Timmins Lucas H, Molony David S, Eshtehardi Parham, McDaniel Michael C, Oshinski John N, Samady Habib, Giddens Don P
Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Room 2127, Atlanta, GA, 30332, USA,
Ann Biomed Eng. 2015 Jan;43(1):94-106. doi: 10.1007/s10439-014-1155-9. Epub 2014 Oct 15.
Wall shear stress (WSS) has been investigated as a potential prospective marker to identify rapidly progressing coronary artery disease (CAD) and potential for lesions to acquire vulnerable characteristics. Previous investigations, however, are limited by a lack of understanding of the focal association between WSS and CAD progression (i.e., data are notably spatially averaged). Thus, the aim of this investigation was to examine the focal association between WSS and coronary atherosclerosis progression, and compare these results to those determined by spatial averaging. Five patients with CAD underwent baseline and 6-month follow-up angiographic and virtual histology-intravascular ultrasound imaging to quantify CAD progression. Patient-specific computational fluid dynamics models were constructed to compute baseline WSS values, which were either averaged around the entire artery circumference or examined in focal regions (sectors). Analysis of data within each sector (n = 3871) indicated that circumferentially averaged and sector WSS values were statistically different (p < 0.05) and exhibited poor agreement (concordance correlation coefficient = 0.69). Furthermore, differences were observed between the analysis techniques when examining the association of WSS and CAD progression. This investigation highlights the importance of examining spatially heterogeneous variables at a focal level to reduce the affect of data reduction and warrants implementation in a larger clinical study to determine the predictive power in prospectively identifying rapidly progressing and/or vulnerable coronary plaques.
壁面切应力（WSS）已被作为一种潜在的前瞻性标志物进行研究，以识别快速进展的冠状动脉疾病（CAD）以及病变获得易损特征的可能性。然而，以往的研究因对WSS与CAD进展之间的局灶性关联缺乏了解而受到限制（即数据明显是空间平均的）。因此，本研究的目的是检查WSS与冠状动脉粥样硬化进展之间的局灶性关联，并将这些结果与通过空间平均确定的结果进行比较。五名CAD患者接受了基线和6个月随访的血管造影及虚拟组织学-血管内超声成像，以量化CAD进展。构建了患者特异性的计算流体动力学模型，以计算基线WSS值，这些值要么在整个动脉圆周周围进行平均，要么在局灶区域（扇区）进行检查。对每个扇区内的数据（n = 3871）进行分析表明，圆周平均WSS值和扇区WSS值在统计学上存在差异（p < 0.05），且一致性较差（一致性相关系数 = 0.69）。此外，在检查WSS与CAD进展的关联时，分析技术之间也存在差异。本研究强调了在局灶水平检查空间异质性变量以减少数据缩减影响的重要性，并保证在更大规模的临床研究中实施，以确定前瞻性识别快速进展和/或易损冠状动脉斑块的预测能力。
