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Focal Association Between Wall Shear Stress and Clinical Coronary Artery Disease Progression

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Abstract

Wall shear stress (WSS) has been investigated as a potential prospective marker to identify rapidly progressing coronary artery disease (CAD) and potential for lesions to acquire vulnerable characteristics. Previous investigations, however, are limited by a lack of understanding of the focal association between WSS and CAD progression (i.e., data are notably spatially averaged). Thus, the aim of this investigation was to examine the focal association between WSS and coronary atherosclerosis progression, and compare these results to those determined by spatial averaging. Five patients with CAD underwent baseline and 6-month follow-up angiographic and virtual histology-intravascular ultrasound imaging to quantify CAD progression. Patient-specific computational fluid dynamics models were constructed to compute baseline WSS values, which were either averaged around the entire artery circumference or examined in focal regions (sectors). Analysis of data within each sector (n = 3871) indicated that circumferentially averaged and sector WSS values were statistically different (p < 0.05) and exhibited poor agreement (concordance correlation coefficient = 0.69). Furthermore, differences were observed between the analysis techniques when examining the association of WSS and CAD progression. This investigation highlights the importance of examining spatially heterogeneous variables at a focal level to reduce the affect of data reduction and warrants implementation in a larger clinical study to determine the predictive power in prospectively identifying rapidly progressing and/or vulnerable coronary plaques.

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Acknowledgments

We acknowledge funding from the American Heart Association Greater Southeast Affiliate—Postdoctoral Fellowships (L. H. T., D. S. M.), the Georgia Research Alliance (D. P. G.), the Wallace H. Coulter Translational Research Grant Program (H. S., D. P. G.), Toshiba America Medical Systems (H. S., D. P. G.), Pfizer Pharmaceuticals (H. S.), and Volcano Corp. (H. S.).

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Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 313 Ferst Drive, Room 2127, Atlanta, GA, 30332, USA

    Lucas H. Timmins, David S. Molony, John N. Oshinski & Don P. Giddens

  2. Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA

    Lucas H. Timmins, Michael C. McDaniel & Habib Samady

  3. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA

    Parham Eshtehardi

  4. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA

    John N. Oshinski

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  1. Lucas H. Timmins
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  2. David S. Molony
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Correspondence to Lucas H. Timmins.

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Associate Editor Diego Gallo oversaw the review of this article.

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Timmins, L.H., Molony, D.S., Eshtehardi, P. et al. Focal Association Between Wall Shear Stress and Clinical Coronary Artery Disease Progression. Ann Biomed Eng 43, 94–106 (2015). https://doi.org/10.1007/s10439-014-1155-9

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  • DOI: https://doi.org/10.1007/s10439-014-1155-9

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