Advertisement

Models of the intracoronary pathogenesis of acute coronary heart disease

  • Joseph P. Jiang
  • Charles L. Feldman
  • Peter H. Stone
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 170)

Abstract

Coronary atherosclerosis is a pervasive disease. One early study of autopsy cases in New Orleans showed that 99% of individuals dying between the ages of 30 and 69 had significant raised atherosclerotic lesions (1). Every year over 5 million individuals are diagnosed clinically as having coronary artery disease. The ultimate toll of this disease is staggering with approximately one million myocardial infarctions and 500,000 deaths per year due to ischemic heart disease in the United States alone (1, 2). Since approximately two-thirds of the deaths occur suddenly, primarily among patients with known coronary atherosclerosis, there is a need to identify which patients with known coronary disease are at increased risk and may benefit from aggressive intervention such as surgery, angioplasty, or intensified medical treatment.

Keywords

Shear Stress Wall Shear Stress Atherosclerotic Plaque Plaque Rupture Circumferential Stress 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Strong JP, McGill HC. The natural history of coronary atherosclerosis. Am J Pathol 1962;40:37–49.PubMedGoogle Scholar
  2. 2.
    Fry DL. Acute vascular endothelial changes associated with increased blood velocity gradient. Circ Res 1986;22:165–97.Google Scholar
  3. 3.
    Davies MJ, Woolf N, Robertson WB. Pathology of acute myocardial infarction with particular references to occlusive coronary thrombi. Br. Heart J 1976,38:659–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Constantinides P. Cause of thrombosis in human atherosclerotic arteries. Am J Cardiol 1990;66:37G–40G.PubMedCrossRefGoogle Scholar
  5. 5.
    Davies MJ, Thomas T. The pathological basis and microanatomy of occlusive thrombus formation in human coronary arteries. Phil Trans R Soc London B 1981;294:225–9.CrossRefGoogle Scholar
  6. 6.
    Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis: Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. British Heart J 1983;50:1271–34.CrossRefGoogle Scholar
  7. 7.
    Little WL, Constantinescu M, Applegate RJ et al. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild to moderate coronary artery disease? Circulation 1988;78:1157–66.PubMedCrossRefGoogle Scholar
  8. 8.
    Giroud D, Li JM, Urban P, Meier B, Rutishauser W. Relation of the site of acute myocardial infarction to the most severe coronary artery stenosis at prior angiography. Am J Cardiol 1992;69:729–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Webster MWI, Chesebro JH, Smith HC et al. Myocardial infarction and coronary artery occlusion: A prospective 5-year angiographic study. J Am Coll Cardiol 1990;15:218A (abstract).Google Scholar
  10. 10.
    Brown BG, Zhao XQ, Sacco DE, Albers JJ. Lipid lowering and plaque regression: New insights into prevention of plaque disruption and clinical events in coronary disease. Circulation 1993;87:171–91.Google Scholar
  11. 11.
    Ross R. The pathogenesis of atherosclerosis. In: Braunwald E, editor. Heart Disease, A Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders, 1988:1135–52.Google Scholar
  12. 12.
    Gibson CM, Kuntz RE, Nobuyoshi M, Rosner B, Bain DS. Lesion-to-lesion independence of restenosis after treatment by conventional angioplasty, stenting, or directional atherectomy. Validation of lesion-based restenosis analysis. Circulation 1993:87:1123–9.PubMedGoogle Scholar
  13. 13.
    Davies MJ, Bland JM, Hangartner JRW, Angelini A, Thomas AC. Factors influencing the presence or absence of acute coronary artery thrombi in sudden ischemic death. Eur Heart J 1989;10:203–8.PubMedGoogle Scholar
  14. 14.
    Nagatomo Y, Nakagawa S, Koiwaya Y, Tanaka K. Coronary angiographic ruptured atheromatous plaque as a predictor of future progression of stenosis. Am H J 1990;119:1244.CrossRefGoogle Scholar
  15. 15.
    Falk E. Unstable angina with fatal outcome: dynamic coronary thrombus leading to infarction and or sudden death. Autopsy evidence of recent mural thrombosis with peripheral embolization culminating in fatal vascular occlusion. Circulation 1985;71:699–709.PubMedCrossRefGoogle Scholar
  16. 16.
    Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J 1983;50:127–34.PubMedCrossRefGoogle Scholar
  17. 17.
    Badimon L, Badimon JJ, Galvez A, Chesebro JH, Fuster V. Influence of arterial damage and wall shear rate on platelet deposition. Ex vivo study in a swine model. Arteriosclerosis 1986;6:312–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Chesebro JH, Zoldhelyi P, Fuster V. Pathogenesis of thrombosis in unstable angina. Am J Cardiol 1991;68:2B–10B.PubMedCrossRefGoogle Scholar
  19. 19.
    Lam JVT, Chesebro JH, Fuster V. Platelets, vasoconstriction, and nitroglycerin during arterial wall injury: a new antithrombotic role for an old drug. Circulation 1988;78:712–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Lam JYT, Chesebro JH, Steele PM, Badimon L, Fuster V. Is vasospasm related to platelet deposition? Relationship in a porcine preparation of arterial injury in vivo. Circulation 1987;75:243–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Badimon L, Chesebro JH, Badimon JJ. Thrombus formation on ruptured atherosclerotic plaques and re-thrombosis on evolving thrombi. Circulation 1992;86[Suppl III]: 11174–11185.Google Scholar
  22. 22.
    Lam JYT, Chesebro JH, Steele PM, Dewanjee MK, Badimon L, Fuster V. Deep arterial injury during experimental angioplasty: relation to a positive indium-111 labeled platelet scintigram, quantitative platelet deposition and mural thrombosis. J Am Coll Cardiol 1986;8:1380–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Friedman M, Van den Bovenkamp GJ. The pathogenesis of a coronary thrombus. Am J Pathol 1966;48(1): 19–31.PubMedGoogle Scholar
  24. 24.
    Fernandez-Ortiz A, Badimon JJ, Falk E, Fuster V, Meyer B, Mailhac A, Weng D, Shah PK, Badimon L. Characterization of the relative thrombogenicity of atherosclerotic plaque components: implications for consequences of plaque rupture. J Am Coll Cardiol 1994;23:1562–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Maclsaac AI, Thomas JD, Topol EJ. Toward the quiescent coronary plaque. J Am Coll Cardiol 1993;22:1228–41.CrossRefGoogle Scholar
  26. 26.
    Thaulow E, Erikssen J, Sandvik L, Stormorken H, Cohn PF. Blood platelet count and function are related to total and cardiovascular death in apparently healthy men. Circulation 1991;84:613–7.PubMedGoogle Scholar
  27. 27.
    Jansson JH, Nilsson TK, Johnson W. Von Willebrand factor in plasma: a novel risk factor for recurrent myocardial infraction and death. Br Heart J 1991;66:351–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Asnar J, Estelles A, Tormo G et al. Plasminogen activator inhibitor activity and other finrinolytic variables in patients with coronary artery disease. Br Heart J 1988;59:535–41.CrossRefGoogle Scholar
  29. 29.
    Jannson JH, Nilsson TK, Olofsson BO. Tissue plasminogen activator and other risk factor as predictors of cardiovascular events in patients with severe angina pectoris. Eur Heart J 1991,12:157–61.Google Scholar
  30. 30.
    Wilhelmsen L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Eng J Med 1984;311:501–5.CrossRefGoogle Scholar
  31. 31.
    Glagov S, Oxoa A. Significance of the relatively low incidence of atherosclerosis in the pulmonary, renal and mesenteric arteries. Ann NY Acad Sci 1968; 149:940.PubMedCrossRefGoogle Scholar
  32. 32.
    Enos WF, Holmes RH, Beyer J. Coronary disease among United States soldiers killed in action in Korea. J Am Med Assoc 1953;152:1090.PubMedGoogle Scholar
  33. 33.
    Ku DN, Giddens DO, Zarins CZ, Glagov S: Pulsatile flow and atherosclerosis in the human carotid bifurcation: positive correlation between plaque location and low and oscillating shear stress. Arteriosclerosis 1985;5:293–302.PubMedCrossRefGoogle Scholar
  34. 34.
