Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
Department of Radiology, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
Nat Rev Cardiol. 2016 Apr;13(4):210-20. doi: 10.1038/nrcardio.2015.203. Epub 2016 Jan 29.
Atherosclerosis remains a major cause of morbidity and mortality worldwide, and a thorough understanding of the underlying pathophysiological mechanisms is crucial for the development of new therapeutic strategies. Although atherosclerosis is a systemic inflammatory disease, coronary atherosclerotic plaques are not uniformly distributed in the vascular tree. Experimental and clinical data highlight that biomechanical forces, including wall shear stress (WSS) and plaque structural stress (PSS), have an important role in the natural history of coronary atherosclerosis. Endothelial cell function is heavily influenced by changes in WSS, and longitudinal animal and human studies have shown that coronary regions with low WSS undergo increased plaque growth compared with high WSS regions. Local alterations in WSS might also promote transformation of stable to unstable plaque subtypes. Plaque rupture is determined by the balance between PSS and material strength, with plaque composition having a profound effect on PSS. Prospective clinical studies are required to ascertain whether integrating mechanical parameters with medical imaging can improve our ability to identify patients at highest risk of rapid disease progression or sudden cardiac events.
动脉粥样硬化仍然是全球发病率和死亡率的主要原因，深入了解其潜在的病理生理机制对于开发新的治疗策略至关重要。尽管动脉粥样硬化是一种系统性炎症性疾病，但冠状动脉粥样硬化斑块在血管树中并非均匀分布。实验和临床数据强调，生物力学力，包括壁切应力（WSS）和斑块结构应力（PSS），在冠状动脉粥样硬化的自然史中具有重要作用。内皮细胞功能受 WSS 变化的影响很大，纵向动物和人类研究表明，与高 WSS 区域相比，WSS 低的冠状动脉区域会发生更多的斑块生长。WSS 的局部变化也可能促进稳定斑块向不稳定斑块亚型的转化。斑块破裂取决于 PSS 和材料强度之间的平衡，斑块成分对 PSS 有深远的影响。需要进行前瞻性临床研究，以确定将机械参数与医学成像相结合是否可以提高我们识别疾病快速进展或心脏性猝死风险最高的患者的能力。
