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Implications of the local haemodynamic forces on the phenotype of coronary plaques
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Personen und Körperschaften: | , , , , , , , , , , , , , , , , |
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Titel: |
Implications of the local haemodynamic forces on the phenotype of coronary plaques |
In: | Heart, 105, 2019, 14, S. 1078-1086 |
veröffentlicht: |
BMJ
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Umfang: | 1078-1086 |
ISSN: |
1355-6037 1468-201X |
DOI: | 10.1136/heartjnl-2018-314086 |
Zusammenfassung: | <jats:sec><jats:title>Aim</jats:title><jats:p>To examine the effect of endothelial shear stress (ESS) on the dynamic changes in plaque phenotype.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients with myocardial infarction that had intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT) at baseline and 13-month follow-up were studied. The IVUS-VH data were used to reconstruct the nonculprit vessels, and in the obtained models the ESS was estimated in 3 mm segments. Plaque morphology was derived in each segment from IVUS-VH and OCT. Disease progression was defined as the presence of ≥2 out of the following criteria: reduction in lumen area, increase in plaque burden and change of plaque morphology to a more vulnerable phenotype. Linear mixed effects models were used to assess the effect of ESS in different phenotypes.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Sixty-eight vessels were included in the analysis. Low ESS was associated with plaque progression in all phenotypes. The effect of ESS on plaque burden (p for interaction=0.467) and phenotype (p for interaction=0.188) was similar in all plaque types, whereas the effect of ESS on the changes in lumen dimensions was more prominent in disease-free (β=0.70, p<0.001) than fibrotic/fibrocalcific (β=0.28, p<0.001) or lipid-rich plaques (β=0.15, p=0.015). Standalone IVUS-VH misclassified plaque morphology in one-third of the cases leading to erroneous estimations about the effect of ESS on plaque evolution in different phenotypes.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The effect of ESS on plaque progression is similar in all phenotypes and cannot be accurately assessed by standalone IVUS-VH which often misclassifies plaque morphology. Therefore, multimodality imaging should be considered to examine the implications of ESS on plaque evolution.</jats:p></jats:sec><jats:sec><jats:title>Clinical trial registration</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="NCT00962416" ext-link-type="clintrialgov" specific-use="clinicaltrial post-results">NCT00962416</jats:ext-link>; Post-results.</jats:p></jats:sec> |
Format: | E-Article |
Quelle: | BMJ (CrossRef) |
Sprache: | Englisch |