    Friedman MH, Deters OJ, Bargeron CB, Hutchins GM, Mark FF. Shear-dependent thickening of the human arterial intima. Atherosclerosis 1986;60:161–71.PubMedCrossRefGoogle Scholar
  35. 35.
    Asakura T, Karino T. Flow patterns and spacial distribution of atherosclerotic lesions in human coronary arteries. Circ Res 1990;66:1045–66.PubMedGoogle Scholar
  36. 36.
    Uematsu M, Kitabatake A, Tanouchi J et al. Reduction of endothelial microfilament bundles in the low shear region of the canine aorta. Association with intimai plaque formation in hypercholesterolemia. Arteriosclerois and thrombosis 1991; 11:107–5.CrossRefGoogle Scholar
  37. 37.
    Gibson CM, Diaz L, Kandarpa K et al. Relation of vessel wall shear stress to atherosclerosis progression in human coronary arteries. Arteriosclerosis and thrombosis 1990;13:310–5.CrossRefGoogle Scholar
  38. 38.
    Goldsmith MF. Endothelial dysfunction plays a dynamic role in coronary artery disease. J Am Med Assoc 1990;263:789–90.CrossRefGoogle Scholar
  39. 39.
    Olesen SP, Clapham DE, Davies PF. Haemodynamic shear stress activates a K+ current in vascular endothelial cells. Nature 1988;331:168–70.PubMedCrossRefGoogle Scholar
  40. 40.
    Flaherty JT, Pierce JE, Ferrans VJ, Patel DJ, Tucker WK, Fry DL. Endothelial nuclear patterns in the canine arterial tree with particular reference to hemodynamic events. Circ Res 1972;30:23–33.PubMedGoogle Scholar
  41. 41.
    Frangos JA, Eskin SG, McIntire LV, Ives CL. Flow effects on prostacyclin production by cultured human endothelial cells. Science 1985;227:1477–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Davies PF, Dewey CF, Bussolari SR, Gordon EJ, Gimbrone MA. Influence of hemodynamic forces on vascular endothelial function. In vitro studies of shear stress and pinocytosis in bovine aortic cells. J Clin Invest 1983;73:1121–9.CrossRefGoogle Scholar
  43. 43.
    Okano M, Yoshida Y. Influence of shear stress on endothelial cell shapes and junction complexes at flow dividers of aortic bifurcations in cholesterol-fed rabbits. Front Med Biol Eng 1993;5:95–120.PubMedGoogle Scholar
  44. 44.
    Davies PF, Remuzzi A, Gordon EJ, Dewey CF Jr, Gimbrone MA Jr. Turbulent fluid shear stress induces vascular endothelial cell turnover in vitro. Proc Natl Acad Sci USA 1986;83:2114–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Zeiher AM, Drexler H, Wollschlager H, Just H. Modulation of coronary vasomotor tone in humans. Progressive endothelial dysfunction with different early stages of coronary atherosclerosis. Circulation 1991;83:391–401.PubMedGoogle Scholar
  46. 46.
    Nabel EG, Selwyn AP, Ganz P. Large coronary arteries are responsive to changing blood flow: An endothelium-dependent mechanism that fails in patients with atherosclerosis. J Am Coll Cardiol 1990;16:349–56.PubMedCrossRefGoogle Scholar
  47. 47.
    Vita JA, Treasure CB, Ganz P, Cox DA, Fish RD, Selwyn AP. Control of shear stress in the epicardial coronary arteries of human: Impairment by atherosclerosis. J Am Coll Cardiol 1989;14:1193–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Ohno M, Gibbons GH, Dzau VJ, Cooke JP. Shear stress elevates endothelial cGMP. Role of a potassium channel and G protein coupling. Circulation 1993;88:193–7.PubMedGoogle Scholar
  49. 49.
    Werns SW, Walton JA, Hsia HH, Nabel EG, Sanz ML, Pitt B. Evidence of endothelial dysfunction in angiographically normal coronary arteries of patients with coronary artery disease. Circulation 1989;79:287–91.PubMedCrossRefGoogle Scholar
  50. 50.
