Morphometric and computational fluid dynamics analysis of 13 vessels with healed SCAD revealed that 100% of proximal SCAD segments co-localized with at least one anatomical or hemodynamic hot spot.
Observational (n=13)
Are vascular segments that are sites of spontaneous coronary artery dissection (SCAD) associated with distinctive local anatomy and hemodynamic profiles?
Vascular segments of healed SCAD are characterized by high curvature/torsion and wall shear stress profiles, suggesting a pathophysiological role of local flow disturbances in SCAD.
AIMS: Spontaneous coronary artery dissection (SCAD) is an increasingly diagnosed cause of myocardial infarction with unclear pathophysiology. The aim of the study was to test if vascular segments site of SCAD present distinctive local anatomy and hemodynamic profiles. METHODS: Coronary arteries with spontaneously healed SCAD (confirmed by follow-up angiography) underwent three-dimensional reconstruction, morphometric analysis with definition of vessel local curvature and torsion, and computational fluid dynamics (CFD) simulations with derivation of time-averaged wall shear stress (TAWSS) and topological shear variation index (TSVI). The (reconstructed) healed proximal SCAD segment was visually inspected for co-localization with curvature, torsion, and CFD-derived quantities hot spots. RESULTS: Thirteen vessels with healed SCAD underwent the morpho-functional analysis. Median time between baseline and follow-up coronary angiograms was 57 (interquartile range IQR 45-95) days. In seven cases (53.8%), SCAD was classified as type 2b and occurred in the left anterior descending artery or near a bifurcation. In all cases (100%), at least one hot spot co-localized within the healed proximal SCAD segment, in 9 cases (69.2%) ≥ 3 hot spots were identified. Healed SCAD in proximity of a coronary bifurcation presented lower TAWSS peak values (6.65 IQR 6.20-13.20 vs. 3.81 2.53-5.17 Pa, p = 0.008) and hosted less frequently TSVI hot spots (100% vs. 57.1%, p = 0.034). CONCLUSION: Vascular segments of healed SCAD were characterized by high curvature/torsion and WSS profiles reflecting increased local flow disturbances. Hence, a pathophysiological role of the interaction between vessel anatomy and shear forces in SCAD is hypothesized.
Candreva et al. (Tue,) conducted a observational in Spontaneous coronary artery dissection (SCAD) (n=13). Morphometric analysis and computational fluid dynamics (CFD) was evaluated on Co-localization of healed proximal SCAD segment with curvature, torsion, and CFD-derived quantities hot spots. Morphometric and computational fluid dynamics analysis of 13 vessels with healed SCAD revealed that 100% of proximal SCAD segments co-localized with at least one anatomical or hemodynamic hot spot.