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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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High endothelial shear stress and stress gradient at plaque erosion persist up to 12 months

Hyung Oh Kim1, Bo Jiang2, Eric K W Poon2

  • 1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

International Journal of Cardiology
|March 20, 2022
PubMed

Insights

Hemodynamic forces like endothelial shear stress (ESS) and ESS gradient (ESSG) are elevated at plaque erosion sites. These elevated levels persist for up to 12 months in patients treated conservatively, indicating a sustained pro-thrombotic environment.

Area of Science:

  • Cardiovascular research
  • Biomedical engineering
  • Medical imaging analysis

Background:

  • Local hemodynamics significantly influence the development of plaque erosion.
  • Recent findings suggest conservative management may be viable for erosion patients, potentially avoiding stent implantation.
  • Understanding hemodynamic changes at erosion sites is crucial for optimizing conservative treatment strategies.

Purpose of the Study:

  • To investigate the evolution of hemodynamic parameters at plaque erosion sites in patients managed conservatively.
  • To compare hemodynamic factors between erosion and non-erosion sites over time.
  • To assess the persistence of altered hemodynamics following non-stent treatment for plaque erosion.

Main Methods:

  • Computational fluid dynamics (CFD) simulations were employed using coronary angiogram and optical coherence tomography (OCT) images.
  • CFD parameters, including endothelial shear stress (ESS), ESS gradient (ESSG), and oscillatory shear index (OSI), were calculated.
  • Serial OCT studies allowed for longitudinal analysis of hemodynamic parameters at baseline, 1-month, and 12-month follow-ups.

Main Results:

  • Plaque erosion sites exhibited significantly higher ESS and ESSG values compared to non-erosion sites at all time points (baseline, 1 month, 12 months).
  • Elevated ESS and ESSG at erosion sites demonstrated persistence up to 12 months post-conservative treatment.
  • No significant difference in oscillatory shear index (OSI) was observed between erosion and non-erosion sites.

Conclusions:

  • Endothelial shear stress and its gradient are consistently elevated at plaque erosion sites.
  • These hemodynamic perturbations at erosion sites are sustained for at least 12 months under conservative management.
  • A persistent local thrombogenic milieu, driven by hemodynamic alterations, exists at plaque erosion sites even after conservative treatment.
Abstract

Keywords:
Computational fluid dynamicsEndothelial shear stressEndothelial shear stress gradientOptical coherence tomographyPlaque erosion

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