Abstract 15854: Association of Low Endothelial Shear Stress With Coronary Microvascular Endothelial Dysfunction in Patients With Early Coronary Atherosclerosis
Introduction: Coronary microvascular disease is related to higher risk of cardiovascular events in patients without significant epicardial stenosis.
Hypothesis: Low endothelial shear stress (ESS) is associated with coronary microvascular endothelial dysfunction and high risk plaque characteristics in patients with early atherosclerosis.
Methods: Fifty one subjects (age 53±10 y) with mild coronary atherosclerosis (diameter stenosis <40% throughout entire coronary arteries) were included. Coronary microvascular endothelial function was estimated using intracoronary acetylcholine infusion. Vascular profiling, using 2-plane coronary angiography and intravascular ultrasound, was used to reconstruct the 3-D anatomy of left anterior descending artery (LAD). Each reconstructed artery was divided into sequential 3mm segments and analyzed for the local ESS with computational fluid dynamics. Each segment was characterized by local predominant ESS values, including the average ESS and the lowest ESS in a 90° arc around circumference of the artery. Plaque characteristics (plaque area, maximum plaque thickness) were also assessed.
Results: Thirty one patients had abnormal microvascular endothelial function (group A) and twenty patients had normal microvascular endothelial function (group B). Coronary segments in group A (n=443 segments), compared to segments in group B (n=316 segments) had significantly greater plaque area (3.63±2.29 vs. 3.06±2.08 mm2, p<0.001) and max plaque thickness (0.36±0.22 vs. 0.32±0.21 mm, p<0.01). Importantly, coronary segments in group A exhibited significantly lower ESS, compared to segments in group B (average: 1.60±1.03 vs. 2.01±1.56 Pa, p<0.001; lowest90°arc: 1.27±0.82 vs. 1.65±1.37 Pa, p<0.001) (Figure).
Conclusions: Coronary arteries exposed to low ESS are associated with microvascular endothelial dysfunction and high-risk plaque characteristics in subjects with early coronary atherosclerosis.
Author Disclosures: G. Siasos: None. J.D. Sara: None. M. Zaromitidou: None. K.H. Park: None. S. Yang: None. A. Coskun: None. L.O. Lerman: None. D. Fotiadis: None. L. Michalis: None. M. Papafaklis: None. K. Stefanou: None. C. Feldman: None. A. Lerman: None. P.H. Stone: None.
- © 2016 by American Heart Association, Inc.