BACKGROUND:Plaque composition and wall shear stress (WSS) magnitude act as well-established players in coronary plaque progression. However, WSS magnitude per se does not completely capture the mechanical stimulus to which the endothelium is subjected, since endothelial cells experience changes in the WSS spatiotemporal configuration on the luminal surface. This study explores WSS profile and lipid content signatures of plaque progression to identify novel biomarkers of coronary atherosclerosis.METHODS:Thirty-seven patients with acute coronary syndrome underwent coronary computed tomography angiography, near-infrared spectroscopy intravascular ultrasound, and optical coherence tomography of at least 1 nonculprit vessel at baseline and 1-year follow-up. Baseline coronary artery geometries were reconstructed from intravascular ultrasound and coronary computed tomography angiography and combined with flow information to perform computational fluid dynamics simulations to assess the time-averaged WSS magnitude (TAWSS) and the variability in the contraction/expansion action exerted by WSS on the endothelium, quantifiable in terms of topological shear variation index (TSVI). Plaque progression was measured as intravascular ultrasound-derived percentage plaque atheroma volume change at 1-year follow-up. Plaque composition information was extracted from near-infrared spectroscopy and optical coherence tomography.RESULTS:Exposure to high TSVI and low TAWSS was associated with higher plaque progression (4.00±0.69% and 3.60±0.62%, respectively). Plaque composition acted synergistically with TSVI or TAWSS, resulting in the highest plaque progression (≥5.90%) at locations where lipid-rich plaque is exposed to high TSVI or low TAWSS.CONCLUSIONS:Luminal exposure to high TSVI, solely or combined with a lipid-rich plaque phenotype, is associated with enhanced plaque progression at 1-year follow-up. Where plaque progression occurred, low TAWSS was also observed. These findings suggest TSVI, in addition to low TAWSS, as a potential biomechanical predictor for plaque progression, showing promise for clinical translation to improve patient prognosis.

中文翻译：

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使用多模态成像和壁剪切应力特征预测冠状动脉中富含脂质的斑块进展

背景：斑块成分和壁剪切应力（WSS）大小在冠状动脉斑块进展中发挥着重要作用。然而，WSS 幅度本身并不能完全捕获内皮细胞所受到的机械刺激，因为内皮细胞会经历管腔表面上的 WSS 时空配置的变化。本研究探讨了斑块进展的 WSS 谱和脂质含量特征，以确定冠状动脉粥样硬化的新生物标志物。 方法：37 名急性冠状动脉综合征患者接受了冠状动脉计算机断层扫描血管造影、近红外光谱血管内超声和光学相干断层扫描至少基线和 1 年随访时有 1 条非罪魁祸首血管。通过血管内超声和冠状动脉计算机断层扫描血管造影重建基线冠状动脉几何形状，并结合血流信息进行计算流体动力学模拟，以评估时间平均 WSS 幅度 (TAWSS) 以及 WSS 对冠状动脉施加的收缩/扩张作用的变异性。内皮细胞，可根据拓扑剪切变化指数（TSVI）进行量化。斑块进展的测量是 1 年随访时血管内超声得出的斑块粥样斑块体积变化百分比。从近红外光谱和光学相干断层扫描中提取斑块成分信息。结果：暴露于高 TSVI 和低 TAWSS 与较高的斑块进展相关（分别为 4.00±0.69% 和 3.60±0.62%）。斑块成分与 TSVI 或 TAWSS 协同作用，在富含脂质的斑块暴露于高 TSVI 或低 TAWSS 的位置处导致最高的斑块进展 (≥5.90%)。结论：管腔暴露于高 TSVI，单独或与脂质结合-丰富的斑块表型，与一年随访时斑块进展增强相关。在发生斑块进展的地方，还观察到低 TAWSS。这些发现表明，除了低 TAWSS 之外，TSVI 还可以作为斑块进展的潜在生物力学预测因子，显示出临床转化以改善患者预后的前景。