title: Association of coronary wall shear stress with atherosclerotic plaque burden, composition, and distribution in patients with coronary artery disease.
abstract: BACKGROUND
  Extremes of wall shear stress (WSS) have been associated with plaque progression and transformation, which has raised interest in the clinical assessment of WSS. We hypothesized that calculated coronary WSS is predicted only partially by luminal geometry and that WSS is related to plaque composition.
  
  
  RESULTS
  Twenty-seven patients with coronary artery disease underwent virtual histology intravascular ultrasound and Doppler velocity measurement for computational fluid dynamics modeling for WSS calculation in each virtual histology intravascular ultrasound segment (N=3581 segments). We assessed the association of WSS with plaque burden and distribution and with plaque composition. WSS remained relatively constant across the lower 3 quartiles of plaque burden (P=0.08) but increased in the highest quartile of plaque burden (P<0.001). Segments distal to lesions or within bifurcations were more likely to have low WSS (P<0.001). However, the majority of segments distal to lesions (80%) and within bifurcations (89%) did not exhibit low WSS. After adjustment for plaque burden, there was a negative association between WSS and percent necrotic core and calcium. For every 10 dynes/cm(2) increase in WSS, percent necrotic core decreased by 17% (P=0.01), and percent dense calcium decreased by 17% (P<0.001). There was no significant association between WSS and percent of fibrous or fibrofatty plaque components (P=NS).
  
  
  CONCLUSIONS
  IN PATIENTS WITH CORONARY ARTERY DISEASE: (1) Luminal geometry predicts calculated WSS only partially, which suggests that detailed computational techniques must be used to calculate WSS. (2) Low WSS is associated with plaque necrotic core and calcium, independent of plaque burden, which suggests a link between WSS and coronary plaque phenotype. (J Am Heart Assoc. 2012;1:e002543 doi: 10.1161/JAHA.112.002543.).
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine,  Atlanta, GA (P.E., M.C.M., S.S.D., L.H.T., L.J.G., M.T.C., A.V.F., A.A.Q., H.S.).
authors.forename: Parham
authors.initials: P
authors.lastname: Eshtehardi
authors.forename: Michael C
authors.initials: MC
authors.lastname: McDaniel
authors.forename: Jin
authors.initials: J
authors.lastname: Suo
authors.forename: Saurabh S
authors.initials: SS
authors.lastname: Dhawan
authors.forename: Lucas H
authors.initials: LH
authors.lastname: Timmins
authors.forename: José Nilo G
authors.initials: JN
authors.lastname: Binongo
authors.forename: Lucas J
authors.initials: LJ
authors.lastname: Golub
authors.forename: Michel T
authors.initials: MT
authors.lastname: Corban
authors.forename: Aloke V
authors.initials: AV
authors.lastname: Finn
authors.forename: John N
authors.initials: JN
authors.lastname: Oshinski
authors.forename: Arshed A
authors.initials: AA
authors.lastname: Quyyumi
authors.forename: Don P
authors.initials: DP
authors.lastname: Giddens
authors.forename: Habib
authors.initials: H
authors.lastname: Samady
keywords: atherosclerosis; computational fluid dynamics; coronary arteries; histology, virtual; ultrasonography, intravascular; wall shear stress