Biomechanical Stress Profiling of Coronary Atherosclerosis Identifying a Multifactorial Metric to Evaluate Plaque Rupture Risk

JACC-CARDIOVASCULAR IMAGING

卷:13

Article

Doradla, Pallavi¹  Otsuka, Kenichiro¹  Nadkarni, Abhijay¹  Villiger, Martin¹  Karanasos, Antonios²  van Zandvoort, Laurens J. C.²  Dijkstra, Jouke³  Zijlstra, Felix²  van Soest, Gijs²  Daemen, Joost²  Regar, Evelyn²  Bouma, Brett E.^1,4  Nadkarni, Seemantini K.¹ 

[1] Harvard Med Sch, Massachusetts Gen Hosp, Wellman Ctr Photomed, 50 Blossom St, Boston, MA 02114 USA

[2] Erasmus MC, Thorax Ctr, Dept Intervent Cardiol, Rotterdam, Netherlands

[3] Leiden Univ, Dept Radiol, Med Ctr, Leiden, Netherlands

[4] Harvard MIT, Program Hlth Sci & Technol, Cambridge, MA USA

关键词: atherosclerosis;    biomechanics;    computational modeling;    finite element;    plaque rupture;    stress;   

DOI  :  10.1016/j.jcmg.2019.01.033

来源: Elsevier

【 摘 要 】

OBJECTIVES The purpose of this study was to derive a biomechanical stress metric that was based on the multifactorial assessment of coronary plaque morphology, likely related to the propensity of plaque rupture in patients. BACKGROUND Plaque rupture, the most frequent cause of coronary thrombosis, occurs at locations of elevated tensile stress in necrotic core fibroatheromas (NCFAs). Finite element modeling (FEM), typically used to calculate tensile stress, is computationally intensive and impractical as a clinical tool for locating rupture-prone plaques. This study derived a multifactorial stress equation (MSE) that accurately computes peak stress in NCFAs by combining the influence of several morphological parameters. METHODS Intravascular ultrasound and optical frequency domain imaging were conducted in 30 patients, and plaque morphological parameters were defined in 61 NCFAs. Multivariate regression analysis was applied to derive the MSE and compute a peak stress metric (PSM) that was based on the analysis of plaque morphological parameters. The accuracy of the MSE was determined by comparing PSM with FEM-derived peak stress values. The ability of the PSM in locating plaque rupture sites was tested in 3 additional patients. RESULTS The following parameters were found to be independently associated with peak stress: fibrous cap thickness (p < 0.0001), necrotic core angle (p = 0.024), necrotic core thickness (p < 0.0001), lumen area (p < 0.0001), necrotic core including calcium areas (p = 0.017), and plaque area (p = 0.003). The PSM showed excellent correlation (R = 0.85; p < 0.0001) with FEM-derived peak stress, thus confirming the accuracy of the MSE. In only 56% (n = 34) of plaques, the thinnest fibrous cap thickness was a determining parameter in identifying the cross section with highest PSM. In coronary segments with plaque ruptures, the MSE precisely located the rupture site. CONCLUSIONS The MSE shows potential to calculate the PSM in coronary lesions rapidly. However, further studies are warranted to investigate the use of biomechanical stress profiling for the prognostic evaluation of patients with atherosclerosis. (C) 2020 by the American College of Cardiology Foundation.

【 授权许可】

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