title: Biomechanics and inflammation in atherosclerotic plaque erosion and plaque rupture: implications for cardiovascular events in women.
abstract: OBJECTIVE
  Although plaque erosion causes approximately 40% of all coronary thrombi and disproportionally affects women more than men, its mechanism is not well understood. The role of tissue mechanics in plaque rupture and regulation of mechanosensitive inflammatory proteins is well established, but their role in plaque erosion is unknown. Given obvious differences in morphology between plaque erosion and rupture, we hypothesized that inflammation in general as well as the association between local mechanical strain and inflammation known to exist in plaque rupture may not occur in plaque erosion. Therefore, our objective was to determine if similar mechanisms underlie plaque rupture and plaque erosion.
  
  
  RESULTS
  We studied a total of 74 human coronary plaque specimens obtained at autopsy. Using lesion-specific computer modeling of solid mechanics, we calculated the stress and strain distribution for each plaque and determined if there were any relationships with markers of inflammation. Consistent with previous studies, inflammatory markers were positively associated with increasing strain in specimens with rupture and thin-cap fibroatheromas. Conversely, overall staining for inflammatory markers and apoptosis were significantly lower in erosion, and there was no relationship with mechanical strain. Samples with plaque erosion most closely resembled those with the stable phenotype of thick-cap fibroatheromas.
  
  
  CONCLUSIONS
  In contrast to classic plaque rupture, plaque erosion was not associated with markers of inflammation and mechanical strain. These data suggest that plaque erosion is a distinct pathophysiological process with a different etiology and therefore raises the possibility that a different therapeutic approach may be required to prevent plaque erosion.
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, United States of America.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Campbell
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, United States of America.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Suever
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, United States of America; Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Lucas H
authors.initials: LH
authors.lastname: Timmins
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, United States of America; Department of Mathematics and Computer Science, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Veneziani
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, United States of America; George W. Woodruff Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America.
authors.forename: Raymond P
authors.initials: RP
authors.lastname: Vito
authors.affiliation: CVPath Institute, Inc., Gaithersburg, Maryland, United States of America.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, United States of America; Department of Radiology and Imaging Science, Emory University, Atlanta, Georgia, United States of America.
authors.forename: John N
authors.initials: JN
authors.lastname: Oshinski
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, United States of America; Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America; Cardiology Division, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America.
authors.forename: W Robert
authors.initials: WR
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D003328:Coronary Thrombosis / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D058226:Plaque, Atherosclerotic / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D012727:Sex Characteristics