Abstract
Introduction
Intravascular ultrasound (IVUS) studies have shown that biomechanical variables, particularly
endothelial shear stress (ESS), add synergistic prognostic insight when combined with
anatomic high-risk plaque features. Non-invasive risk assessment of coronary plaques
with coronary computed tomography angiography (CCTA) would be helpful to enable broad
population risk-screening.
Aim
To compare the accuracy of ESS computation of local ESS metrics by CCTA vs IVUS imaging.
Methods
We analyzed 59 patients from a registry of patients who underwent both IVUS and CCTA
for suspected CAD. CCTA images were acquired using either a 64- or 256-slice scanner.
Lumen, vessel, and plaque areas were segmented from both IVUS and CCTA (59 arteries,
686 3-mm segments). Images were co-registered and used to generate a 3-D arterial
reconstruction, and local ESS distribution was assessed by computational fluid dynamics
(CFD) and reported in consecutive 3-mm segments.
Results
Anatomical plaque characteristics (vessel, lumen, plaque area and minimal luminal
area [MLA] per artery) were correlated when measured with IVUS and CCTA: 12.7 ± 4.3
vs 10.7 ± 4.5 mm2, r = 0.63; 6.8 ± 2.7 vs 5.6 ± 2.7 mm2, r = 0.43; 5.9 ± 2.9 vs 5.1 ± 3.2 mm2, r = 0.52; 4.5 ± 1.3 vs 4.1 ± 1.5 mm2, r = 0.67 respectively. ESS metrics of local minimal, maximal, and average ESS
were also moderately correlated when measured with IVUS and CCTA (2.0 ± 1.4 vs 2.5 ± 2.6 Pa, r = 0.28; 3.3 ± 1.6 vs 4.2 ± 3.6 Pa, r = 0.42; 2.6 ± 1.5 vs 3.3 ± 3.0 Pa,
r = 0.35, respectively). CCTA-based computation accurately identified the spatial
localization of local ESS heterogeneity compared to IVUS, with Bland-Altman analyses
indicating that the absolute ESS differences between the two CCTA methods were pathobiologically
minor.
Conclusion
Local ESS evaluation by CCTA is possible and similar to IVUS; and is useful for identifying
local flow patterns that are relevant to plaque development, progression, and destabilization.
Keywords
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References
- Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease.Circulation. 2011; 124: 779-788
- Role of low endothelial shear stress and plaque characteristics in the prediction of nonculprit major adverse cardiac events: the PROSPECT study.JACC Cardiovasc Imag. 2018; 11: 462-471
- Low endothelial shear stress predicts evolution to high-risk coronary plaque phenotype in the future: a serial optical coherence tomography and computational fluid dynamics study.Circ Cardiovasc Interv. 2017; 10e005455
- Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease.J Am Coll Cardiol. 2014; 64: 2510-2518
- Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study.Lancet. 2019; 394: 1629-1637
- Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study.Lancet. 2021; 397: 985-995
- Association between IVUS findings and adverse outcomes in patients with coronary artery disease: the VIVA (VH-IVUS in Vulnerable Atherosclerosis) Study.JACC Cardiovasc Imag. 2011; 4: 894-901
- In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study.Eur Heart J. 2014; 35: 639-647
- A prospective natural-history study of coronary atherosclerosis.N Engl J Med. 2011; 364: 226-235
- Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior.J Am Coll Cardiol. 2007; 49: 2379-2393
- Role of biomechanical forces in the natural history of coronary atherosclerosis.Nat Rev Cardiol. 2016; 13: 210-220
- High coronary shear stress in patients with coronary artery disease predicts myocardial infarction.J Am Coll Cardiol. 2018; 72: 1926-1935
- High spatial endothelial shear stress gradient independently predicts site of acute coronary plaque rupture and erosion.Cardiovasc Res. 2021; 117: 1974-1985
- Total coronary atherosclerotic plaque burden assessment by CT angiography for detecting obstructive coronary artery disease associated with myocardial perfusion abnormalities.J Cardiovasc Comput Tomogr. 2016; 10: 121-127
- Identification of high-risk plaques destined to cause acute coronary syndrome using coronary computed tomographic angiography and computational fluid dynamics.JACC Cardiovasc Imag. 2019; 12: 1032-1043
- Impact of plaque burden versus stenosis on ischemic events in patients with coronary atherosclerosis.J Am Coll Cardiol. 2020; 76: 2803-2813
- Non-obstructive high-risk plaques increase the risk of future culprit lesions comparable to obstructive plaques without high-risk features: the ICONIC study.Eur Heart J Cardiovasc Imag. 2020; 21: 973-980
- Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study.Int J Cardiovasc Imag. 2020; 36: 2357-2364
- Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: a comparison between standard and last generation computed tomography scanners.Eur Heart J Cardiovasc Imag. 2020; 21: 191-201
- American College of Cardiology clinical Expert Consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS). A report of the American College of Cardiology task force on clinical Expert Consensus documents.J Am Coll Cardiol. 2001; 37: 1478-1492
- Vulnerable plaques and patients: state-of-the-art.Eur Heart J. 2020; 41: 2997-3004
- PREDICTION Investigators. Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study.Circulation. 2012 Jul 10; 126: 172-181
- Coronary computed tomography angiography based assessment of endothelial shear stress and its association with atherosclerotic plaque distribution in-vivo.PLoS One. 2015; 10e0115408
- Prediction of coronary artery plaque progression and potential rupture from 320-detector row prospectively ECG-gated single heart beat CT angiography: Lattice Boltzmann evaluation of endothelial shear stress.Int J Cardiovasc Imag. 2009; 25: 289-299
- Computational fluid dynamic measures of wall shear stress are related to coronary lesion characteristics.Heart. 2016; 102: 1655-1661
- Optical coherence tomography of coronary plaque progression and destabilization: JACC focus seminar Part 3/3.J Am Coll Cardiol. 2021; 78: 1275-1287
- A head-to-head comparison between CT- and IVUS-derived coronary blood flow models.J Biomech. 2017; 51: 65-76
- Validation of wall shear stress assessment in non-invasive coronary CTA versus invasive imaging: a patient-specific computational study.Ann Biomed Eng. 2021; 49: 1151-1168
- Diagnostic value of coronary CT angiography in comparison with invasive coronary angiography and intravascular ultrasound in patients with intermediate coronary artery stenosis: results from the prospective multicentre FIGURE-OUT (Functional Imaging criteria for GUiding REview of invasive coronary angiOgraphy, intravascular Ultrasound, and coronary computed Tomographic angiography) study.Eur Heart J Cardiovasc Imag. 2014; 15: 870-877
Article info
Publication history
Published online: April 17, 2023
Accepted:
March 23,
2023
Received in revised form:
March 18,
2023
Received:
September 23,
2022
Identification
Copyright
© 2023 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
