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Published on: January 15, 2022
Efficacy of the Shear Stress Pattern Computed in Coronary Artery Reconstruction Models With and Without Side Branches
Anantharaman Ramasamy1,2,3, Akash Sivananthan4, Ibrahim Halil Tanboga5
1Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.R., M.H., T.C., A. Mathur, A.B., C.V.B.).
Insights
Complete vessel reconstruction, including side branches, improves wall shear stress (WSS) analysis for predicting atherosclerotic disease progression more accurately than single-vessel reconstruction (SVR). This method enhances understanding of cardiovascular health.
Area of Science:
- Cardiovascular Imaging and Mechanics
- Biomedical Engineering
- Medical Image Analysis
Background:
- Side branches in vessel geometry significantly impact wall shear stress (WSS) distribution.
- Conventional single-vessel reconstruction (SVR) is time-efficient but lacks evidence of superior prediction for atherosclerotic disease progression compared to more complex methods.
Purpose of the Study:
- To compare the predictive performance of complete 3D vessel reconstruction versus SVR for atherosclerotic disease progression.
- To assess the influence of side branches on WSS distribution and its predictive capability.
Main Methods:
- Included patients with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) imaging (n=40 vessels, n=13 neoatherosclerotic lesions).
- Performed 3D complete vessel reconstruction and SVR on vessels with side branches (>1 mm diameter).
- Computed time-averaged WSS and multidirectional WSS; assessed predictive performance for disease progression.
Main Results:
- Complete vessel reconstruction yielded lower minimum time-averaged WSS in both IVUS (1.09 vs. 1.58 Pa) and OCT (0.68 vs. 1.33 Pa) reconstructions (P<0.001).
- Complete vessel reconstruction demonstrated superior prediction of disease progression (lumen area reduction, plaque burden increase) in native segments compared to SVR (e.g., accuracy, discrimination, calibration).
- Complete vessel reconstruction also more accurately predicted neointimal proliferation in stented segments than SVR.
Conclusions:
- Incorporating side branches in 3D vessel reconstruction alters WSS distribution.
- Complete vessel reconstruction provides more accurate predictions of atherosclerotic disease progression in both native and stented vessels compared to SVR.
Background:
The incorporation of side branches in vessel geometry influences wall shear stress (WSS) distribution. However, complete vessel reconstruction is time-consuming, and there is no evidence that its WSS estimations better predict atherosclerotic disease progression compared with the output of the conventional single-vessel reconstruction (SVR).
Methods:
Patients who had baseline and 1-year follow-up intravascular ultrasound imaging (n=40 vessels), and patients with neoatherosclerotic lesions (n=13 vessels) on optical coherence tomography were included. All the studied vessels had at least one side branch with a diameter >1 mm; 3-dimensional complete vessel reconstruction and SVR were performed, and the time-averaged WSS and multidirectional WSS were computed. The performance of both methods in predicting disease progression in intravascular ultrasound and optical coherence tomography models was assessed.
Results:
The incorporation of side branches in 3-dimensional geometry resulted in lower minimum predominant time-averaged WSS in the intravascular ultrasound (1.09 versus 1.58 Pa, P<0.001) and optical coherence tomography-based reconstructions (0.68 versus 1.33 Pa, P<0.001) and influenced the multidirectional WSS distribution. In native segments, complete vessel reconstruction-derived WSS metrics demonstrated superior predictive performance for disease progression-defined as lumen area reduction and plaque burden increase-compared with SVR, as evidenced by improved out-of-sample accuracy (leave-one-out information criterion: 429 versus 551), discrimination (C statistic: 0.725 versus 0.651), calibration (Brier score: 0.172 versus 0.226), and explained variance (27.8% versus 20.7%). Consistent findings were observed in stented segments, where complete vessel reconstruction-derived WSS metrics more accurately predicted neointimal proliferation than SVR-derived metrics.
Conclusions:
Incorporating side branches into vessel reconstruction influences WSS distribution and enables more accurate prediction of atherosclerotic disease progression in native and stented segments than SVR.
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