title: Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of 'shear stress score'.
abstract: OBJECTIVE
  The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes.
  
  
  RESULTS
  A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89 ± 84 vs.138 ± 83 µm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina.
  
  
  CONCLUSIONS
  Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.
authors.affiliation: Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.|Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
authors.forename: Yiannis S
authors.initials: YS
authors.lastname: Chatzizisis
authors.affiliation: First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.affiliation: First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.|Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Giannopoulos
authors.affiliation: First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Riga
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
authors.forename: Antonios P
authors.initials: AP
authors.lastname: Antoniadis
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujinom
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mitsouras
authors.affiliation: Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece.|Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece.
authors.forename: Vassilis G
authors.initials: VG
authors.lastname: Koutkias
authors.affiliation: Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Cheimariotis
authors.affiliation: Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Doulaverakis
authors.affiliation: Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsampoulatidis
authors.affiliation: Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece.|Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Chouvarda
authors.affiliation: Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kompatsiaris
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.affiliation: Laboratory of Medical Informatics, Aristotle University Medical School, Thessaloniki, Greece.|Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece.
authors.forename: Nicos
authors.initials: N
authors.lastname: Maglaveras
authors.affiliation: First Department of Cardiology, Hippokration Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: First Department of Cardiology, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
authors.forename: George D
authors.initials: GD
authors.lastname: Giannoglou
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D000704:Analysis of Variance; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D033081:Shear Strength / Q000502:physiology*; D016019:Survival Analysis; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
keywords: clinical events; coronary artery disease; endothelial shear stress; high-risk plaque; optical coherence tomography; shear stress score; vascular remodelling