Predicting Lipid-Rich Plaque Progression in Coronary Arteries Using Multimodal Imaging and Wall Shear Stress...

Area of Science:

• Cardiovascular research
• Biomedical engineering
• Medical imaging

Background:

• Coronary plaque progression is influenced by plaque composition and wall shear stress (WSS).
• WSS magnitude alone does not fully represent the mechanical forces on the endothelium.
• Understanding WSS spatiotemporal patterns is crucial for identifying atherosclerosis biomarkers.

Purpose of the Study:

• To investigate the relationship between WSS profiles, plaque composition, and coronary plaque progression.
• To identify novel biomechanical biomarkers for coronary atherosclerosis.
• To explore the synergistic effects of WSS and plaque characteristics on plaque growth.

Main Methods:

• Utilized coronary computed tomography angiography, near-infrared spectroscopy, and optical coherence tomography in 37 acute coronary syndrome patients.
• Reconstructed coronary artery geometries and performed computational fluid dynamics simulations.
• Assessed time-averaged WSS magnitude (TAWSS) and topological shear variation index (TSVI).
• Quantified plaque progression via percentage plaque atheroma volume change over 1 year.

Main Results:

• High TSVI and low TAWSS were associated with increased plaque progression (4.00% and 3.60%, respectively).
• Lipid-rich plaque combined with high TSVI or low TAWSS resulted in the highest plaque progression (≥5.90%).
• Synergistic effects between plaque composition and WSS parameters were observed.

Conclusions:

• Luminal exposure to high TSVI, alone or with lipid-rich plaque, significantly enhances plaque progression.
• Low TAWSS was also observed where plaque progression occurred.
• TSVI and low TAWSS show promise as biomechanical predictors for coronary plaque progression and clinical translation.