高冠状动脉壁切应力使斑块易损性恶化：系统评价和荟萃分析。

High Coronary Wall Shear Stress Worsens Plaque Vulnerability: A Systematic Review and Meta-Analysis.

机构信息

Institute of Public Health and Clinical Medicine, Umea University, Sweden.

University College, Bardhosh, Kosovo.

出版信息

Angiology. 2021 Sep;72(8):706-714. doi: 10.1177/0003319721991722. Epub 2021 Feb 4.

AIM

The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability.

METHODS

We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) -0.11 (95% CI: -0.20 to -0.02, = .02) and fibrofatty area, WMD -0.09 (95% CI: -0.17 to -0.01, = .02), reduction in plaque total area, WMD -0.09 (95% CI: -0.14 to -0.04, = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm; > .05). High WSS resulted in profound remodeling (40% vs 18%, < .05) and with more constructive remodeling than low WSS (78% vs 40%, < .01).

CONCLUSIONS

High WSS in coronary arteries is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared with low WSS.

目的

本荟萃分析旨在评估壁面切应力（WSS）严重程度对动脉斑块易损性的影响。

方法

我们系统地检索了电子数据库，并选择了评估血管内超声测量的 WSS 与冠状动脉斑块特征之间关系的研究。在 7 项研究中，共纳入了 615 例患者的 28276 个动脉节段（中位随访时间：7.71 个月）。随访时的汇总分析显示，高壁面切应力与斑块纤维面积的消退、平均加权差（WMD）-0.11（95%可信区间：-0.20 至 -0.02， =.02）和纤维脂肪面积、WMD-0.09（95%可信区间：-0.17 至 -0.01， =.02）、斑块总面积减少、WMD-0.09（95%可信区间：-0.14 至 -0.04， =.007）以及坏死核心面积增加有关，与低壁面切应力相比，WMD 为 0.04（95%可信区间：0.01-0.09， =.03）。高壁面切应力与低壁面切应力相比，致密钙沉积无明显变化（0.01 对 0.02mm； >.05）。高壁面切应力导致显著的重构（40%对 18%， <.05），且比低壁面切应力更具有建设性的重构（78%对 40%， <.01）。