Elevated endothelial shear stress metrics around eruptive calcified nodules were significantly associated with NSTEMI and unstable angina in patients.
Are endothelial shear stress metrics associated with the eruption of coronary calcified nodules?
Elevated endothelial shear stress metrics are associated with eruptive calcified nodules, providing a potential biomechanical mechanism for their role in acute coronary syndromes.
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BACKGROUND AND AIMS: Calcified nodules (CNs), accounting for about 5 % of acute coronary syndrome (ACS) cases, represent a significant challenge during percutaneous coronary intervention (PCI). CNs are classified into non-eruptive calcified nodules (NECNs) and eruptive calcified nodules (ECNs), each with distinct pathophysiological and prognostic characteristics. While the roles of endothelial shear stress (ESS) and its gradient (ESSG) in plaque rupture and erosion are established, their contribution to CNs development and eruption remains unclear. We investigated the role of ESS and ESSG in the formation and eruption of coronary calcified nodules. METHODS: We analyzed 108 CNs from 65 patients, 70 arteries (41 LAD, 19 RCA, 10 LCx) who underwent coronary angiography and optical coherence tomography (OCT), followed by 3D reconstruction and computational fluid dynamics calculations of ESS/ESSG. The cohort was divided into 3 groups, NECNs (n = 35) and ECNs (n = 35) and calcified sheets as a control (n = 38). ESS metrics were reported at the site of each calcified nodule, and their values were compared among the three groups. RESULTS: Mean patient age was 67.1 ± 13.2 years; 73 % were male. ECNs were associated with NSTEMI and unstable angina, while NECNs were presented more with stable angina. All ESS metrics (maximum and average ESS, as well as ESSG in axial and circumferential directions) were substantially elevated around ECNs compared with NECNs and calcified sheets. There was no difference in these metrics between NECNs and calcified sheets. CONCLUSION: This study proposes that analyzing high-risk ESS metrics could enhance understanding of how calcified nodules form and erupt, which are key contributors to acute coronary syndrome (ACS). This insight may improve risk assessment in coronary artery disease and support the development of targeted preemptive therapies or imaging methods to detect and treat high-risk plaques.
Hakim et al. (Wed,) reported a other. Elevated endothelial shear stress metrics around eruptive calcified nodules were significantly associated with NSTEMI and unstable angina in patients.
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