Abstract 15743: Relationship Between Endothelial Wall Shear Stress and High-risk Atherosclerotic Plaque Characteristic for Identification of Coronary Lesions That Cause Ischemia Ischemia: A Direct Comparison to Fractional Flow Reserve
Introduction: Wall shear stress (WSS) is an established predictor of coronary atherosclerosis progression. Prior studies have reported that high WSS has been associated with high-risk plaque characteristics (APCs). WSS and APCs are quantifiable by coronary CT angiography (CCTA) but to date, the relationship of coronary lesion ischemia—evaluated by fractional flow reserve (FFR)—to WSS and APCs has not been examined.
Methods: WSS measures were obtained from 100 evaluable patients who underwent CCTA and invasive coronary angiography with FFR. Patients were categorized according to tertiles of mean WSS values defined as low (5-146 dyne/cm2), intermediate (146-259 dyne/cm2), and high (259-891 dyne/cm2). Coronary ischemia was defined as FFR ≤0.80. Stenosis severity by CCTA was determined by minimal luminal diameter (MLD) at the site of greatest stenosis within a vessel. APCs by CCTA were defined as positive remodeling (PR), low attenuation plaque (LAP), and spotty calcification (SC).
Results: The likelihood of having PR and LAP were greater in the high WSS group compared with the low WSS group after adjusting for stenosis severity (odds ratio [OR] for PR: 2.54, 95% confidence interval [95% CI]: 1.12-5.77, P-value: 0.026; OR for LAP: 2.68, 95% CI: 1.02-7.06, P-value: 0.046). No significant relationship was observed between WSS and low FFR when adjusting for either coronary stenosis or APCs (P-value: 0.436). WSS displayed no incremental benefit above stenosis severity and APCs for detecting lesions that caused ischemia (Figure, AUC value for stenosis and APCs: 0.87, 95% CI: 0.81-0.93; AUC for stenosis, APCs and WSS: 0.88, 95% CI: 0.82-0.93; P-value for difference: 0.297).
Conclusions: High WSS is associated with APCs independent of stenosis severity. WSS provided no added value beyond stenosis severity and APCs for detecting lesions with significant ischemia. As such, WSS might indirectly influence hemodynamically significant ischemia via APCs and stenosis severity.
Author Disclosures: D. Han: None. A. Starikov: None. G. Xiong: None. B. ó Hartaigh: None. H. Gransar: None. K.K. Kolli: None. J. Lee: None. A. Rizvi: None. L. Baskaran: None. J. Schulman-Marcus: None. F.Y. Lin: None. J.K. Min: Research Grant; Modest; GE Healthcare, NIH/NHLBI R01 HL118019, NIH/NHLBI R01 HL115150, NIH/NHLBI R01 HL111141, NIH/NHLBI U01 HL105907, QNRF NPR-370-3-089. Ownership Interest; Modest; Autoplaq, MDDX. Consultant/Advisory Board; Modest; HeartFlow. Other; Modest; Arineta.
- © 2016 by American Heart Association, Inc.