs. 56.70 ± 13.34%, p<0.001) compared with non-large LRP arteries.
Conclusions:
There is significant spatial heterogeneity of destabilizing plaque features along the course of both large and non-large LRPs. Large LRPs exhibit significantly more abnormal destabilizing plaque features than non-large LRPs. Prospective, longitudinal studies are required to determine which patterns of heterogeneous destabilizing features act synergistically to cause plaque destabilization.
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