Sabbah H N, Khaja F, Brymer J F, Hawkins E T, Stein P D
Am J Cardiol. 1984 Apr 1;53(8):1008-12. doi: 10.1016/0002-9149(84)90627-1.
Vascular endothelial injury by high shear stresses and adverse effects of low shear rates on mass transfer across the arterial wall have been suggested as factors in atherogenesis. This study describes differences in blood velocity, and therefore differences of shear rate, across the lumen of the right coronary artery (RCA) of man. Selective coronary arteriograms of 30 patients without obstructive RCA disease were reviewed. Velocity was assessed qualitatively based on the rate of clearance of contrast material. There was a rapid clearing of contrast material along the outer wall of the RCA as it curved around the border of the heart. A much slower clearing occurred along the inner wall, bordering the myocardium, which persisted 2 to 6 cardiac cycles after the outer wall had cleared. This suggests that velocity, and therefore shear rate, is much lower along the inner wall of the RCA. To determine the relation of the distribution of atherosclerotic plaques in the RCA to local blood velocity, the RCA in 17 randomly selected human subjects who died of noncardiac disease were studied histologically. There was an uneven distribution of atherosclerotic plaques in the RCA with greater involvement of the inner wall. These observations demonstrate an association between the lower shear rate along the inner wall of the RCA and the site of higher concentration of atherosclerosis.
高剪切应力导致的血管内皮损伤以及低剪切速率对动脉壁物质转运的不利影响被认为是动脉粥样硬化形成的因素。本研究描述了人体右冠状动脉（RCA）管腔内血流速度的差异，进而描述了剪切速率的差异。回顾了30例无RCA阻塞性疾病患者的选择性冠状动脉造影。基于造影剂的清除速率对血流速度进行定性评估。当RCA沿着心脏边界弯曲时，造影剂沿其外壁快速清除。沿着与心肌相邻的内壁清除速度则慢得多，在外壁清除后仍持续2至6个心动周期。这表明RCA内壁的血流速度，进而剪切速率，要低得多。为了确定RCA中动脉粥样硬化斑块分布与局部血流速度的关系，对17例死于非心脏疾病的随机选取的人体受试者的RCA进行了组织学研究。RCA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，RCA内壁较低的剪切速率与动脉粥样硬化较高浓度部位之间存在关联。
