Combination of plaque burden, wall shear stress, and plaque phenotype has incremental value for prediction of coronary atherosclerotic plaque progression and vulnerability.
OBJECTIVE
Large plaque burden, certain phenotypes, and low wall shear stress (WSS) are associated with adverse outcomes and high WSS with development of plaque vulnerability. We aimed to investigate the incremental value of the combination of plaque burden, WSS and plaque phenotype for prediction of coronary atherosclerotic plaque progression and vulnerability.


METHODS
Twenty patients with CAD underwent baseline and 6-month follow-up coronary virtual histology-intravascular ultrasound (VH-IVUS) and computational fluid dynamics modeling for calculation of WSS. Low WSS was defined as <10 dynes/cm(2) and high WSS as ≥25 dynes/cm(2). Baseline plaque characteristics and WSS were related to plaque progression and vulnerability.


RESULTS
In 2249 VH-IVUS frames analyzed, coronary segments with both plaque burden >40% and low WSS had significantly greater change in plaque area at follow-up (+0.68 ± 1.05 mm(2)), compared to segments with plaque burden >40% without low WSS (-0.28 ± 1.32 mm(2)) or segments with low WSS and plaque burden ≤40% (+0.05 ± 0.71 mm(2)) (p = 0.047). Among plaque phenotypes, pathologic intimal thickening (PIT) had the greatest increase in necrotic core (NC) area (p = 0.06) and greatest decrease in fibro-fatty (FF) area (p < 0.0001). At follow-up, compared to segments with either plaque burden >60%, PIT, or high WSS, those with a combination of plaque burden >60%, PIT, and high WSS developed greater increase in NC area (p = 0.002), greater decrease in FF (p = 0.004) and fibrous areas (p < 0.0001), and higher frequency of expansive remodeling (p = 0.019).


CONCLUSIONS
Combination of plaque burden, WSS, and plaque phenotype has incremental value for prediction of coronary plaque progression and increased plaque vulnerability in patients with non-obstructive CAD.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Michel T
MT
Corban
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Parham
P
Eshtehardi
Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
Jin
J
Suo
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Michael C
MC
McDaniel
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
Lucas H
LH
Timmins
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Emad
E
Rassoul-Arzrumly
Department of Health Services, University of Washington, Seattle, WA, USA.
Charles
C
Maynard
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Girum
G
Mekonnen
Saint Joseph's Hospital, Atlanta, GA, USA.
Spencer
S
King
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Arshed A
AA
Quyyumi
Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
Don P
DP
Giddens
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: hsamady@emory.edu.
Habib
H
Samady
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology*; D011379:Prognosis; D033081:Shear Strength; D013314:Stress, Mechanical; D018084:Ultrasonography, Interventional
Atherosclerosis; CAD; CFD; Computational Fluid Dynamics; Computational fluid dynamics; Coronary Artery Disease; Coronary artery; DC; Dense Calcium; EEM; External Elastic Membrane; FA; FF; FI; Fibro-fatty Tissue; Fibroatheroma; Fibrous Tissue; Intravascular ultrasound; NC; Necrotic Core; PIT; Pathological Intimal Thickening; VH-IVUS; Virtual Histology-Intravascular Ultrasound; WSS; Wall Shear Stress; Wall shear stress