title: Extension of increased atherosclerotic wall thickness into high shear stress regions is associated with loss of compensatory remodeling.
abstract: BACKGROUND
  Atherosclerosis preferentially develops at average low shear stress (SS) locations. SS-related signaling maintains lumen dimensions by inducing outward arterial remodeling. Prolonged plaque accumulation at low SS predilection locations explains an inverse relation between wall thickness (WT) and SS. No data exist on WT-SS relations when lumen narrowing and loss of compensatory remodeling commence.
  
  
  RESULTS
  In 14 patients, an angiographically normal artery (stenosis <50%) was investigated with ANGiography and ivUS (ANGUS) to provide 3D lumen and wall geometry. Selection of segments >5 mm in length, in between side branches, yielded 25 segments in 12 patients. SS at the wall was calculated by computational fluid dynamics. WT smaller than 0.2*lumen diameter was defined as normal. Largest arc of normal WT defined reference cross sections. Lumen area relative to the reference cross sections defined area stenosis (AS). Average segmental AS smaller or greater than 10% defined preserved or narrowed lumen, respectively. Total vessel area relative to the reference defined vascular remodeling (VR). For the preserved lumens (n=11, AS=1.7+/-5.6%, P=NS), axially averaged WT and SS were inversely related (slope, -0.46+/-0.55 mm/Pa, P<0.05) and VR was positive (7+/-9%, P<0.05). Narrowed segments (n=13, 1 excluded, AS=18+/-6%, P<0.05) showed no relation between WT and SS or vascular remodeling.
  
  
  CONCLUSIONS
  In patient coronary arteries, the often-reported inverse WT-SS relationship appears restricted to lumen preservation and positive vascular remodeling. Its disappearance with lumen narrowing suggests a growing importance of non-SS-related plaque progression.
authors.affiliation: Department of Cardiology, Hemodynamics Laboratory, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. j.wentzel@erasmusmc.nl
authors.forename: Jolanda J
authors.initials: JJ
authors.lastname: Wentzel
authors.forename: Elbert
authors.initials: E
authors.lastname: Janssen
authors.forename: Jeroen
authors.initials: J
authors.lastname: Vos
authors.forename: Johan C H
authors.initials: JC
authors.lastname: Schuurbiers
authors.forename: Rob
authors.initials: R
authors.lastname: Krams
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Slager
mesh_terms: D000367:Age Factors; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013314:Stress, Mechanical; D018084:Ultrasonography, Interventional; D014654:Vascular Patency