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Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients

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Abstract

Purpose

Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque.

Methods

We identified N = 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS.

Results

WSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cm2, p value < 0.01). Plaque area and plaque burden measured from IVUS peaked at 1–3 cm proximal to the MB entrance, coinciding with the first diagonal branch. Normalized WSS showed a statistically significant moderate correlation with plaque area (r = 0.41, p < 0.01).

Conclusion

WSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.

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Abbreviations

MB:

Myocardial Bridges

LAD:

Left anterior descending artery

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CFD:

Computational fluid dynamics

IVUS:

Intravascular ultrasound

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Acknowledgments

M.O.K acknowledges the support of National Sciences and Engineering Research Council of Canada, and American Heart Association for their Postdoctoral Fellowship. A.L.M acknowledges supported from NIH grant (NIH R01- RHL123689A). K.N. acknowledges supported from the NIH (NIH R01- HL141712; NIH R01 - HL146754), and reports unrestricted institutional research support from Siemens Heathineers, Bayer, HeartFlow Inc unrelated to this work. This work was supported in part by a generous gift from The Ron and Sanne Higgins Women’s Heart Health Fund.

Author Contributions

All authors have contributed to the manuscript.

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Not applicable.

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Conflict of interest

K.N report consulting for Siemens Medical Solutions USA unrelated to this work.

Ethical Approval

Study approval was granted by the Stanford University Institutional Review Board, and informed consent was obtained prior to all patient procedures.

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Correspondence to Alison Marsden.

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Khan, M., Nishi, T., Imura, S. et al. Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients. Cardiovasc Eng Tech 13, 797–807 (2022). https://doi.org/10.1007/s13239-022-00616-4

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