Research paper| Volume 17, ISSUE 3, P201-210, May 2023

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Endothelial shear stress computed from coronary computed tomography angiography: A direct comparison to intravascular ultrasound

Published:April 17, 2023DOI:



      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.


      To compare the accuracy of ESS computation of local ESS metrics by CCTA vs IVUS imaging.


      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.


      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.


      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.


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        • Samady H.
        • Eshtehardi P.
        • McDaniel M.C.
        • et al.
        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
        • Stone P.H.
        • Maehara A.
        • Coskun A.U.
        • et al.
        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
        • Yamamoto E.
        • Siasos G.
        • Zaromytidou M.
        • et al.
        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
        • Oemrawsingh R.M.
        • Cheng J.M.
        • García-García H.M.
        • et al.
        Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease.
        J Am Coll Cardiol. 2014; 64: 2510-2518
        • Waksman R.
        • Di Mario C.
        • Torguson R.
        • et al.
        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
        • Erlinge D.
        • Maehara A.
        • Ben-Yehuda O.
        • et al.
        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
        • Calvert P.A.
        • Obaid D.R.
        • O'Sullivan M.
        • et al.
        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
        • Cheng J.M.
        • Garcia-Garcia H.M.
        • de Boer S.P.M.
        • et al.
        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
        • Stone G.W.
        • Maehara A.
        • Lansky A.J.
        • et al.
        A prospective natural-history study of coronary atherosclerosis.
        N Engl J Med. 2011; 364: 226-235
        • Chatzizisis Y.S.
        • Coskun A.U.
        • Jonas M.
        • Edelman E.R.
        • Feldman C.L.
        • Stone P.H.
        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
        • Brown A.J.
        • Teng Z.
        • Evans P.C.
        • Gillard J.H.
        • Samady H.
        • Bennett M.R.
        Role of biomechanical forces in the natural history of coronary atherosclerosis.
        Nat Rev Cardiol. 2016; 13: 210-220
        • Kumar A.
        • Thompson E.W.
        • Lefieux A.
        • et al.
        High coronary shear stress in patients with coronary artery disease predicts myocardial infarction.
        J Am Coll Cardiol. 2018; 72: 1926-1935
        • Thondapu V.
        • Mamon C.
        • Poon E.K.W.
        • et al.
        High spatial endothelial shear stress gradient independently predicts site of acute coronary plaque rupture and erosion.
        Cardiovasc Res. 2021; 117: 1974-1985
        • Kishi S.
        • Magalhães T.A.
        • Cerci R.J.
        • et al.
        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
        • Lee J.M.
        • Choi G.
        • Koo B.-K.
        • et al.
        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
        • Mortensen M.B.
        • Dzaye O.
        • Steffensen F.H.
        • et al.
        Impact of plaque burden versus stenosis on ischemic events in patients with coronary atherosclerosis.
        J Am Coll Cardiol. 2020; 76: 2803-2813
        • Ferraro R.A.
        • van Rosendael A.R.
        • Lu Y.
        • et al.
        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
        • Lee S.-E.
        • Sung J.M.
        • Andreini D.
        • et al.
        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
        • Conte E.
        • Mushtaq S.
        • Pontone G.
        • et al.
        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
        • Mintz G.S.
        • Nissen S.E.
        • Anderson W.D.
        • et al.
        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
        • Tomaniak M.
        • Katagiri Y.
        • Modolo R.
        • et al.
        Vulnerable plaques and patients: state-of-the-art.
        Eur Heart J. 2020; 41: 2997-3004
        • Stone P.H.
        • Saito S.
        • Takahashi S.
        • et al.
        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
        • Hetterich H.
        • Jaber A.
        • Gehring M.
        • et al.
        Coronary computed tomography angiography based assessment of endothelial shear stress and its association with atherosclerotic plaque distribution in-vivo.
        PLoS One. 2015; 10e0115408
        • Rybicki F.J.
        • Melchionna S.
        • Mitsouras D.
        • et al.
        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
        • Park J.-B.
        • Choi G.
        • Chun E.J.
        • et al.
        Computational fluid dynamic measures of wall shear stress are related to coronary lesion characteristics.
        Heart. 2016; 102: 1655-1661
        • Adriaenssens T.
        • Allard-Ratick M.P.
        • Thondapu V.
        • et al.
        Optical coherence tomography of coronary plaque progression and destabilization: JACC focus seminar Part 3/3.
        J Am Coll Cardiol. 2021; 78: 1275-1287
        • Bulant C.A.
        • Blanco P.J.
        • Maso Talou G.D.
        • Bezerra C.G.
        • Lemos P.A.
        • Feijóo R.A.
        A head-to-head comparison between CT- and IVUS-derived coronary blood flow models.
        J Biomech. 2017; 51: 65-76
        • Eslami P.
        • Hartman E.M.J.
        • Albaghadai M.
        • et al.
        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
        • Doh J.-H.
        • Koo B.-K.
        • Nam C.-W.
        • et al.
        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