    McLenachan JM, Vita JA, Fish RD et al. Early evidence of endothelial vasodilator dysfunction at coronary branch points. Circulation 1990;82:1169–73.PubMedCrossRefGoogle Scholar
  51. 51.
    Taeymans Y, Theroux P, Lesperance J. Quantitative angiographic morphology of the coronary artery lesions at risk of thrombotic occlusions. Circulation 1992;85:78–85.PubMedGoogle Scholar
  52. 52.
    Ambrose JA, Hjemdahl-Mousen CE. Arteriographic anatomy and mechanisms of myocardial ischemia in unstable angina. J Am Coll Cardiol. 1987;9:1397–402.PubMedCrossRefGoogle Scholar
  53. 53.
    Svindland A, Torvik A. Atherosclerotic carotid disease in asymptomatic individual. A histological study of 53 cases. Acta Neurol Scand 1988;78:506–17.PubMedCrossRefGoogle Scholar
  54. 54.
    Bassiouny HS, Davis H, Massawa N, Gewertz BL, Glagov S, Zarins CK. Critical carotid stenoses. Morphologic and chemical similarity between symptomatic and asymptomatic plaques. J Vasc Surg 1989;9:202–12.PubMedGoogle Scholar
  55. 55.
    Fry DL. Acute vascular endothelial changes associated with increased blood velocity gradients. Circ Res 1968;22:165–97.PubMedGoogle Scholar
  56. 56.
    Richardson PD, Davies MJ, Born GVR. Influence of plaque configuration and stress distribution on Assuring of coronary atherosclerotic plaques. Lancet 1989;2:941–4.PubMedCrossRefGoogle Scholar
  57. 57.
    Loree HM, Kamm RD, Stringfellow RG, Lee RT. Effects of fibrous cap thickness on peak circumferential stress in model atherosclerotic vessels. Circ Res 1992;71:850–8.PubMedGoogle Scholar
  58. 58.
    Gertz SD, Roberts WC. Hemodynamic shear force in rupture of coronary arterial atherosclerotic plaques. Am J Cardiol 1990;66:1368–72.PubMedCrossRefGoogle Scholar
  59. 59.
    Falk E. Why do plaques rupture? Circulation 1992;86[Suppl III];III30-III42.PubMedGoogle Scholar
  60. 60.
    Stary HC. The sequence of cell and matrix changes in atherosclerotic lesions of coronary arteries in the first forty years of life. Eur Heart J 1990;11(Suppl E):3–19.PubMedGoogle Scholar
  61. 61.
    Welgus HG, Campbell EJ, Cury JD et al. Neutral metalloproteinases produced by human mononuclear phagocytes. Enzyme profile, regulation, and expression during cellular development. J Clin Invest 1990;86:1496–502.PubMedCrossRefGoogle Scholar
  62. 62.
    Lendon CL, Davies MJ, Born GVR, Richardson PD. Atherosclerotic plaque caps are locally weakened where macrophage density is increased. Atherosclerosis 1991;87:87–90.PubMedCrossRefGoogle Scholar
  63. 63.
    Lee RT, Grodzinsky AJ, Frank EH, Kamm RD, Sxhoen FJ. Structure dependent dynamic mechanical behavior of fibrous caps from human atherosclerotic plaques. Circulation 1991;83:1764–70.PubMedGoogle Scholar
  64. 64.
    Cheng GC, Loree HM, Kamm RD, Fishbein MC, Lee RT. Distribution of circumferential stress in ruptured and stable atherosclerotic lesions. A structural analysis with histopathologic correlation. Circulation 1993;87:1179–87.PubMedGoogle Scholar
  65. 65.
    Cliff WJ, Heathcote CR, Moss NS, Reichenbach DD. The coronary arteries in cases of cardiac and noncardiac sudden death. Am J Pathol 1988;132:319–29.PubMedGoogle Scholar
  66. 66.
    Moreno PR, Falk E, Palacios IF, Newell JB, Fuster VF, Falloon JT. Macrophage infiltration in acute coronary syndromes. Implications for plaque rupture. Circulation 1994;90:775–8.PubMedGoogle Scholar
  67. 67.
