Baseline endothelial shear stress was significantly associated with follow-up fibrous cap thickness (β 9.089; 95% CI 2.539-15.640; P=0.007) and lipid arc.
Cohort (n=20)
Does low endothelial shear stress predict evolution to a high-risk coronary plaque phenotype in patients undergoing optical coherence tomography?
Low endothelial shear stress is a significant predictor of coronary plaque progression to a high-risk phenotype, characterized by thinner fibrous caps and wider lipid arcs over 6 months.
Effect estimate: β 9.089 (95% CI 2.539-15.640)
p-value: p=0.007
Background— Low endothelial shear stress (ESS) is associated with plaque progression and vulnerability. To date, changes in plaque phenotype over time in relation to ESS have not been studied in humans. The aim of this study was to investigate whether local ESS can predict subsequent changes to plaque phenotype using optical coherence tomography. Methods and Results— A total of 25 coronary arteries from 20 patients who underwent baseline and 6-month follow-up optical coherence tomography were included. Arteries were divided into serial 3-mm segments, and plaque characteristics were evaluated in each segment. A total of 145 segments were divided into low-ESS group (ESS <1 Pa) and higher-ESS group (ESS ≥1 Pa) based on baseline computational flow dynamics analyses. At baseline, low-ESS segments had significantly thinner fibrous cap thickness compared with higher-ESS segments (128.2±12.3 versus 165.0±12.0 μm; P =0.03), although lipid arc was similar. At follow-up, fibrous cap thickness remained thin in low-ESS segments, whereas it significantly increased in higher-ESS segments (165.0±12.0 to 182.2±14.1 μm; P =0.04). Lipid arc widened only in plaques with low ESS (126.4±15.2° to 141.1±14.0°; P =0.01). After adjustment, baseline ESS was associated with fibrous cap thickness (β, 9.089; 95% confidence interval, 2.539–15.640; P =0.007) and lipid arc (β, −4.381; 95% confidence interval, −6.946 to −1.815; P =0.001) at follow-up. Conclusions— Low ESS is significantly associated with baseline high-risk plaque phenotype and progression to higher-risk phenotype at 6 months. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01110538.
Yamamoto et al. (2017) conducted a cohort in Coronary plaque (n=20). Low endothelial shear stress (<1 Pa) vs. Higher endothelial shear stress (≥1 Pa) was evaluated on Fibrous cap thickness at follow-up (β 9.089, 95% CI 2.539-15.640, p=0.007). Baseline endothelial shear stress was significantly associated with follow-up fibrous cap thickness (β 9.089; 95% CI 2.539-15.640; P=0.007) and lipid arc.