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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Relationship of Endothelial Shear Stress with Plaque Features with Coronary CT Angiography and Vasodilating
Georgios-Eleftherios Kalykakis1, Alexios S Antonopoulos1, Thomas Pitsargiotis1
1From the Department of Informatics, Ionian University, Kerkyra, Greece (G.E.K., T.E.); Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, 115 27 Athens, Greece (G.E.K., T.P., P.K., C.D.A.); CMR Unit, Royal Brompton Hospital, London, England (A.S.A.); Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece (T.P.); Department of Materials Science and Engineering University of Ioannina, Ioannina, Greece (P.S., D.I.F.); Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Athens, Greece (P.K.); Biomedical Research Institute-FORTH, Ioannina, Greece (A.S.); Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (R.L.); Division of Imaging Sciences and Biomedical Engineering, King's College London, London, England (A.T.); Cardiac Imaging (P.A.K.) Department of Nuclear Medicine (A.G.), University Hospital Zurich, Zurich, Switzerland (A.G.); Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands (A.J.H.A.S.); Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy (O.P., D.N.); Institute of Information Science and Technologies, National Research Council-CNR, Pisa, Italy (O.P.); PET Center, University Hospital and University of Turku, Turku, Finland (J.K.); Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy (D.N.); and Sant'Anna School of Advanced Studies, Pisa, Italy (D.N.).
Abstract:
Background Advances in three-dimensional reconstruction techniques and computational fluid dynamics of coronary CT angiography (CCTA) data sets make feasible evaluation of endothelial shear stress (ESS) in the vessel wall. Purpose To investigate the relationship between CCTA-derived computational fluid dynamics metrics, anatomic and morphologic characteristics of coronary lesions, and their comparative performance in predicting impaired coronary vasodilating capability assessed by using PET myocardial perfusion imaging (MPI). Materials and Methods In this retrospective study, conducted between October 2019 and September 2020, coronary vessels in patients with stable chest pain and with intermediate probability of coronary artery disease who underwent both CCTA and PET MPI with oxygen 15-labeled water or nitrogen 13 ammonia and quantification of myocardial blood flow were analyzed. CCTA images were used in assessing stenosis severity, lesion-specific total plaque volume (PV), noncalcified PV, calcified PV, and plaque phenotype. PET MPI was used in assessing significant coronary stenosis. The predictive performance of the CCTA-derived parameters was evaluated by using area under the receiver operating characteristic curve (AUC) analysis. Results There were 92 coronary vessels evaluated in 53 patients (mean age, 65 years ± 7; 31 men). ESS was higher in lesions with greater than 50% stenosis versus those without significant stenosis (mean, 15.1 Pa ± 30 vs 4.6 Pa ± 4 vs 3.3 Pa ± 3; P = .004). ESS was higher in functionally significant versus nonsignificant lesions (median, 7 Pa [interquartile range, 5-23 Pa] vs 2.6 Pa [interquartile range, 1.8-5 Pa], respectively; P ≤ .001). Adding ESS to stenosis severity improved prediction (change in AUC, 0.10; 95% CI: 0.04, 0.17; P = .002) for functionally significant lesions. Conclusion The combination of endothelial shear stress with coronary CT angiography (CCTA) stenosis severity improved prediction of an abnormal PET myocardial perfusion imaging result versus CCTA stenosis severity alone. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Kusmirek and Wieben in this issue.
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