Key result
High wall shear stress links to ~154% greater odds of positive remodeling without improving ischemia detection.
Why the study?
The relationship of coronary lesion ischemia evaluated by fractional flow reserve to wall shear stress and high-risk atherosclerotic plaque characteristics has not been examined.
Does high wall shear stress associate with high-risk atherosclerotic plaque characteristics and coronary ischemia in patients undergoing CCTA and invasive angiography?
Observational (n=100)
Does high wall shear stress associate with high-risk atherosclerotic plaque characteristics and coronary ischemia in patients undergoing CCTA and invasive angiography?
Odds Ratio: 2.54 (95% CI 1.12–5.77)
p-value: p=<0.05
While high wall shear stress is associated with high-risk plaque characteristics, it does not provide incremental value over stenosis severity and plaque characteristics for identifying ischemia-causing lesions.
High wall shear stress should not yet guide ischemia assessment; extends cross-sectional links to positive remodeling but leaves incremental utility open.
BACKGROUND: Wall shear stress (WSS) is an established predictor of coronary atherosclerosis progression. Prior studies have reported that high WSS has been associated with high-risk atherosclerotic plaque characteristics (APCs). WSS and APCs are quantifiable by coronary computed tomography angiography, but the relationship of coronary lesion ischemia-evaluated by fractional flow reserve-to WSS and APCs has not been examined. METHODS AND RESULTS: WSS measures were obtained from 100 evaluable patients who underwent coronary computed tomography angiography and invasive coronary angiography with fractional flow reserve. Patients were categorized according to tertiles of mean WSS values defined as low, intermediate, and high. Coronary ischemia was defined as fractional flow reserve ≤0.80. Stenosis severity was determined by minimal luminal diameter. APCs were defined as positive remodeling, low attenuation plaque, and spotty calcification. The likelihood of having positive remodeling and low-attenuation plaque was greater in the high WSS group compared with the low WSS group after adjusting for minimal luminal diameter (odds ratio for positive remodeling: 2.54, 95% CI 1.12-5.77; odds ratio for low-attenuation plaque: 2.68, 95% CI 1.02-7.06; both P<0.05). No significant relationship was observed between WSS and fractional flow reserve when adjusting for either minimal luminal diameter or APCs. WSS displayed no incremental benefit above stenosis severity and APCs for detecting lesions that caused ischemia (area under the curve for stenosis and APCs: 0.87, 95% CI 0.81-0.93; area under the curve for stenosis, APCs, and WSS: 0.88, 95% CI 0.82-0.93; P=0.30 for difference). CONCLUSIONS: High WSS is associated with APCs independent of stenosis severity. WSS provided no added value beyond stenosis severity and APCs for detecting lesions with significant ischemia.
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Han et al. (2016) conducted an observational in Coronary atherosclerosis (n=100). High wall shear stress vs. Low wall shear stress was evaluated on Positive remodeling (OR 2.54, 95% CI 1.12-5.77, p=<0.05). High wall shear stress was associated with a greater likelihood of positive remodeling (OR 2.54; 95% CI 1.12-5.77) but provided no incremental benefit for detecting ischemia-causing lesions (P=0.30).
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