title: Plaque structural stress assessed by virtual histology-intravascular ultrasound predicts dynamic changes in phenotype and composition of untreated coronary artery lesions.
abstract: We aimed to determine whether finite element analysis (FEA)-derived plaque structural stress (PSS) analysis can predict serial changes in atheroma volume, type, and tissue composition within a fibroatheroma-containing target segment.
  
  
  
  Overall, 210 patients (210 untreated coronary artery lesions) underwent serial (baseline and 12-month follow-up) grayscale- and virtual histology (VH)-intravascular ultrasound (IVUS). Baseline PSS was assessed at the minimal lumen and at the maximum necrotic core (NC) sites.
  
  
  
  Overall, there was a significant decrease in %NC volume. The highest PSS tertile was associated with a smaller on-statin reduction in %NC volume (-1.55 ± 1.03% in the highest vs. -5.18 ± 1.12% in the lowest tertile, p = 0.025). Of the 115 lesions with baseline VH-thin cap fibroatheroma (TCFA), 36 (31%) showed persistent VH-TCFA at follow-up. Five of the 95 lesions with baseline thick-cap fibroatheroma evolved into VH-TCFA. Independent predictors of VH-TCFA at follow-up (including persistent and new VH-TCFAs) were diabetes mellitus (odds ratio [OR] = 3.87, 95% CI = 1.58-9.47), a large MLA (OR = 1.39, 95% CI = 1.10-1.75), a greater percent atheroma volume (OR = 1.12, 95% CI = 1.05-1.19), VH-TCFA at baseline (OR = 8.01, 95% CI = 2.73-23.50), and a higher superficial PSS at the maximum NC site (OR = 1.02, 95% CI = 1.00-1.03), (all p < 0.05). Independent determinants of the serial change in %NC volume were high-sensitive C-reactive protein (β = -2.79, 95% CI = -5.31 to -0.27), baseline %NC volume (β = -0.70, 95% CI = -0.84 to -0.56), and superficial PSS at the maximum NC site (β = 0.05, 95% CI = 0.01-0.08), (all p < 0.05).
  
  
  
  An elevated PSS was more likely associated with an increase in atheroma volume, a smaller on-statin reduction in %NC volumes, and the presence of VH-TCFA at follow-up. Morphologic and hemodynamic assessment by utilizing VH-IVUS may help understand and predict atherosclerotic progression.
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Hojin
authors.initials: H
authors.lastname: Ha
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: June-Goo
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seung-Bong
authors.initials: SB
authors.lastname: Han
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kweon
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Mineok
authors.initials: M
authors.lastname: Chang
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Roh
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Pil Hyung
authors.initials: PH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: mdyhkim@amc.seoul.kr.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D020342:Finite Element Analysis; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010641:Phenotype; D058226:Plaque, Atherosclerotic / Q000473:pathology; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: Plaque structural stress; Thin-cap fibroatheroma; Virtual histology-intravascular ultrasound