Author + information
- Received November 8, 2018
- Revision received December 31, 2018
- Accepted January 2, 2019
- Published online March 2, 2020.
- Pallavi Doradla, PhDa,∗,
- Kenichiro Otsuka, MD, PhDa,
- Abhijay Nadkarnia,
- Martin Villiger, PhDa,
- Antonios Karanasos, MD, PhDb,
- Laurens J.C. van Zandvoort, MDb,
- Jouke Dijkstra, PhDc,
- Felix Zijlstra, MD, PhDb,
- Gijs van Soest, PhDb,
- Joost Daemen, MD, PhDb,
- Evelyn Regar, MD, PhDb,
- Brett E. Bouma, PhDa,d and
- Seemantini K. Nadkarni, PhDa,∗∗ ()
- aWellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- bDepartment of Interventional Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
- cDepartment of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- dHarvard-Massachusetts Institute of Technology, Program in Health Sciences and Technology, Cambridge, Massachusetts
- ↵∗Address for correspondence:
Dr. Seemantini K. Nadkarni, Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114.
Objectives The purpose of this study was to derive a biomechanical stress metric that was based on the multifactorial assessment of coronary plaque morphology, likely related to the propensity of plaque rupture in patients.
Background Plaque rupture, the most frequent cause of coronary thrombosis, occurs at locations of elevated tensile stress in necrotic core fibroatheromas (NCFAs). Finite element modeling (FEM), typically used to calculate tensile stress, is computationally intensive and impractical as a clinical tool for locating rupture-prone plaques. This study derived a multifactorial stress equation (MSE) that accurately computes peak stress in NCFAs by combining the influence of several morphological parameters.
Methods Intravascular ultrasound and optical frequency domain imaging were conducted in 30 patients, and plaque morphological parameters were defined in 61 NCFAs. Multivariate regression analysis was applied to derive the MSE and compute a peak stress metric (PSM) that was based on the analysis of plaque morphological parameters. The accuracy of the MSE was determined by comparing PSM with FEM-derived peak stress values. The ability of the PSM in locating plaque rupture sites was tested in 3 additional patients.
Results The following parameters were found to be independently associated with peak stress: fibrous cap thickness (p < 0.0001), necrotic core angle (p = 0.024), necrotic core thickness (p < 0.0001), lumen area (p < 0.0001), necrotic core including calcium areas (p = 0.017), and plaque area (p = 0.003). The PSM showed excellent correlation (R = 0.85; p < 0.0001) with FEM-derived peak stress, thus confirming the accuracy of the MSE. In only 56% (n = 34) of plaques, the thinnest fibrous cap thickness was a determining parameter in identifying the cross section with highest PSM. In coronary segments with plaque ruptures, the MSE precisely located the rupture site.
Conclusions The MSE shows potential to calculate the PSM in coronary lesions rapidly. However, further studies are warranted to investigate the use of biomechanical stress profiling for the prognostic evaluation of patients with atherosclerosis.
↵∗ Dr. Doradla is the first author of this manuscript and Dr. Nakarni is the Principal Investigator of the lab.
This work was supported by the National Institutes of Health contract NIH RO1HL119065 and in part by Terumo Corporation. Dr. Villiger’s institution has patent licensing arrangements with Terumo Corporation, and he has the right to receive royalties as part of this patent licensing arrangements. Dr. van Soest’s institution has a patent licensing agreement with Terumo Corporation, and he has the right to receive royalties as part of that agreement. Dr. Bouma's institutions have patent licensing arrangements with Terumo Corporation, and he has the right to receive royalties as part of the arrangements; and he has received grant NIH p41EB015903. Dr. S.K. Nadkarni is on the Board of Directors of Coalesenz; and has received grant support from the National Institutes of Health for retrospective analysis of optical frequency domain imaging and intravascular ultrasound images in this study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Gregg Stone, MD, served as Guest Editor for this paper.
- Received November 8, 2018.
- Revision received December 31, 2018.
- Accepted January 2, 2019.
- 2020 American College of Cardiology Foundation
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