Key result
High coronary wall shear stress is associated with worsening plaque vulnerability, including a significant regression of plaque fibrous area (WMD -0.11) compared with low wall shear stress.
Why the study?
The study was conducted to assess the impact of wall shear stress severity on arterial plaque vulnerability.
Does high wall shear stress worsen plaque vulnerability in patients with coronary artery disease?
Meta-Analysis (n=615)
Does high wall shear stress worsen plaque vulnerability in patients with coronary artery disease?
Mean Difference: -0.11 (95% CI -0.2–-0.02)
p-value: p=.02
High coronary wall shear stress is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared to low wall shear stress.
High wall shear stress may flag vulnerable plaques; hypothesis-generating and requires prospective validation before clinical use.
Aim: The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability. Methods: We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) −0.11 (95% CI: −0.20 to −0.02, P = .02) and fibrofatty area, WMD −0.09 (95% CI: −0.17 to −0.01, P = .02), reduction in plaque total area, WMD −0.09 (95% CI: −0.14 to −0.04, P = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm 2 ; P > .05). High WSS resulted in profound remodeling (40% vs 18%, P < .05) and with more constructive remodeling than low WSS (78% vs 40%, P < .01). Conclusions: High WSS in coronary arteries is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared with low WSS.
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Bajraktari et al. (2021) conducted a meta-analysis in Coronary artery disease (n=615). High wall shear stress vs. Low wall shear stress was evaluated on Regression of plaque fibrous area (WMD -0.11, 95% CI -0.20 to -0.02, p=.02). High coronary wall shear stress is associated with worsening plaque vulnerability, including a significant regression of plaque fibrous area (WMD -0.11) compared with low wall shear stress.
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