Introduction: Intravascular ultrasound (IVUS) studies have shown that biomechanical variables, particularly endothelial shear stress (ESS), add synergistic prognostic insight when combined with anatomic high-risk plaque features. Non-invasive risk assessment of coronary plaques with coronary computed tomography angiography (CCTA) would be helpful to enable broad population risk-screening. Aim: To compare the accuracy of ESS computation of local ESS metrics by CCTA vs IVUS imaging. Methods: We analyzed 59 patients from a registry of patients who underwent both IVUS and CCTA for suspected CAD. CCTA images were acquired using either a 64- or 256-slice scanner. Lumen, vessel, and plaque areas were segmented from both IVUS and CCTA (59 arteries, 686 3-mm segments). Images were co-registered and used to generate a 3-D arterial reconstruction, and local ESS distribution was assessed by computational fluid dynamics (CFD) and reported in consecutive 3-mm segments. Results: Anatomical plaque characteristics (vessel, lumen, plaque area and minimal luminal area [MLA] per artery) were correlated when measured with IVUS and CCTA: 12.7 ± 4.3 vs 10.7 ± 4.5 mm2, r = 0.63; 6.8 ± 2.7 vs 5.6 ± 2.7 mm2, r = 0.43; 5.9 ± 2.9 vs 5.1 ± 3.2 mm2, r = 0.52; 4.5 ± 1.3 vs 4.1 ± 1.5 mm2, r = 0.67 respectively. ESS metrics of local minimal, maximal, and average ESS were also moderately correlated when measured with IVUS and CCTA (2.0 ± 1.4 vs 2.5 ± 2.6 Pa, r = 0.28; 3.3 ± 1.6 vs 4.2 ± 3.6 Pa, r = 0.42; 2.6 ± 1.5 vs 3.3 ± 3.0 Pa, r = 0.35, respectively). CCTA-based computation accurately identified the spatial localization of local ESS heterogeneity compared to IVUS, with Bland-Altman analyses indicating that the absolute ESS differences between the two CCTA methods were pathobiologically minor. Conclusion: Local ESS evaluation by CCTA is possible and similar to IVUS; and is useful for identifying local flow patterns that are relevant to plaque development, progression, and destabilization.
Endothelial shear stress computed from coronary computed tomography angiography: A direct comparison to intravascular ultrasound / D. Hakim, A.U. Coskun, C. Maynard, Z. Pu, D. Rupert, N. Cefalo, M. Cormier, M. Ahmed, J. Earls, R. Jennings, K. Croce, S. Mushtaq, D. Andreini, E. Conte, D. Molony, H. Samady, J.K. Min, P.H. Stone. - In: JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY. - ISSN 1934-5925. - 17:3(2023 Jun), pp. 201-210. [10.1016/j.jcct.2023.03.009]
Endothelial shear stress computed from coronary computed tomography angiography: A direct comparison to intravascular ultrasound
R. Jennings;S. Mushtaq;D. Andreini;E. Conte;
2023
Abstract
Introduction: Intravascular ultrasound (IVUS) studies have shown that biomechanical variables, particularly endothelial shear stress (ESS), add synergistic prognostic insight when combined with anatomic high-risk plaque features. Non-invasive risk assessment of coronary plaques with coronary computed tomography angiography (CCTA) would be helpful to enable broad population risk-screening. Aim: To compare the accuracy of ESS computation of local ESS metrics by CCTA vs IVUS imaging. Methods: We analyzed 59 patients from a registry of patients who underwent both IVUS and CCTA for suspected CAD. CCTA images were acquired using either a 64- or 256-slice scanner. Lumen, vessel, and plaque areas were segmented from both IVUS and CCTA (59 arteries, 686 3-mm segments). Images were co-registered and used to generate a 3-D arterial reconstruction, and local ESS distribution was assessed by computational fluid dynamics (CFD) and reported in consecutive 3-mm segments. Results: Anatomical plaque characteristics (vessel, lumen, plaque area and minimal luminal area [MLA] per artery) were correlated when measured with IVUS and CCTA: 12.7 ± 4.3 vs 10.7 ± 4.5 mm2, r = 0.63; 6.8 ± 2.7 vs 5.6 ± 2.7 mm2, r = 0.43; 5.9 ± 2.9 vs 5.1 ± 3.2 mm2, r = 0.52; 4.5 ± 1.3 vs 4.1 ± 1.5 mm2, r = 0.67 respectively. ESS metrics of local minimal, maximal, and average ESS were also moderately correlated when measured with IVUS and CCTA (2.0 ± 1.4 vs 2.5 ± 2.6 Pa, r = 0.28; 3.3 ± 1.6 vs 4.2 ± 3.6 Pa, r = 0.42; 2.6 ± 1.5 vs 3.3 ± 3.0 Pa, r = 0.35, respectively). CCTA-based computation accurately identified the spatial localization of local ESS heterogeneity compared to IVUS, with Bland-Altman analyses indicating that the absolute ESS differences between the two CCTA methods were pathobiologically minor. Conclusion: Local ESS evaluation by CCTA is possible and similar to IVUS; and is useful for identifying local flow patterns that are relevant to plaque development, progression, and destabilization.
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