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Assessment of endothelial shear stress in patients with mild or intermediate coronary stenoses using coronary computed tomography angiography: comparison with invasive coronary angiography

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Abstract

Characterization of endothelial shear stress (ESS) may allow for prediction of the progression of atherosclerosis. The aim of this investigation was to develop a non-invasive approach for in vivo assessment of ESS by coronary computed tomography angiography (CTA) and to compare it with ESS derived from invasive coronary angiography (ICA). A total of 41 patients with mild or intermediate coronary stenoses who underwent both CTA and ICA were included in the analysis. Two geometrical models of the interrogated vessels were reconstructed separately from CTA and ICA images. Subsequently, computational fluid dynamics were applied to calculate the ESS, from which ESSCTA and ESSICA were derived, respectively. Comparisons between ESSCTA and ESSICA were performed on 163 segments of 57 vessels in the CTA and ICA models. ESSCTA and ESSICA were similar: mean ESS: 4.97 (4.37–5.57) Pascal versus 4.86 (4.27–5.44) Pascal, p = 0.58; minimal ESS: 0.86 (0.67–1.05) Pascal versus 0.79 (0.63–0.95) Pascal, p = 0.37; and maximal ESS: 14.50 (12.62–16.38) Pascal versus 13.76 (11.44–16.08) Pascal, p = 0.44. Good correlations between the ESSCTA and the ESSICA were observed for the mean (r = 0.75, p < 0.001), minimal (r = 0.61, p < 0.001), and maximal (r = 0.62, p < 0.001) ESS values. In conclusion, geometrical reconstruction by CTA yields similar results to ICA in terms of segment-based ESS calculation in patients with low and intermediate stenoses. Thus, it has the potential of allowing combined local hemodynamic and plaque morphologic information for risk stratification in patients with coronary artery disease.

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Abbreviations

ADCT:

320-Row area detector CT

CFD:

Computational fluid dynamics

CTA:

Computed tomography angiography

DSCT:

128-Slice dual-source CT

ESS:

Endothelial shear stress

ICA:

Invasive coronary angiography

IVUS:

Intravascular ultrasound

MLA:

Minimum lumen area

OCT:

Optical coherence tomography

QCA:

Quantitative coronary angiography

VFR:

Volumetric flow rate

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Acknowledgments

The authors acknowledged Saeb R. Lamooki for his contribution in preparing the manuscript and data management. S. Tu acknowledges the support by The Program for Professor of Special Appointment (Eastern Scholar) at Shanghai Institutions of Higher Learning, The Shanghai Pujiang Program (No. 15PJ1404200), the National Natural Science Foundation of China (Grants 31500797 and 81570456) and the National Key Research Program of China (Grant 2016YFC0100500). W. Yang acknowledges the support by the National Natural Science Foundation of China (Grants 81501467). J. Pu acknowledges the support by the National Science Fund for Distinguished Young Scholars (81625002), Program for New Century Excellent Talents in University from Ministry of Education of China (NCET-12-0352), Shanghai Shuguang Program (12SG22) and Shanghai Gaofeng Clinical Medicine Program (20152209).

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Authors and Affiliations

  1. Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, 515041, Guangdong, People’s Republic of China

    Dexiao Huang & Renhua Wu

  2. Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan

    Takashi Muramatsu, Yasuomi Nagahara, Masayoshi Sarai & Yukio Ozaki

  3. Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Yingguang Li, Pieter Kitslaar & Johan H. C. Reiber

  4. Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Wenjie Yang & Fuhua Yan

  5. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

    Miao Chu & Shengxian Tu

  6. Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA

    Yiannis S. Chatzizisis

  7. Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Jun Pu

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  1. Dexiao Huang
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  2. Takashi Muramatsu
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  8. Masayoshi Sarai
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  9. Yukio Ozaki
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  12. Johan H. C. Reiber
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  13. Renhua Wu
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  14. Jun Pu
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  15. Shengxian Tu
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Corresponding authors

Correspondence to Renhua Wu or Jun Pu.

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Conflict of interest

Y. Li and P. Kitslaar are employed by Medis medical imaging systems bv and have a research appointment at the Leiden University Medical Center (LUMC). John H. C. Reiber is the CEO of Medis, and has a part-time appointment at LUMC as Prof of Medical Imaging. S. Tu receives research grant support from Medis. All other authors declare that they have no conflict of interest.

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Huang, D., Muramatsu, T., Li, Y. et al. Assessment of endothelial shear stress in patients with mild or intermediate coronary stenoses using coronary computed tomography angiography: comparison with invasive coronary angiography. Int J Cardiovasc Imaging 33, 1101–1110 (2017). https://doi.org/10.1007/s10554-016-1003-0

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  • DOI: https://doi.org/10.1007/s10554-016-1003-0

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