Influence of intracoronary hemodynamic forces on atherosclerotic plaque phenotypes

Alessandro Candreva; Diego Gallo; Daniel Munhoz; Maurizio Lodi Rizzini; Takuya Mizukami; Ruiko Seki; Koshiro Sakai; Jeroen Sonck; Valentina Mazzi; Brian Ko; Bjarne Linde Nørgaard; Jesper Møller Jensen; Michael Maeng; Hiromasa Otake; Bon-Kwon Koo; Toshiro Shinke; Jean-Paul Aben; Daniele Andreini; Emanuele Gallinoro; Barbara E Stähli; Christian Templin; Claudio Chiastra; Bernard De Bruyne; Umberto Morbiducci; Carlos Collet

doi:10.1016/j.ijcard.2023.131668

Influence of intracoronary hemodynamic forces on atherosclerotic plaque phenotypes

Int J Cardiol. 2024 Mar 15:399:131668. doi: 10.1016/j.ijcard.2023.131668. Epub 2023 Dec 22.

Authors

Alessandro Candreva¹, Diego Gallo², Daniel Munhoz³, Maurizio Lodi Rizzini², Takuya Mizukami⁴, Ruiko Seki⁵, Koshiro Sakai⁵, Jeroen Sonck⁶, Valentina Mazzi², Brian Ko⁷, Bjarne Linde Nørgaard⁸, Jesper Møller Jensen⁸, Michael Maeng⁸, Hiromasa Otake⁹, Bon-Kwon Koo¹⁰, Toshiro Shinke¹¹, Jean-Paul Aben¹², Daniele Andreini¹³, Emanuele Gallinoro¹⁴, Barbara E Stähli¹⁵, Christian Templin¹⁶, Claudio Chiastra², Bernard De Bruyne¹⁷, Umberto Morbiducci², Carlos Collet¹⁸

Affiliations

¹ Department of Cardiology, Zurich University Hospital, Zurich, Switzerland; Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
² PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
³ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Department of internal medicine, University of Campinas (Unicamp), Campinas, Brazil.
⁴ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Showa University School of Medicine, Tokyo, Japan.
⁵ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
⁶ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
⁷ Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia.
⁸ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
⁹ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Aichi, Japan.
¹⁰ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
¹¹ Department of Cardiology, Showa University School of Medicine, Tokyo, Japan.
¹² Pie Medical Imaging BV, Maastricht, the Netherlands.
¹³ Department of Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy and Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
¹⁴ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy and Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
¹⁵ Department of Cardiology, Zurich University Hospital, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
¹⁶ Department of Cardiology, Zurich University Hospital, Zurich, Switzerland.
¹⁷ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
¹⁸ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. Electronic address: carloscollet@gmail.com.

PMID: 38141723
DOI: 10.1016/j.ijcard.2023.131668

Abstract

Background and aims: Coronary hemodynamics impact coronary plaque progression and destabilization. The aim of the present study was to establish the association between focal vs. diffuse intracoronary pressure gradients and wall shear stress (WSS) patterns with atherosclerotic plaque composition.

Methods: Prospective, international, single-arm study of patients with chronic coronary syndromes and hemodynamic significant lesions (fractional flow reserve [FFR] ≤ 0.80). Motorized FFR pullback pressure gradient (PPG), optical coherence tomography (OCT), and time-average WSS (TAWSS) and topological shear variation index (TSVI) derived from three-dimensional angiography were obtained.

Results: One hundred five vessels (median FFR 0.70 [Interquartile range (IQR) 0.56-0.77]) had combined PPG and WSS analyses. TSVI was correlated with PPG (r = 0.47, [95% Confidence Interval (95% CI) 0.30-0.65], p < 0.001). Vessels with a focal CAD (PPG above the median value of 0.67) had significantly higher TAWSS (14.8 [IQR 8.6-24.3] vs. 7.03 [4.8-11.7] Pa, p < 0.001) and TSVI (163.9 [117.6-249.2] vs. 76.8 [23.1-140.9] m^-1, p < 0.001). In the 51 vessels with baseline OCT, TSVI was associated with plaque rupture (OR 1.01 [1.00-1.02], p = 0.024), PPG with the extension of lipids (OR 7.78 [6.19-9.77], p = 0.003), with the presence of thin-cap fibroatheroma (OR 2.85 [1.11-7.83], p = 0.024) and plaque rupture (OR 4.94 [1.82 to 13.47], p = 0.002).

Conclusions: Focal and diffuse coronary artery disease, defined using coronary physiology, are associated with differential WSS profiles. Pullback pressure gradients and WSS profiles are associated with atherosclerotic plaque phenotypes. Focal disease (as identified by high PPG) and high TSVI are associated with high-risk plaque features.

Clinical trial registration: https://clinicaltrials,gov/ct2/show/NCT03782688.

Keywords: Computational fluid dynamics; Coronary artery disease; Plaque rupture; Plaque vulnerability; Pullback pressure gradient; Wall shear stress.

Publication types

Clinical Study

MeSH terms

Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Vessels / diagnostic imaging
Coronary Vessels / pathology
Fractional Flow Reserve, Myocardial* / physiology
Hemodynamics
Humans
Phenotype
Plaque, Atherosclerotic* / diagnostic imaging
Plaque, Atherosclerotic* / pathology
Predictive Value of Tests
Prospective Studies

Associated data

ClinicalTrials.gov/NCT03782688