Gu Sophie Z, Bennett Martin R
Section of Cardiorespiratory Medicine, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
Front Cardiovasc Med. 2022 Jul 7;9:875413. doi: 10.3389/fcvm.2022.875413. eCollection 2022.
Atherosclerosis remains a major cause of death worldwide, with most myocardial infarctions being due to rupture or erosion of coronary plaques. Although several imaging modalities can identify features that confer risk, major adverse cardiovascular event (MACE) rates attributable to each plaque are low, such that additional biomarkers are required to improve risk stratification at plaque and patient level. Coronary arteries are exposed to continual mechanical forces, and plaque rupture occurs when plaque structural stress (PSS) exceeds its mechanical strength. Prospective studies have shown that peak PSS is correlated with acute coronary syndrome (ACS) presentation, plaque rupture, and MACE, and provides additional prognostic information to imaging. In addition, PSS incorporates multiple variables, including plaque architecture, plaque material properties, and haemodynamic data into a defined solution, providing a more detailed overview of higher-risk lesions. We review the methods for calculation and determinants of PSS, imaging modalities used for modeling PSS, and idealized models that explore structural and geometric components that affect PSS. We also discuss current experimental and clinical data linking PSS to the natural history of coronary artery disease, and explore potential for refining treatment options and predicting future events.
动脉粥样硬化仍是全球主要的死亡原因，大多数心肌梗死是由冠状动脉斑块破裂或糜烂所致。尽管有几种成像方式可以识别具有风险的特征，但每个斑块导致的主要不良心血管事件（MACE）发生率较低，因此需要额外的生物标志物来改善斑块和患者层面的风险分层。冠状动脉受到持续的机械力作用，当斑块结构应力（PSS）超过其机械强度时就会发生斑块破裂。前瞻性研究表明，峰值PSS与急性冠状动脉综合征（ACS）的表现、斑块破裂和MACE相关，并为成像提供额外的预后信息。此外，PSS将多个变量，包括斑块结构、斑块材料特性和血流动力学数据纳入一个确定的解决方案中，从而更详细地概述高风险病变。我们回顾了PSS的计算方法和决定因素、用于模拟PSS的成像方式，以及探索影响PSS的结构和几何成分的理想化模型。我们还讨论了将PSS与冠状动脉疾病自然史联系起来的当前实验和临床数据，并探讨了优化治疗方案和预测未来事件的潜力。
