title: High wall shear stress and high-risk plaque: an emerging concept.
abstract: In recent years, there has been a significant effort to identify high-risk plaques in vivo prior to acute events. While number of imaging modalities have been developed to identify morphologic characteristics of high-risk plaques, prospective natural-history observational studies suggest that vulnerability is not solely dependent on plaque morphology and likely involves additional contributing mechanisms. High wall shear stress (WSS) has recently been proposed as one possible causative factor, promoting the development of high-risk plaques. High WSS has been shown to induce specific changes in endothelial cell behavior, exacerbating inflammation and stimulating progression of the atherosclerotic lipid core. In line with experimental and autopsy studies, several human studies have shown associations between high WSS and known morphological features of high-risk plaques. However, despite increasing evidence, there is still no longitudinal data linking high WSS to clinical events. As the interplay between atherosclerotic plaque, artery, and WSS is highly dynamic, large natural history studies of atherosclerosis that include WSS measurements are now warranted. This review will summarize the available clinical evidence on high WSS as a possible etiological mechanism underlying high-risk plaque development.
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA.
authors.forename: Parham
authors.identifier: http://orcid.org/0000-0001-8134-1787
authors.initials: P
authors.lastname: Eshtehardi
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Brown
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA.
authors.forename: Ankit
authors.initials: A
authors.lastname: Bhargava
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA.
authors.forename: Olivia Y
authors.initials: OY
authors.lastname: Hung
authors.affiliation: Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA.
authors.forename: Michel T
authors.initials: MT
authors.lastname: Corban
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Hosseini
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA.
authors.forename: Bill D
authors.initials: BD
authors.lastname: Gogas
authors.affiliation: Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
authors.forename: Don P
authors.initials: DP
authors.lastname: Giddens
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road F622, Atlanta, GA, 30322, USA. hsamady@emory.edu.
authors.forename: Habib
authors.initials: H
authors.lastname: Samady
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013314:Stress, Mechanical
keywords: Acute coronary syndrome; Computational fluid dynamics; Coronary artery disease; High-risk plaque; Wall shear stress