Highlights
- •There is a strong correlation between ESS metrics and plaque erosion.
- •Plaque slope steepness plays an important role in the development of plaque erosion.
- •These data shed light on plaque erosion development, location, and possibilities for early identification of high-risk plaque areas.
Abstract
Background and aims
Plaque erosion is a common underlying cause of acute coronary syndromes. The role
of endothelial shear stress (ESS) and endothelial shear stress gradient (ESSG) in
plaque erosion remains unknown.
We aimed to determine the role of ESS metrics and maximum plaque slope steepness in
plaques with erosion versus stable plaques.
Methods
This analysis included 46 patients/plaques from TOTAL and COMPLETE trials and Brigham
and Women's Hospital's database who underwent angiography and OCT. Plaques were divided
into those with erosion (n = 24) and matched stable coronary plaques (n = 22). Angiographic
views were used to generate a 3-D arterial reconstruction, with centerlines merged
from angiography and OCT pullback. Local ESS metrics were assessed by computational
fluid dynamics. Among plaque erosions, the up- and down-slope (Δ lumen area/frame)
was calculated for each culprit plaque.
Results
Compared with stable plaque controls, plaques with an erosion were associated with
higher max ESS (8.3 ± 4.8 vs. 5.0 ± 1.9 Pa, p = 0.02) and max ESSG any direction (9.2 ± 7.5 vs. 4.3 ± 3.11 Pa/mm, p = 0.005). Proximal erosion was associated with a steeper plaque
upslope while distal erosion with a steeper plaque downslope. Max ESS and Max ESSG
any direction were independent factors in the development of plaque erosion (OR 1.32,
95%CI 1.06–1.65, p = 0.014; OR 1.22, 95% CI 1.03–1.45, p = 0.009, respectively).
Conclusions
In plaques with similar luminal stenosis, plaque erosion was strongly associated with
higher ESS, ESS gradients, and plaque slope as compared with stable plaques. These
data support that ESS and slope metrics play a key role in the development of plaque
erosion and may help prognosticate individual plaques at risk for future erosion.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Accepted:
May 16,
2023
Received in revised form:
May 12,
2023
Received:
October 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier B.V.
