title: Coronary artery wall shear stress is associated with endothelial dysfunction and expansive arterial remodelling in patients with coronary artery disease.
abstract: OBJECTIVE
  To investigate in vivo relationships between segmental wall shear stress (WSS), endothelium-dependent vasoreactivity and arterial remodelling.
  
  
  RESULTS
  Twenty-four patients with minor angiographic coronary arterial disease (≤30% stenosis severity) underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound (IVUS)-upon-Doppler guidewire imaging. Macrovascular response (change in segmental lumen volume [SLV] at baseline and following IC salbutamol), plaque burden (percent atheroma volume [PAV]), remodelling indices (RI), eccentricity indices (EI) and WSS were evaluated in 179 consecutive 5 mm coronary segments. Baseline WSS was directly related to endothelium-dependent epicardial coronary vasomotion (% change SLV, coefficient 17.2, p=0.004), and inversely related to RI (coefficient -0.23, p=0.02) and EI (coefficient -10.0, p=0.001). Baseline WSS was lower in segments displaying endothelial dysfunction (defined as any change in SLV ≤0) compared with preserved function (0.66±0.33 vs. 0.71±0.22 N/m2, p=0.046). Independent of plaque burden, segments with the lowest tertile of WSS displayed less vasodilatation, or vasoconstriction, than segments with the highest tertile of WSS. Higher plaque burden segments harbouring the lowest tertiles of WSS displayed vasoconstriction, expansive arterial remodelling and greater plaque eccentricity.
  
  
  CONCLUSIONS
  In patients with stable coronary syndromes and minor angiographic coronary disease, coronary segments with lower in vivo WSS values display functional and morphological features of plaque vulnerability.
authors.affiliation: Discipline of Medicine, Cardiovascular Research Centre, University of Adelaide, Adelaide, Australia.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: Darryl P
authors.initials: DP
authors.lastname: Leong
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: Gary Y L
authors.initials: GY
authors.lastname: Liew
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Nelson
authors.forename: Angelo
authors.initials: A
authors.lastname: Carbone
authors.forename: Barbara
authors.initials: B
authors.lastname: Copus
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Wong
authors.forename: John F
authors.initials: JF
authors.lastname: Beltrame
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Worthley
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Worthley
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000494:pharmacology; D000420:Albuterol / Q000494:pharmacology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology*; D004791:Enzyme Inhibitors / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D033081:Shear Strength / Q000502:physiology*; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D066253:Vascular Remodeling / Q000502:physiology*; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology*; D019323:omega-N-Methylarginine / Q000494:pharmacology
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D004791:Enzyme Inhibitors; D019323:omega-N-Methylarginine; D000420:Albuterol