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Title: Endothelial shear stress computed from coronary computed tomography angiography: A direct comparison to intravascular ultrasound.
Author: Hakim D, Coskun AU, Maynard C, Pu Z, Rupert D, Cefalo N, Cormier M, Ahmed M, Earls J, Jennings R, Croce K, Mushtaq S, Andreini D, Conte E, Molony D, Samady H, Min JK, Stone PH.
Journal: J Cardiovasc Comput Tomogr; 2023; 17(3):201-210. PubMed ID: 37076326.
Abstract:
INTRODUCTION: Intravascular ultrasound (IVUS) studies have shown that biomechanical variables, particularly endothelial shear stress (ESS), add synergistic prognostic insight when combined with anatomic high-risk plaque features. Non-invasive risk assessment of coronary plaques with coronary computed tomography angiography (CCTA) would be helpful to enable broad population risk-screening. AIM: To compare the accuracy of ESS computation of local ESS metrics by CCTA vs IVUS imaging. METHODS: We analyzed 59 patients from a registry of patients who underwent both IVUS and CCTA for suspected CAD. CCTA images were acquired using either a 64- or 256-slice scanner. Lumen, vessel, and plaque areas were segmented from both IVUS and CCTA (59 arteries, 686 3-mm segments). Images were co-registered and used to generate a 3-D arterial reconstruction, and local ESS distribution was assessed by computational fluid dynamics (CFD) and reported in consecutive 3-mm segments. RESULTS: Anatomical plaque characteristics (vessel, lumen, plaque area and minimal luminal area [MLA] per artery) were correlated when measured with IVUS and CCTA: 12.7 ± 4.3 vs 10.7 ± 4.5 mm², r = 0.63; 6.8 ± 2.7 vs 5.6 ± 2.7 mm², r = 0.43; 5.9 ± 2.9 vs 5.1 ± 3.2 mm², r = 0.52; 4.5 ± 1.3 vs 4.1 ± 1.5 mm², r = 0.67 respectively. ESS metrics of local minimal, maximal, and average ESS were also moderately correlated when measured with IVUS and CCTA (2.0 ± 1.4 vs 2.5 ± 2.6 Pa^, r = 0.28; 3.3 ± 1.6 vs 4.2 ± 3.6 Pa, r = 0.42; 2.6 ± 1.5 vs 3.3 ± 3.0 Pa, r = 0.35, respectively). CCTA-based computation accurately identified the spatial localization of local ESS heterogeneity compared to IVUS, with Bland-Altman analyses indicating that the absolute ESS differences between the two CCTA methods were pathobiologically minor. CONCLUSION: Local ESS evaluation by CCTA is possible and similar to IVUS; and is useful for identifying local flow patterns that are relevant to plaque development, progression, and destabilization.

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