Computational fluid dynamic measures of wall shear stress are related to coronary lesion characteristics.
To assess the distribution of pressure and shear-related forces acting on atherosclerotic plaques and their association with lesion characteristics using coronary CT angiography (cCTA)-based computational fluid dynamics (CFD) model of epicardial coronary arteries.



Patient-specific models of epicardial coronary arteries were reconstructed from cCTA in 80 patients (12 women, 63.8±9.0 years). The pressure and wall shear stress (WSS) in left anterior descending coronary arteries were assessed using CFD. High-risk plaques were defined as the presence of at least one of the following adverse plaque characteristics: low-density plaque, positive remodelling, napkin-ring sign and spotty calcification.



At resting condition, 39.5% of stenotic segments (% diameter stenosis 52.3±14.4%) were exposed to high WSS (>40 dyne/cm(2)). When the stenotic lesion was subdivided into three segments, the distribution of WSS was different from that of pressure change and its magnitude was highest at minimal lumen area (p<0.001). High pressure gradient, proximal location, small lumen and short length were independent determinants of WSS (all p<0.05). The plaques exposed to the highest WSS tertile had a significantly greater proportion of high-risk plaques. The addition of WSS to % diameter stenosis significantly improved the measures of discrimination and reclassification of high-risk plaques (area under the curves from 0.540 to 0.718, p=0.031; net reclassification index 0.827, p<0.001).



The cCTA-based CFD method can improve the identification of high-risk plaques and the risk stratification for coronary artery disease patients by providing non-invasive measurements of WSS affecting coronary plaques.
Department of Medicine, Seoul National University Hospital, Seoul, South Korea.
Jun-Bean
JB
Park
HeartFlow, Inc., Redwood City, California, USA Department of Surgery, Stanford University Medical Center, Stanford, California, USA.
Gilwoo
G
Choi
Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
Eun Ju
EJ
Chun
HeartFlow, Inc., Redwood City, California, USA.
Hyun Jin
HJ
Kim
Department of Medicine, Seoul National University Hospital, Seoul, South Korea.
Jonghanne
J
Park
Department of Medicine, Seoul National University Hospital, Seoul, South Korea.
Ji-Hyun
JH
Jung
Department of Medicine, Soonchunhyang University Hospital, Seoul, South Korea.
Min-Ho
MH
Lee
Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Hiromasa
H
Otake
Department of Medicine, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea.
Joon-Hyung
JH
Doh
Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.
Chang-Wook
CW
Nam
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Eun-Seok
ES
Shin
Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Bernard
B
De Bruyne
HeartFlow, Inc., Redwood City, California, USA Department of Bioengineering, Stanford University, Stanford, California, USA.
Charles A
CA
Taylor
Department of Medicine, Seoul National University Hospital, Seoul, South Korea Institute of Aging, Seoul National University, Seoul, South Korea.
Bon-Kwon
BK
Koo
D000368:Aged; D062186:Arterial Pressure; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D057446:Hydrodynamics; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013314:Stress, Mechanical; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology