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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Localized Elevation of Shear Stress Is Related to Coronary Plaque Rupture

A 3-Dimensional Intravascular Ultrasound Study With In-Vivo Color Mapping of Shear Stress Distribution

Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.

Manuscript received March 7, 2007; revised manuscript received August 23, 2007, accepted October 11, 2007.

^_* Reprint requests and correspondence: Dr. Takafumi Hiro, Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami Kogushi, Ube, Yamaguchi, 755-8505, Japan. (Email: thiro{at}yamaguchi-u.ac.jp).

This study was presented, in part, at the 54th Annual Scientific Sessions of the American College of Cardiology, Orlando, Florida, March 6–9, 2005.

Objectives: The purpose of the present study was to assess the relationship between shear stress distribution and coronary plaque rupture by means of a new color-mapping program of shear stress with 3-dimensional intravascular ultrasound (IVUS).

Background: Various in-vitro studies have demonstrated that shear stress of the vascular lumen is one of the important determinants of coronary plaque vulnerability. However, the in-vivo relationship between shear stress and plaque rupture is still unclear.

Methods: In the present study, 3-dimensional IVUS was used to obtain spatial information on luminal geometry from 20 patients with acute coronary syndrome having a distinct ulcerative lesion. These 3-dimensional contours for each lumen were first reconstructed into mesh polygons, and then analyzed by means of a program for calculating the fluid dynamics. The flow was considered to be a constant laminar one. Then, colorized mappings of the distribution of the streamline, blood pressure, and shear stress were performed. The original luminal contour for each ruptured lesion was obtained by smoothing and extrapolation.

Results: All patients had a coronary plaque rupture in the proximal or top portion of the plaque hill. In the color mapping, localized elevation of blood pressure and shear stress could be observed on each plaque surface. The shear stress concentration was frequently correlated with the plaque rupture site (kappa = 0.79).

Conclusions: Although the absolute value of shear stress is not sufficient to directly provoke mechanical destruction of the fibrous cap, localized high shear stress might be a trigger of fibrous cap rupture.

Abbreviations and Acronyms   ACS = acute coronary syndrome(s)   BP = blood pressure   IVUS = intravascular ultrasound

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