    Born GVR. Arterial thrombosis and its prevention. In: Hayase S, Murao S, editors. Cardiology. Proceedings of the VIII World Congress of Cardiology, Tokyo, 17–23 September, 1978. Amsterdam/Oxford/Princeton: Excerpta Medica, 1979:81–91.Google Scholar
  68. 68.
    Fitzgerald JD. By what means might beta blockers prolong life after acute myocardial infarction? Eur Heart J 1987;8:945–51.PubMedGoogle Scholar
  69. 69.
    Nobuyoshi M, Tanaka M, Nosaka H et al. Progression of coronary atherosclerosis: is coronary artery spasm related to progression? J Am Coll Cardiol 1991;18:904–10.PubMedCrossRefGoogle Scholar
  70. 70.
    Joris I, Majno G. Endothelial changes induced by arterial spasm. Am J Pathol 1981;102:346–58.PubMedGoogle Scholar
  71. 71.
    Kobori K, Suzuki K, Yoshida Y, Ooneda G. Light and electron microscopic studies on rat arterial lesions induced by experimental arterial contraction. Virchow’s Arch [Pathol Anat] 1979;385:29–39.CrossRefGoogle Scholar
  72. 72.
    Constantinides P, Lawder J. Experimental thrombosis and haemorrhage in atherosclerosis (abstr). Fed Proc 1963;22:251.Google Scholar
  73. 73.
    Bertrand ME, LaBlanche JM, Tilmant PY et al. Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography. Circulation 1982;65:1299–306.PubMedCrossRefGoogle Scholar
  74. 74.
    Kaski JC, Tousoulis D, McFadden E, Crea F, Pereira WI, Maseri A. Variant angina pectoris: Role of coronary spasm in the development of fixed coronary obstructions. Circulation 1992;85:619–26.PubMedGoogle Scholar
  75. 75.
    Barger AC, Beeuwkes R, Lainey LL, Silverman KJ. Hypothesis: Vasa vasorum and neovascularization of human coronary arteries: A possible role in the pathophysiology of atherosclerosis. N Engl J Med 1984;310:175–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Deshpand MD, Giddens DP, Mabon RF. Steady laminar flow through modeled vascular stenosis. J Biomech 1976;9:165–74.CrossRefGoogle Scholar
  77. 77.
    Kandarpa K, Davids N, Gardiner GA Jr, Harrington DP, Selwyn A, Levin DC. Hemodynamic evaluation of arterial stenoses by computer simulation. Inves Radiol 1987;22:393–403.CrossRefGoogle Scholar
  78. 78.
    Perktold K, Nerem RM, Peter RO. A numerical calculation of flow in a curved tube model of the left main coronary artery. J Biomech 1991;21:175–89.CrossRefGoogle Scholar
  79. 79.
    Feldman CL, Fernandes JS, Stone PH. Flow imaging of 3-dimensional coronary artery models using computational fluid dynamics - effect of coronary artery curvature. IEEE Proceedings of Computers in Cardiology 1993:775–7.Google Scholar
  80. 80.
    Bryant DJ, Payne JA, Firmin DN, Longmore DB. Measurement of flow with NMR imaging using a gradient pulse and phase difference technique. J Comput Assist Tomogr 1984;8:588–93.PubMedCrossRefGoogle Scholar
  81. 81.
    Feinberg DA, Crooks LE, Hoenninger J, Watts J, Arakawa M. Pulsitile blood velocity in human arteries displayed by MRI. Radiology 1984;153:177–80.PubMedGoogle Scholar
  82. 82.
    Loree HM, Ho LW, Kamm RD, Lee RT, Maier MV. Cardiovascular flow modeling using magnetic resonance velocimetry data as a boundary condition for NEKTON. Fluent Incorporated. Users’ Group Meeting Proceedings 1993.Google Scholar
  83. 83.
    Roelandt J, di Mario C, Pandian NG et al. Three-dimensional reconstruction of intracoron-ary ultrasound images. Rationale, approaches, problems, and directions. Circulation 1994;90:1044–55.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Joseph P. Jiang
  • Charles L. Feldman
  • Peter H. Stone

There are no affiliations available

Personalised recommendations