Coronary computed tomography angiography based assessment of endothelial shear stress and its association with atherosclerotic plaque distribution in-vivo

PLoS One. 2015 Jan 30;10(1):e0115408. doi: 10.1371/journal.pone.0115408. eCollection 2015.


Purpose: The relationship between low endothelial shear stress (ESS) and coronary atherosclerosis is well established. ESS assessment so far depended on invasive procedures. The aim of this study was to demonstrate the relationship between ESS and coronary atherosclerosis by using non-invasive coronary computed tomography angiography (CTA) for computational fluid dynamics (CFD) simulations.

Methods: A total number of 7 consecutive patients with suspected coronary artery disease who received CTA and invasive angiography with IVUS analysis were included in this study. CTA examinations were performed using a dual-source scanner. These datasets were used to build a 3D mesh model. CFD calculations were performed using a validated CFD solver. The presence of plaque was assumed if the thickness of the intima-media complex exceeded 0.3 mm in IVUS. Plaque composition was derived by IVUS radiofrequency data analysis.

Results: Plaque was present in 32.1% of all analyzed cross-sections. Plaque prevalence was highest in areas of low ESS (49.6%) and high ESS (34.8%). In parts exposed to intermediate-low and intermediate-high ESS few plaques were found (20.0% and 24.0%) (p<0.001). Wall thickness was closely associated with local ESS. Intima-media thickness was 0.43±0.34 mm in low and 0.38±0.32 mm in high ESS segments. It was significantly lower when the arterial wall was exposed to intermediate ESS (0.25±0.18 mm and 0.28 ± 0.20 mm) (p<0.001). Fibrofatty tissue was predominately found in areas exposed to low ESS (p≤0.023).

Conclusions: In this study a close association of atherosclerotic plaque distribution and ESS pattern could be demonstrated in-vivo. Adding CFD analysis to coronary CTA offers the possibility to gather morphologic and physiologic data within one non-invasive examination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atherosclerosis / diagnostic imaging*
  • Atherosclerosis / physiopathology
  • Carotid Intima-Media Thickness
  • Coronary Angiography*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / physiopathology
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / physiopathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plaque, Atherosclerotic / diagnostic imaging*
  • Plaque, Atherosclerotic / physiopathology
  • Shear Strength
  • Ultrasonography, Interventional

Grants and funding

The study was supported by the Siemens AG, Healthcare Sector and the Friedrich Baur Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.