Sabbah H N, Khaja F, Hawkins E T, Brymer J F, McFarland T M, van der Bel-Kahn J, Doerger P T, Stein P D
Am Heart J. 1986 Sep;112(3):453-8. doi: 10.1016/0002-8703(86)90505-3.
Low fluid dynamic shear acting on the vascular endothelium has been suggested as a factor in atherogenesis. This study describes qualitatively differences of wall shear rate in the left anterior descending coronary artery (LAD) of man and relates the distribution of wall shear to that of atheromatous plaques. Selective coronary arteriograms of 21 patients without obstructive LAD diseases were reviewed. Blood velocity, and therefore wall shear in the LAD, was assessed qualitatively based upon the rate of clearance of contrast material. There was a rapid clearing of contrast material along the outer wall of the LAD as it curved around the border of the heart. A much slower clearing occurred along the inner wall, bordering the myocardium, which persisted two to six cardiac cycles after the outer wall had cleared. This suggests that velocity, and therefore shear rate, is lower along the inner wall of the LAD than along the outer wall. In 27 patients who died of noncardiac disease, an uneven distribution of atheromatous plaques in the LAD was observed histologically, with greater involvement of the inner wall. These observations demonstrate an association between the lower shear rate along the inner wall of the LAD and the site of higher concentration of atherosclerosis.
作用于血管内皮的低流体动力剪切力被认为是动脉粥样硬化形成的一个因素。本研究定性描述了人类左前降支冠状动脉（LAD）壁面剪切率的差异，并将壁面剪切力的分布与动脉粥样硬化斑块的分布联系起来。回顾了21例无LAD阻塞性疾病患者的选择性冠状动脉造影。基于造影剂的清除率对LAD中的血流速度以及壁面剪切力进行了定性评估。当LAD在心脏边缘弯曲时，造影剂沿其外壁迅速清除。沿与心肌相邻的内壁清除速度要慢得多，在外壁清除后仍持续两到六个心动周期。这表明LAD内壁的速度以及剪切率低于外壁。在27例死于非心脏疾病的患者中，组织学观察发现LAD中动脉粥样硬化斑块分布不均，内壁受累更严重。这些观察结果表明，LAD内壁较低的剪切率与动脉粥样硬化较高浓度的部位之间存在关联。
