Morphological and Physiological Characteristics of Ruptured Plaques in Native Arteries and Neoatherosclerotic Segments: An OCT-Based and Computational Fluid Dynamics Study.

Autor:	Jin C; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.; Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom., Torii R; Department of Mechanical Engineering, University College London, London, United Kingdom., Ramasamy A; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom., Tufaro V; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Little CD; Royal Free Hospital, University College London, London, United Kingdom., Konstantinou K; Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom., Tan YY; Department of Mechanical Engineering, University College London, London, United Kingdom., Yap NAL; Barts and The London School of Medicine and Dentistry, London, United Kingdom., Cooper J; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom., Crake T; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom., O'Mahony C; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.; Institute of Cardiovascular Science, University College London, London, United Kingdom., Rakhit R; Royal Free Hospital, University College London, London, United Kingdom., Egred M; Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom., Ahmed J; Freeman Hospital, Newcastle University, Newcastle upon Tyne, United Kingdom., Karamasis G; Essex Cardiothoracic Centre, Anglia Ruskin School of Medicine, Essex, United Kingdom., Räber L; Department of Cardiology, University of Bern, Bern, Switzerland., Baumbach A; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Yale University School of Medicine, New Haven, CT, United States., Mathur A; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom., Bourantas CV; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.; Institute of Cardiovascular Science, University College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 May 26; Vol. 9, pp. 890799. Date of Electronic Publication: 2022 May 26 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.890799
Abstrakt:	Background: Intravascular imaging has been used to assess the morphology of lesions causing an acute coronary syndrome (ACS) in native vessels (NV) and identify differences between plaques that ruptured (PR) and caused an event and those that ruptured without clinical manifestations. However, there is no data about the morphological and physiological characteristics of neoatherosclerotic plaques that ruptured (PR-NA) which constitute a common cause of stent failure. Methods: We retrospectively analyzed data from patients admitted with an acute myocardial infarction that had optical coherence tomography (OCT) imaging of the culprit vessel before balloon pre-dilation. OCT pullbacks showing PR were segmented at every 0.4 mm. The extent of the formed cavity, lipid and calcific tissue, thrombus, and macrophages were measured, and the fibrous cap thickness (FCT) and the incidence of micro-channels and cholesterol crystals were reported. These data were used to reconstruct a representative model of the native and neoatherosclerotic lesion geometry that was processed with computational fluid dynamics (CFD) techniques to estimate the distribution of the endothelial shear stress and plaque structural stress. Result: Eighty patients were included in the present analysis: 56 had PR in NV (PR-NV group) and 24 in NA segments (PR-NA group). The PR-NV group had a larger minimum lumen area (2.93 ± 2.03 vs. 2.00 ± 1.26 mm 2 , p = 0.015) but similar lesion length and area stenosis compared to PR-NA group. The mean FCT (186 ± 65 vs. 232 ± 80 μm, p = 0.009) and the lipid index was smaller (16.7 ± 13.8 vs. 25.9 ± 14.1, p = 0.008) while the of calcific index (8.3 ± 9.5 vs. 2.2 ± 1.6%, p = 0.002) and the incidence of micro-channels (41.4 vs. 12.5%, p = 0.013) was higher in the PR-NV group. Conversely, there was no difference in the incidence of cholesterol crystals, thrombus burden or the location of the rupture site between groups. CFD analysis revealed higher maximum endothelial shear stress (19.1 vs. 11.0 Pa) and lower maximum plaque structural stress (38.8 vs. 95.1 kPa) in the PR-NA compared to the PR-NV model. Conclusion: We reported significant morphological and physiological differences between culprit ruptured plaques in native and stented segments. Further research is needed to better understand the causes of these differences and the mechanisms regulating neoatherosclerotic lesion destabilization. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Jin, Torii, Ramasamy, Tufaro, Little, Konstantinou, Tan, Yap, Cooper, Crake, O’Mahony, Rakhit, Egred, Ahmed, Karamasis, Räber, Baumbach, Mathur and Bourantas.)
Databáze:	MEDLINE
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